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Malignant middle cerebral artery (MCA) infarction in people over 85 years old - Diagnosis, management and risk

Żanna Pastuszak1, Zbigniew Czernicki2, Waldemar Koszewski2

  • 1Department of Neurosurgery, Mossakowski Medical Research Centre, Polish Academy of Sciences, Pawińskiego 5, 02-106 Warsaw, Poland.

Neurologia I Neurochirurgia Polska
|April 30, 2018
PubMed
Abstract

Insights

Atrial fibrillation is a key risk factor for malignant middle cerebral artery (MCA) stroke in patients over 85. Intensive monitoring for this condition is crucial for elderly stroke patients.

Area of Science:

  • Neurology
  • Geriatrics
  • Stroke Medicine

Background:

  • Malignant ischemic stroke in the middle cerebral artery (MCA) territory leads to severe neurological deficits due to space-occupying cerebral edema.
  • Poor prognosis is common, often resulting in brainstem compression and death.
  • Limited data exists on malignant stroke in individuals over 85 years old.

Purpose of the Study:

  • To retrospectively analyze the disease course, risk factors, survival rates, and treatment of malignant MCA infarction in patients aged 85 and above.
  • To identify prevalent risk factors such as hypertension, hyperlipidemia, atrial fibrillation, heart failure, and diabetes in this demographic.
  • To assess the safety and efficacy of anticoagulants in patients with atrial fibrillation and malignant MCA stroke.

Main Methods:

  • Retrospective analysis of 66 patients diagnosed with malignant MCA stroke.
  • Evaluation of risk factor frequencies and disability using the National Institutes of Health Stroke Scale (NIHSS).
  • Statistical analysis using Chi-quadrat and Mann-Whitney U tests; case description of a neurosurgically treated patient.

Main Results:

  • Atrial fibrillation was identified in 65% of the studied patients.
  • No statistically significant difference in survival rates was observed between patients treated with mannitol and those who were not.
  • The study included a description of an 85-year-old patient with malignant brain stroke who showed positive outcomes after neurosurgical treatment.

Conclusions:

  • Atrial fibrillation emerges as the primary risk factor for malignant MCA stroke in the elderly population (over 85).
  • Elderly patients necessitate vigilant health monitoring, particularly concerning stroke risk factors like atrial fibrillation.
  • Early identification and management of atrial fibrillation are critical for improving outcomes in older adults experiencing malignant stroke.
Keywords:
Brain edemaIschemic strokeMalignant strokeNeurosurgical treatmentPeople over 85 years old

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