Outcome of large hemispheric infarcts: an experience of 50 patients in Taiwan

Wei-Hung Chen, Chyi Huey Bai, Sheng Jean Huang, Hou Chang Chiu, Li Ming Lien

研究成果: 雜誌貢獻文章

5 引文 (Scopus)

摘要

Background: Large hemispheric infarcts cause high mortality and morbidity. Understanding the clinical course and prognostic factors in patients with LHI, thereby enabling the identification of patients who will benefit from early aggressive intervention, is important. This study describes the clinical course of patients who had LHI and identifies the predictors for mortality. Methods: A retrospective collection of clinical and laboratory data in patients admitted to a neurologic intensive care unit of a medical center was examined. Large hemispheric infarct was defined as an infarct that involved at least 2 of the 3 (deep, superior, and posterior) MCA territories. Patients who received a hemicraniectomy were not included. Results: Fifty patients with radiologically confirmed LHI were analyzed. The 30-day mortality rate was 22%. Only patients who had massive infarcts (complete MCA territory infarcts and beyond) died, whereas none with i-MCAs died (P <.001). For the 26 patients with massive infarcts, the 30-day mortality was 42.3%. Early deterioration, ipsilateral pupil dilation, and a low GCS were associated with mortality. Further analysis revealed that an age less than 70 years (OR 24.5, 95% CI 2.3-262.6) and a GCS less than 10 at the second day of stroke (OR 15, 95% CI 1.5-149.5) predicted a fatal outcome among patients with massive infarcts. A GCS less than 12 at the first day of stroke and early CT findings of hypodensity more than one half of the MCA territory were associated with massive infarct. Conclusions: The extent of infarction is a crucial factor for mortality. The consciousness level may identify patients at risk for massive infarct at the first day of stroke and predict a fatal outcome as early as the second day. Early identification of the extent of infarction and close monitoring of the consciousness level help predict outcome.
原文英語
期刊Surgical Neurology
68
發行號5 SUPPL.
DOIs
出版狀態已發佈 - 十一月 2007

指紋

Taiwan
Mortality
Fatal Outcome
Stroke
Consciousness
Infarction
Pupil
Nervous System
Intensive Care Units
Dilatation
Morbidity

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

引用此文

Outcome of large hemispheric infarcts : an experience of 50 patients in Taiwan. / Chen, Wei-Hung; Bai, Chyi Huey; Huang, Sheng Jean; Chiu, Hou Chang; Lien, Li Ming.

於: Surgical Neurology, 卷 68, 編號 5 SUPPL., 11.2007.

研究成果: 雜誌貢獻文章

Chen, Wei-Hung ; Bai, Chyi Huey ; Huang, Sheng Jean ; Chiu, Hou Chang ; Lien, Li Ming. / Outcome of large hemispheric infarcts : an experience of 50 patients in Taiwan. 於: Surgical Neurology. 2007 ; 卷 68, 編號 5 SUPPL.
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title = "Outcome of large hemispheric infarcts: an experience of 50 patients in Taiwan",
abstract = "Background: Large hemispheric infarcts cause high mortality and morbidity. Understanding the clinical course and prognostic factors in patients with LHI, thereby enabling the identification of patients who will benefit from early aggressive intervention, is important. This study describes the clinical course of patients who had LHI and identifies the predictors for mortality. Methods: A retrospective collection of clinical and laboratory data in patients admitted to a neurologic intensive care unit of a medical center was examined. Large hemispheric infarct was defined as an infarct that involved at least 2 of the 3 (deep, superior, and posterior) MCA territories. Patients who received a hemicraniectomy were not included. Results: Fifty patients with radiologically confirmed LHI were analyzed. The 30-day mortality rate was 22{\%}. Only patients who had massive infarcts (complete MCA territory infarcts and beyond) died, whereas none with i-MCAs died (P <.001). For the 26 patients with massive infarcts, the 30-day mortality was 42.3{\%}. Early deterioration, ipsilateral pupil dilation, and a low GCS were associated with mortality. Further analysis revealed that an age less than 70 years (OR 24.5, 95{\%} CI 2.3-262.6) and a GCS less than 10 at the second day of stroke (OR 15, 95{\%} CI 1.5-149.5) predicted a fatal outcome among patients with massive infarcts. A GCS less than 12 at the first day of stroke and early CT findings of hypodensity more than one half of the MCA territory were associated with massive infarct. Conclusions: The extent of infarction is a crucial factor for mortality. The consciousness level may identify patients at risk for massive infarct at the first day of stroke and predict a fatal outcome as early as the second day. Early identification of the extent of infarction and close monitoring of the consciousness level help predict outcome.",
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AU - Lien, Li Ming

