TY  - JOUR
AU  - Dohmen, C.
AU  - Galldiks, N.
AU  - Bosche, B.
AU  - Kracht, L.
AU  - Graf, R.
TI  - The Severity of Ischemia Determines and Predicts Malignant Brain Edema in Patients with Large Middle Cerebral Artery Infarction
JO  - Cerebrovascular diseases
VL  - 33
SN  - 1015-9770
CY  - Basel
PB  - Karger
M1  - PreJuSER-19328
SP  - 1 - 7
PY  - 2012
N1  - This study was supported by the Federal Ministry of Education and Research (BMBF), Competence Network Stroke.
AB  - 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.
KW  - Aged
KW  - Brain Edema: etiology
KW  - Brain Edema: physiopathology
KW  - Brain Edema: radiography
KW  - Brain Edema: surgery
KW  - Cerebrovascular Circulation
KW  - Chi-Square Distribution
KW  - Decompressive Craniectomy
KW  - Female
KW  - Flumazenil: diagnostic use
KW  - Germany
KW  - Humans
KW  - Infarction, Middle Cerebral Artery: complications
KW  - Infarction, Middle Cerebral Artery: physiopathology
KW  - Infarction, Middle Cerebral Artery: radionuclide imaging
KW  - Infarction, Middle Cerebral Artery: surgery
KW  - Male
KW  - Middle Aged
KW  - Patient Selection
KW  - Perfusion Imaging: methods
KW  - Positron-Emission Tomography
KW  - Predictive Value of Tests
KW  - Prognosis
KW  - Radiopharmaceuticals: diagnostic use
KW  - Risk Assessment
KW  - Risk Factors
KW  - Sensitivity and Specificity
KW  - Severity of Illness Index
KW  - Time Factors
KW  - Tomography, X-Ray Computed
KW  - Radiopharmaceuticals (NLM Chemicals)
KW  - Flumazenil (NLM Chemicals)
KW  - J (WoSType)
LB  - PUB:(DE-HGF)16
C6  - pmid:22143164
UR  - <Go to ISI:>//WOS:000302135900002
DO  - DOI:10.1159/000330648
UR  - https://juser.fz-juelich.de/record/19328
ER  -