Seizures after decompressive hemicraniectomy for large middle cerebral artery territory infarcts: incidence, associated factors and impact on long‐term outcomes

2021 ◽  
Author(s):  
Olivier Masheka‐Cishesa ◽  
Maéva Kyheng ◽  
Charlotte Cordonnier ◽  
Grégory Kuchcinski ◽  
Maxime Chochoi ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Associated Factors ◽  
Middle Cerebral Artery Territory ◽  
Long Term Outcomes ◽  
Decompressive Hemicraniectomy

Decompressive hemicraniectomy for malignant middle cerebral artery territory infarction: is life worth living?

2012 ◽  
Vol 117 (4) ◽  
pp. 749-754 ◽  
Author(s):  
Ralph Rahme ◽  
Mario Zuccarello ◽  
Dawn Kleindorfer ◽  
Opeolu M. Adeoye ◽  
Andrew J. Ringer
Keyword(s):  
Middle Cerebral Artery ◽  
Functional Outcome ◽  
Cerebral Artery ◽  
Life Assessment ◽  
Physical Aspect ◽  
Worth Living ◽  
Middle Cerebral Artery Territory ◽  
Life Worth Living ◽  
Decompressive Hemicraniectomy ◽  
The Mean

Object Although decompressive hemicraniectomy has been shown to reduce death and improve functional outcome following malignant middle cerebral artery territory infarction, there is ongoing debate as to whether surgery should be routinely performed, considering the very high rates of disability and functional dependence in survivors. Through a systematic review of the literature, the authors sought to determine the outcome from a patient's perspective. Methods In September 2010, a MEDLINE search of the English-language literature was performed using various combinations of 12 key words. A total of 16 papers were reviewed and individual study data were extracted. Results There was significant variability in study design, patient eligibility criteria, timing of surgery, and methods of outcome assessment. There were 382 patients (59% male, 41% female) with a mean age of 50 years, 25% with dominant-hemisphere infarction. The mortality rate was 24% and the mean follow-up in survivors was 19 months (range 3–114 months). Of 156 survivors with available modified Rankin Scale (mRS) scores, 41% had favorable functional outcome (mRS Score ≤ 3), whereas 47% had moderately severe disability (mRS Score 4). Among 157 survivors with quality of life assessment, the mean overall reduction was 45%: 67% for physical aspect and 37% for psychosocial aspect. Of 114 screened survivors, depression affected 56% and was moderate or severe in 25%. Most patients and/or caregivers (77% of the 209 interviewed) were satisfied and would give consent again for the procedure. Conclusions Despite high rates of physical disability and depression, the vast majority of patients are satisfied with life and do not regret having undergone surgery.

scholarly journals Clinical prognosis of isolated anterior cerebral artery territory infarction: a retrospective study

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hyungjong Park ◽  
Young Seok Jeong ◽  
Seo Hyeon Lee ◽  
Seong Hwa Jang ◽  
Doo Hyuk Kwon ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Associated Factors ◽  
Anterior Cerebral Artery ◽  
Long Term Outcomes ◽  
Post Discharge ◽  
Job Status ◽  
Clinical Prognosis ◽  
Short And Long Term ◽  
One Year

Abstract Background Isolated anterior cerebral artery territory (ACA) infarction is a rare phenomenon, and is known to have distinctive clinical features. Little is known regarding the clinical prognosis of isolated ACA territory infarction with associated factors, and its impact on dwelling and job status. We investigated the short- and long-term outcomes of anterior cerebral artery (ACA) territory infarction, and the associated factors involved in the development of the distinctive symptoms. Methods This retrospective study in a prospective cohort of acute ischaemic stroke patients included consecutively enrolled patients with isolated ACA territory infarction. We investigated the functional status using the modified Rankin scale (mRS) score at discharge, three months’ post-discharge, and one-year post-discharge. We also investigated the occlusion site of the ACA (proximal vs. distal); presence of distinctive symptoms of ACA territory infarction including behaviour changes, indifference, aphasia, and urinary incontinence; and the effect of these symptoms on dwelling and job status one year after discharge. Results Between April 2014 and March 2019, 47 patients with isolated ACA territory infarction were included. Twenty-nine patients (61.7 %) had good outcomes (mRS ≤ 2) at discharge; however, the mRS score increased at three months (40; 85.1 %, p < 0.001) and one year (41; 87.2 %) post-discharge. Occlusion of the ACA proximal segment was independently associated with the development of distinctive symptoms (adjusted odds ratio, 17.68; 95 % confidence interval: 2.55–122.56, p < 0.05). Twenty-one (48.8 %) patients with good outcomes at one year experienced a change in dwelling status and job loss; 20 (95.2 %) of them had distinctive ACA territory symptoms with proximal ACA occlusion. Conclusions Short- and long-term outcomes of isolated ACA territory infarction were favourable. However, proximal segment occlusion was associated with the development of distinctive symptoms, possibly related to future dwelling and job status.

