Malignant middle cerebral artery infarction: a clinical study of 32 patients
Adrià Arboix1, Luís García-Eroles2, Montserrat Oliveres1
1Cerebrovascular Division, Neurology Department, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia, Spain.
Background And Objective:
Malignant middle cerebral artery infarction is a devastating type of ischemic stroke whose clinical predictors remain scarcely known. The present study aims to improve the knowledge about the prognosis factors through an analysis of a malignant middle cerebral artery infarction sample of patients from our stroke registry.
Material And Methods:
From a total of 1,396 patients with ischemic stroke in the middle cerebral artery included in the "Sagrat Cor Hospital of Barcelona Stroke Registry", we identified 32 patients with malignant middle cerebral artery infarction (2.3%). Demographic, anamnestic, clinical, and outcome variables in this subgroup of patients were compared with those of the middle cerebral artery. The independent predictive value of each variable on the development of malignant middle cerebral artery infarction was assessed with a logistic regression analysis.
Results:
The mean age was 74.7 (SD, 11.4) years and 50% were males. In-hospital death was observed in eight patients (25%) and early bad prognosis (in-hospital death or severe residual focality at discharge) was present in 16 patients (50%). Decreased consciousness (OR: 4.17; 95% CI: 2.02-8.61), presence of nausea or vomiting (OR: 3.65; 95% CI: 1.40-8.49), and heavy smoking (> 20 cigarettes/day; OR: 2.62; 95% CI: 1.03-6.64) appeared to be independent prognostic factors for malignant middle cerebral artery infarction in the multivariate analysis.
Conclusions:
Malignant middle cerebral artery infarction is an infrequent clinical condition associated with poor prognosis and high mortality rate. In our sample, decreased consciousness, nausea or vomiting, and heavy smoking are the main clinical factors associated.
Insights
Malignant middle cerebral artery infarction is a severe stroke with poor outcomes. Key predictors include decreased consciousness, nausea/vomiting, and heavy smoking, aiding early identification and prognosis.
Area of Science:
- Neurology
- Stroke Medicine
- Clinical Prognosis
Background:
- Malignant middle cerebral artery infarction (MMCAI) is a severe stroke subtype with high mortality.
- Clinical predictors for MMCAI are not well-established, necessitating further research.
Purpose of the Study:
- To identify clinical prognostic factors associated with MMCAI.
- To enhance understanding of MMCAI development and patient outcomes.
Main Methods:
- Analysis of 32 MMCAI patients from a stroke registry of 1,396 ischemic stroke cases.
- Logistic regression analysis to determine independent predictive value of variables.
Main Results:
- MMCAI patients had a mean age of 74.7 years, with 50% males.
- 25% experienced in-hospital death; 50% had poor early prognosis.
- Decreased consciousness (OR: 4.17), nausea/vomiting (OR: 3.65), and heavy smoking (OR: 2.62) were independent predictors.
Conclusions:
- MMCAI is an infrequent but serious condition with high mortality.
- Decreased consciousness, nausea/vomiting, and heavy smoking are significant clinical predictors of MMCAI.