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N2 - Background: Large hemispheric infarcts cause high mortality and morbidity. Understanding the clinical course and prognostic factors in patients with LHI, thereby enabling the identification of patients who will benefit from early aggressive intervention, is important. This study describes the clinical course of patients who had LHI and identifies the predictors for mortality. Methods: A retrospective collection of clinical and laboratory data in patients admitted to a neurologic intensive care unit of a medical center was examined. Large hemispheric infarct was defined as an infarct that involved at least 2 of the 3 (deep, superior, and posterior) MCA territories. Patients who received a hemicraniectomy were not included. Results: Fifty patients with radiologically confirmed LHI were analyzed. The 30-day mortality rate was 22%. Only patients who had massive infarcts (complete MCA territory infarcts and beyond) died, whereas none with i-MCAs died (P <.001). For the 26 patients with massive infarcts, the 30-day mortality was 42.3%. Early deterioration, ipsilateral pupil dilation, and a low GCS were associated with mortality. Further analysis revealed that an age less than 70 years (OR 24.5, 95% CI 2.3-262.6) and a GCS less than 10 at the second day of stroke (OR 15, 95% CI 1.5-149.5) predicted a fatal outcome among patients with massive infarcts. A GCS less than 12 at the first day of stroke and early CT findings of hypodensity more than one half of the MCA territory were associated with massive infarct. Conclusions: The extent of infarction is a crucial factor for mortality. The consciousness level may identify patients at risk for massive infarct at the first day of stroke and predict a fatal outcome as early as the second day. Early identification of the extent of infarction and close monitoring of the consciousness level help predict outcome.

AB - Background: Large hemispheric infarcts cause high mortality and morbidity. Understanding the clinical course and prognostic factors in patients with LHI, thereby enabling the identification of patients who will benefit from early aggressive intervention, is important. This study describes the clinical course of patients who had LHI and identifies the predictors for mortality. Methods: A retrospective collection of clinical and laboratory data in patients admitted to a neurologic intensive care unit of a medical center was examined. Large hemispheric infarct was defined as an infarct that involved at least 2 of the 3 (deep, superior, and posterior) MCA territories. Patients who received a hemicraniectomy were not included. Results: Fifty patients with radiologically confirmed LHI were analyzed. The 30-day mortality rate was 22%. Only patients who had massive infarcts (complete MCA territory infarcts and beyond) died, whereas none with i-MCAs died (P <.001). For the 26 patients with massive infarcts, the 30-day mortality was 42.3%. Early deterioration, ipsilateral pupil dilation, and a low GCS were associated with mortality. Further analysis revealed that an age less than 70 years (OR 24.5, 95% CI 2.3-262.6) and a GCS less than 10 at the second day of stroke (OR 15, 95% CI 1.5-149.5) predicted a fatal outcome among patients with massive infarcts. A GCS less than 12 at the first day of stroke and early CT findings of hypodensity more than one half of the MCA territory were associated with massive infarct. Conclusions: The extent of infarction is a crucial factor for mortality. The consciousness level may identify patients at risk for massive infarct at the first day of stroke and predict a fatal outcome as early as the second day. Early identification of the extent of infarction and close monitoring of the consciousness level help predict outcome.

KW - Ischemic stroke

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