scholarly journals Predicting the Long-Term Outcome after Subacute Stroke within the Middle Cerebral Artery Territory

2005 ◽  
Vol 1 (2) ◽  
pp. 148 ◽  
Author(s):  
Oh Young Bang ◽  
Hee Young Park ◽  
Jung Han Yoon ◽  
Seung Hyeon Yeo ◽  
Ji Won Kim ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Middle Cerebral Artery Territory ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Subacute Stroke

scholarly journals Clinical prognosis of isolated anterior cerebral artery territory infarction: A retrospective study

2021 ◽  
Author(s):  
Hyungjong Park ◽  
Young Seok Jeong ◽  
Seo Hyun Lee ◽  
Seong Hwa Jang ◽  
Doo Hyuk Kwon ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Associated Factors ◽  
Anterior Cerebral Artery ◽  
Long Term Outcomes ◽  
Post Discharge ◽  
Job Status ◽  
Clinical Prognosis ◽  
Short And Long Term ◽  
One Year

Abstract Background Isolated anterior cerebral artery territory (ACA) infarction is a rare phenomenon and had known to have distinctive clinical features. Little is known about the clinical prognosis of isolated ACA territory infarction with associated factors and its impact on dwelling and job status. We investigated the short- and long-term outcomes and associated factors involved in the development of the distinctive symptoms of anterior cerebral artery (ACA) territory infarction. Methods This retrospective study in a prospective cohort of acute ischaemic stroke patients included consecutively enrolled patients with isolated ACA territory infarction. We investigated the functional status using the modified Rankin scale (mRS) score at discharge, three months post-discharge, and one-year post-discharge. We also investigated the occlusion site of the ACA (proximal vs. distal); presence of distinctive symptoms of ACA territory infarction including behaviour changes, indifference, aphasia, and urinary incontinence; and the effect of these symptoms on dwelling and job status one year after discharge. Results From April 2014 to March 2019, 47 patients with isolated ACA territory infarction were included. Twenty-nine patients (61.7%) had good outcomes (mRS ≤ 2) at discharge; however, the mRS score increased at three months (40; 85.1%, p < 0.001) and one year (41; 87.2%) post-discharge. Occlusion of the ACA proximal segment was independently associated with the development of distinctive symptoms (adjusted odds ratio, 17.68; 95% confidence interval: 2.55–122.56, p < 0.05). Twenty-one (48.8%) patients with good outcomes at one year experienced a change in dwelling status and job loss; 20 (95.2%) of them had distinctive ACA territory symptoms with proximal ACA occlusion. Conclusions Short- and long-term outcomes of isolated ACA territory infarction were favourable. However, proximal segment occlusion was associated with the development of distinctive symptoms, possibly related to future dwelling and job status.

Abstract T P289: Long-term Outcome Analysis in Patients With Malignant Middle Cerebral Artery Stroke Who Underwent Decompressive Hemicraniectomy

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jindong Xu ◽  
Sonisha A Warren ◽  
Anna Y Khanna
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Depression Scale ◽  
Functional Evaluation ◽  
Stroke Patients ◽  
Term Outcome ◽  
Cerebral Vessel ◽  
Long Term Outcome ◽  
Decompressive Hemicraniectomy

Background and Purpose: Decompressive hemicraniectomy (DHC) reduces mortality and improves physical outcome in selected patients with malignant middle cerebral artery (mMCA) stroke. In this study, we performed comprehensive functional evaluation in mMCA stroke patients who underwent DHC, and attempted to identify the pre-surgical factors that correlated with long-term physical outcome. Methods: We identified mMCA stroke patients treated with DHC in our institution between January 2007 and April 2013. Functional outcome was assessed in survivors through clinic visit or telephone interview using modified Rankin Scale (mRS), Barthel Index, Geriatric Depression Scale, Stroke Impact Scale, Satisfaction of Life Scale, and retrospective consent. In addition, all patients including survivors and deceased were classified into acceptable outcome (mRS<=4) and bad outcome (mRS>4) groups. Pre-surgical factors including age, gender, stroke risk factors, time to surgery, cerebral vessel involvement, cause of stroke, use of intravenous tPA or endovascular intervention were compared between two groups. Results: 37 patients were identified meeting our study criteria. 11 out of 16 survivors were enrolled for functional assessment (mean age 54.7 years, 73% male, 27% left hemisphere stroke, and mean time after stroke 3.4 years). Psychosocial aspect scored much higher than physical outcome in comprehensive functional evaluation. The majority of participants were satisfied with life and agreed for the retrospective consent. Comparing two groups with acceptable (n=9) and bad (n=23) outcomes, pre-surgical characteristics including age>60, anterior cerebral artery involvement, hemorrhagic transformation, history of diabetes and coronary artery diseases were potentially associated with worse long-term outcome. Conclusions: A better psychological recovery suggests that appropriate mMCA stroke patients should not be deprived a DHC only based on a presumed unfavorable physical outcome. Some pre-surgical factors may be predictive for a worse outcome, which will assist physicians and families making critical decisions.

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