Recommendations for management of large hemispheric infarction

Area of Science:

• Neurology
• Critical Care Medicine

Background:

• Large hemispheric infarction (LHI) is a severe neurological condition with high mortality and morbidity.
• Patients with LHI often require intensive care unit (ICU) admission, demanding substantial medical and nursing resources.

Purpose of the Study:

• To review Intensive Care Unit (ICU) management strategies for large hemispheric infarction.
• To examine the evidence supporting medical and surgical interventions for malignant cerebral edema in LHI.

Main Methods:

• Review of recent American Heart Association and Neurocritical Care Guidelines for LHI management.
• Analysis of updated guidelines and clinical trials concerning surgical interventions for cerebral edema in LHI.

Main Results:

• Current guidelines emphasize airway management, mechanical ventilation, blood pressure, fluid, glucose, and temperature control.
• Guidelines also address indications for surgical management of cerebral edema.
• Recent surgical data support early hemicraniectomy as a viable treatment option, including for elderly patients.

Conclusions:

• Large hemispheric infarcts remain associated with significant adverse outcomes.
• Updated guidelines provide a valuable framework for intensivists managing LHI patients.
• Early hemicraniectomy is increasingly supported by recent data for managing malignant cerebral edema in LHI.