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Extensive hemispheric cerebral infarction.

C R Levi, S J Read, T Hirano

    Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
    |September 27, 2007
    PubMed
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    Extensive hemispheric infarction, a severe stroke type, frequently results from cardioembolic events and leads to high mortality or severe disability. This condition, though uncommon, requires specific attention due to its poor prognosis.

    Area of Science:

    • Neurology
    • Cerebrovascular Diseases
    • Stroke Medicine

    Background:

    • Extensive hemispheric infarction presents a significant challenge due to high mortality and morbidity rates.
    • Patients with this severe stroke subtype often do not benefit from current acute stroke therapies.

    Purpose of the Study:

    • To identify clinical features, underlying pathophysiological mechanisms, and patient outcomes.
    • To characterize a series of cases with radiologically confirmed extensive hemispheric infarction.

    Main Methods:

    • Retrospective analysis of stroke admissions over a 5-year period.
    • Definition of extensive hemispheric infarction: >75% middle cerebral artery territory involvement, with or without adjacent territory compromise.
    • Comparison of clinical data, risk factors, and stroke mechanisms with a control group of ischemic stroke patients.

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    Main Results:

    • Occurred in 3.7% of ischemic stroke cases (53/1440).
    • Cardioembolic mechanism was significantly more frequent (58% of cases, 42% with atrial fibrillation).
    • In-hospital mortality was 52%, with 84% of survivors requiring nursing home care due to severe disability.

    Conclusions:

    • Extensive hemispheric infarction is an uncommon but critical stroke subtype.
    • Characterized by distinct clinical features, a prevalent cardioembolic origin, and a devastating prognosis.
    • This stroke type shows limited benefit from experimental acute therapies, highlighting the need for targeted research and management strategies.