Computed tomographic parameters predicting fatal outcome in large middle cerebral artery infarction

Area of Science:

• Neurology
• Radiology
• Critical Care Medicine

Background:

• Large middle cerebral artery (MCA) ischemic strokes with significant mass effect pose a risk of brain herniation and death.
• Current guidelines for selecting patients for aggressive therapies like decompressive hemicraniectomy are limited.

Purpose of the Study:

• To evaluate early radiological signs on computed tomographic (CT) scans within 48 hours of stroke onset for predicting 30-day mortality.
• To identify specific CT parameters indicative of increased risk in patients with large MCA infarction.

Main Methods:

• A cohort of 135 patients with large MCA infarction requiring neurocritical care from seven centers were analyzed.
• Follow-up CT scans within 48 hours were assessed for parameters including septum pellucidum displacement, pineal shift, temporal lobe infarction, vascular territory involvement, and hydrocephalus.
• In-hospital death within 30 days was the primary outcome measure.

Main Results:

• Univariable analysis showed anteroseptal shift >/=5 mm, pineal shift >/=2 mm, complete temporal lobe infarction, infarction beyond the MCA territory, and hydrocephalus were predictive of death.
• Multivariable analysis identified anteroseptal shift >/=5 mm (OR 10.9), NIHSS within 48 h >20 (OR 6.6), and infarction beyond the MCA territory (OR 4.9) as significant predictors of fatal outcome.
• These findings were adjusted for time to CT scan.

Conclusions:

• Early CT signs, including anteroseptal shift, pineal shift, hydrocephalus, and territorial infarction, are significant predictors of mortality in massive MCA infarction.
• Prospective validation of these CT parameters is necessary for their reliable use in clinical decision-making for stroke management.