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Published on: January 18, 2018
Recommendations for management of large hemispheric infarction
Alicia M Zha1, Murat Sari, Michel T Torbey
1aDepartment of Neurology bDepartment of Neurosurgery, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Insights
Large hemispheric infarcts cause significant mortality. Recent guidelines offer a framework for managing these patients, with early hemicraniectomy supported even in elderly individuals.
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.
Purpose Of Review:
Large hemispheric infarction is a devastating disease that continues to be associated with significant mortality and morbidity. Most often these patients are admitted to the ICU requiring significant physician and nursing resources. This review will address some of the ICU management issues and review the evidence supporting medical and surgical management of malignant cerebral edema.
Recent Findings:
The most recent changes in management of large hemispheric infarct include the American Heart Association and Neurocritical Care Guidelines. These guidelines address airway management and mechanical ventilation, blood pressure control, fluid management, and glucose and temperature control. In addition, they addressed the indication for surgical management of cerebral edema. We review the recent guidelines updates and trials of surgical management of large hemispheric infarcts.
Summary:
Large hemispheric infarcts continue to have significant morbidity and mortality. Recent guidelines have provided an excellent framework to help intensivists manage these complicated patients. Recent surgical data continue to support early hemicraniectomy even in elderly patients.
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