Journal Article

PreJuSER-19328

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png The Severity of Ischemia Determines and Predicts Malignant Brain Edema in Patients with Large Middle Cerebral Artery Infarction

Dohmen, C. ; Galldiks, N.FZJ* ; Bosche, B. ; Kracht, L. ; Graf, R.FZJ*

2012
Karger Basel

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Please use a persistent id in citations: http://hdl.handle.net/2128/7388  doi:10.1159/000330648

Abstract: In order to determine the impact of the severity of ischemia on malignant edema formation, we investigated various degrees of perfusional deficit by (11)C-flumazenil PET in patients with large middle cerebral artery (MCA) infarction.17 patients with large MCA stroke were included. Cerebral blood flow (CBF) was measured 15.9 ± 6.4 h after the ictus. Patients were divided into a malignant (n = 9) and a benign group (n = 8) as a function of their clinical courses and edema. Edema was measured as maximal midline shift on follow-up CTs. Total hypoperfusion volume was divided into different subvolumes according to the degree of CBF reduction.Subvolumes of severe ischemia relative to total ischemic area were significantly larger in the malignant group than in the benign group and were significantly correlated with edema formation. The highest correlation and best predictive values for edema formation with a sensitivity, specificity, and a positive and negative predictive value of 100% were found for subvolumes with severe ischemia. Correlation coefficients and prediction decreased for subvolumes with less severe perfusional deficit, pointing to the risk of misclassifying patients when relying on the volume of total perfusional deficit alone.Malignant MCA infarction seems to be determined more by the volume of severe perfusional deficit than that of total perfusional deficit. Assessment of severely ischemic areas allows prediction of malignant edema formation and might help to select candidates for hemicraniectomy.

Keyword(s): Aged (MeSH) ; Brain Edema: etiology (MeSH) ; Brain Edema: physiopathology (MeSH) ; Brain Edema: radiography (MeSH) ; Brain Edema: surgery (MeSH) ; Cerebrovascular Circulation (MeSH) ; Chi-Square Distribution (MeSH) ; Decompressive Craniectomy (MeSH) ; Female (MeSH) ; Flumazenil: diagnostic use (MeSH) ; Germany (MeSH) ; Humans (MeSH) ; Infarction, Middle Cerebral Artery: complications (MeSH) ; Infarction, Middle Cerebral Artery: physiopathology (MeSH) ; Infarction, Middle Cerebral Artery: radionuclide imaging (MeSH) ; Infarction, Middle Cerebral Artery: surgery (MeSH) ; Male (MeSH) ; Middle Aged (MeSH) ; Patient Selection (MeSH) ; Perfusion Imaging: methods (MeSH) ; Positron-Emission Tomography (MeSH) ; Predictive Value of Tests (MeSH) ; Prognosis (MeSH) ; Radiopharmaceuticals: diagnostic use (MeSH) ; Risk Assessment (MeSH) ; Risk Factors (MeSH) ; Sensitivity and Specificity (MeSH) ; Severity of Illness Index (MeSH) ; Time Factors (MeSH) ; Tomography, X-Ray Computed (MeSH) ; Radiopharmaceuticals ; Flumazenil ; J ; Brain edema (auto) ; Ischemic stroke (auto) ; Malignant infarction (auto) ; Emission tomography (auto)

Note: This study was supported by the Federal Ministry of Education and Research (BMBF), Competence Network Stroke.

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Contributing Institute(s):

1. Kognitive Neurowissenschaften (INM-3)

Research Program(s):

1. Funktion und Dysfunktion des Nervensystems (FUEK409) (FUEK409)
2. 89572 - (Dys-)function and Plasticity (POF2-89572) (POF2-89572)

Appears in the scientific report 2012

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Database coverage:
; ; Allianz-Lizenz / DFG ; Current Contents - Clinical Medicine ; Current Contents - Life Sciences ; JCR ; NCBI Molecular Biology Database ; Nationallizenz ; SCOPUS ; Science Citation Index ; Science Citation Index Expanded ; Thomson Reuters Master Journal List ; Web of Science Core Collection

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