Management of Hemispheric Infarction and Ischemic Swelling

This article provides an overview of large territory hemispheric infarction, with an emphasis on recent developments and practical issues related to its evaluation, diagnosis, monitoring, and treatment. Swelling after large infarction results in severe morbidity and often death. Early vigilance for the development of swelling is critical to optimize patient outcome. Comprehensive management is highly dependent on a strong multidisciplinary, collaborative approach.

Several advances in the last decade have led to an increasingly standardized approach to the patient with significant brain swelling after stroke. In particular, early identification of patients with large stroke at high risk for deterioration, and decompressive craniectomy as an important treatment option, are two significant advances.

Effective management of hemispheric ischemic stroke and swelling requires a team skilled in the neurologic examination of critically ill patients and a broad understanding of the natural history of brain swelling after stroke.