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Related Experiment Videos

Mass effect and death from severe acute stroke

P M Pullicino1, A V Alexandrov, J A Shelton

  • 1Stroke Program, Buffalo General Hospital, NY 14203, USA.

Neurology
|October 27, 1997
PubMed
Summary

Midline cerebral displacement, like pineal displacement (PD), is linked to stroke severity and survival. A PD of 4 mm or more on CT within 48 hours indicates a high risk of early death in acute stroke patients.

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Area of Science:

  • Neurology
  • Radiology
  • Critical Care Medicine

Background:

  • Severe acute stroke can cause midline cerebral displacement, impacting consciousness but not directly survival.
  • Early identification of high-risk patients experiencing mass effect is crucial for management decisions.

Purpose of the Study:

  • To correlate measurements of midline cerebral displacement on CT scans with the probability of 14-day survival in severe acute hemispheric stroke patients.
  • To identify specific CT-based markers predictive of early mortality.

Main Methods:

  • Measured lesion volume, horizontal pineal displacement (PD), and horizontal septum pellucidum displacement (SD) on axial CT scans.
  • Analyzed data from consecutive patients with severe acute hemispheric stroke (Canadian Neurological Scale score ≤ 5).

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  • Correlated CT measurements with 14-day survival probability using univariate and multivariate analyses.

    • Main Results:

    • Of 118 patients, 39% died within 14 days. Significant risk factors for 14-day mortality included lesion volume ≥ 400 ml, SD ≥ 9 mm, PD ≥ 4 mm, intraventricular hemorrhage, and coma.
    • In multivariate analysis, only SD (p=0.001) and coma (p=0.019) remained significant predictors.
    • PD (r=0.82 with SD) ≥ 4 mm within 48 hours of stroke onset predicted a low 14-day survival probability (0.16) with 89% specificity and 46% sensitivity.

    Conclusions:

    • Horizontal midline cerebral displacement, particularly pineal displacement (PD), correlates with the likelihood of death post-stroke.
    • Patients with PD ≥ 4 mm on CT scans obtained within 48 hours of stroke onset face a high risk of early mortality.