[P02.080] Ipsilateral Cerebral Venous Outflow Obstruction Is Associated with Life-Threatening Brain Edema of Middle Cerebral Artery Infarction
Wengui Yu, Joanna Rives, Babu Welch, Jonathan White, Duke Samson, Dallas, TX
OBJECTIVE: The aim of this study was to investigate the role of cerebral venous anomaly in the development of life-threatening brain edema after middle cerebral artery (MCA) infarction. BACKGROUND: Approximately 35% of the patients with complete MCA infarction develop life-threatening brain edema and herniation. Although infarct size was the major determinant, its predictive value was only moderate. DESIGN/METHODS: This is a retrospective study of consecutive patients with complete MCA infarction who were admitted to our Neurointensive Care Unit from January 2007 to October 2008. Patient demographics and clinical features were reviewed. Brain edema on serial CT or MRI scans and cerebral venous anatomy on CTA or digital subtraction angiography were evaluated. Functional outcome at discharge was estimated using modified Rankin scales. RESULTS: A total of 14 patients were identified to have complete MCA infarction and cerebral venography. Four patients (25.6%) were found to have ipsilateral cerebral venous anomaly, including transverse sinus atresia (1), hypoplasia (2), and previous surgical ligation of internal jugular vein (1). All of them had fatal brain edema. The severity and timing of maximal edema were correlated with the degree of cerebral venous outflow obstruction. They all refused surgery and died from transtentorial herniation. The remaining 10 patients had symmetric or ipsilateral dominant cerebral venous drainage. Only one of them developed life-threatening edema possibly due to poor collateral circulation and bilateral carotid stenosis. He underwent decompressive surgery and recovered with moderate left hemiparesis. Patient age, sex, co-morbidity, carotid artery occlusion, or infarct size was not independently associated with life-threatening edema. CONCLUSIONS/RELEVANCE: Our preliminary results suggest that ipsilateral cerebral venous outflow obstruction is independently associated with life-threatening brain edema after MCA infarction and may be an indication for early decompressive craniectomy.
Category - Cerebrovascular Disease - Acute Stroke Therapy
Subscribe to:
Post Comments (Atom)
No comments:
Post a Comment