Later midline shift is associated with better post-hospitalization discharge status after large middle cerebral artery stroke
Space occupying cerebral edema is a feared complication after large ischemic stroke, occurring in up to 30% of patients with middle cerebral artery (MCA) occlusion and peaking 2–4 days after injury. Little is known about the factors and outcomes associated with peak edema timing, especially after 96...
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| Vydáno v: | Scientific reports Ročník 15; číslo 1; s. 11738 - 10 |
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05.04.2025
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| Abstract | Space occupying cerebral edema is a feared complication after large ischemic stroke, occurring in up to 30% of patients with middle cerebral artery (MCA) occlusion and peaking 2–4 days after injury. Little is known about the factors and outcomes associated with peak edema timing, especially after 96 h. We aimed to characterize differences and compare discharge status between patients who experienced maximum midline shift (MLS) or decompressive hemicraniectomy (DHC) in the acute (< 48 h), average (48–96 h), and subacute (> 96 h) groups. We performed a two-center, retrospective study of patients with ≥ 1/2 MCA territory infarct and MLS. We constructed a multivariable model to test the association of subacute peak edema and favorable discharge status, adjusting for various confounders. Of 321 eligible patients, 32%, 36%, and 32% experienced acute, average, and subacute peak edema. Subacute peak edema was significantly associated with higher odds of favorable discharge than acute peak edema (aOR, 2.05; 95% CI, 1.03–4.11). Subacute peak edema after large MCA stroke is associated with better discharge status compared to acute peak edema courses. Understanding how the timing of cerebral edema affects risk of unfavorable discharge has important implications for treatment decisions and prognostication. |
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| AbstractList | Space occupying cerebral edema is a feared complication after large ischemic stroke, occurring in up to 30% of patients with middle cerebral artery (MCA) occlusion and peaking 2–4 days after injury. Little is known about the factors and outcomes associated with peak edema timing, especially after 96 h. We aimed to characterize differences and compare discharge status between patients who experienced maximum midline shift (MLS) or decompressive hemicraniectomy (DHC) in the acute (< 48 h), average (48–96 h), and subacute (> 96 h) groups. We performed a two-center, retrospective study of patients with ≥ 1/2 MCA territory infarct and MLS. We constructed a multivariable model to test the association of subacute peak edema and favorable discharge status, adjusting for various confounders. Of 321 eligible patients, 32%, 36%, and 32% experienced acute, average, and subacute peak edema. Subacute peak edema was significantly associated with higher odds of favorable discharge than acute peak edema (aOR, 2.05; 95% CI, 1.03–4.11). Subacute peak edema after large MCA stroke is associated with better discharge status compared to acute peak edema courses. Understanding how the timing of cerebral edema affects risk of unfavorable discharge has important implications for treatment decisions and prognostication. Space occupying cerebral edema is a feared complication after large ischemic stroke, occurring in up to 30% of patients with middle cerebral artery (MCA) occlusion and peaking 2-4 days after injury. Little is known about the factors and outcomes associated with peak edema timing, especially after 96 h. We aimed to characterize differences and compare discharge status between patients who experienced maximum midline shift (MLS) or decompressive hemicraniectomy (DHC) in the acute (< 48 h), average (48-96 h), and subacute (> 96 h) groups. We performed a two-center, retrospective study of patients with ≥ 1/2 MCA territory infarct and MLS. We constructed a multivariable model to test the association of subacute peak edema and favorable discharge status, adjusting for various confounders. Of 321 eligible patients, 32%, 36%, and 32% experienced acute, average, and subacute peak edema. Subacute peak edema was significantly associated with higher odds of favorable discharge than acute peak edema (aOR, 2.05; 95% CI, 1.03-4.11). Subacute peak edema after large MCA stroke is associated with better discharge status compared to acute peak edema courses. Understanding how the timing of cerebral edema affects risk of unfavorable discharge has important implications for treatment decisions and prognostication. Space occupying cerebral edema is a feared complication after large ischemic stroke, occurring in up to 30% of patients with middle cerebral artery (MCA) occlusion and peaking 2-4 days after injury. Little is known about the factors and outcomes associated with peak edema timing, especially after 96 h. We aimed to characterize differences and compare discharge status between patients who experienced maximum midline shift (MLS) or decompressive hemicraniectomy (DHC) in the acute (< 48 h), average (48-96 h), and subacute (> 96 h) groups. We performed a two-center, retrospective study of patients with ≥ 1/2 MCA territory infarct and MLS. We constructed a multivariable model to test the association of subacute peak edema and favorable discharge status, adjusting for various confounders. Of 321 eligible patients, 32%, 36%, and 32% experienced acute, average, and subacute peak edema. Subacute peak edema was significantly associated with higher odds of favorable discharge than acute peak edema (aOR, 2.05; 95% CI, 1.03-4.11). Subacute peak edema after large MCA stroke is associated with better discharge status compared to acute peak edema courses. Understanding how the timing of cerebral edema affects risk of unfavorable discharge has important implications for treatment decisions and prognostication.Space occupying cerebral edema is a feared complication after large ischemic stroke, occurring in up to 30% of patients with middle cerebral artery (MCA) occlusion and peaking 2-4 days after injury. Little is known about the factors and outcomes associated with peak edema timing, especially after 96 h. We aimed to characterize differences and compare discharge status between patients who experienced maximum midline shift (MLS) or decompressive hemicraniectomy (DHC) in the acute (< 48 h), average (48-96 h), and subacute (> 96 h) groups. We performed a two-center, retrospective study of patients with ≥ 1/2 MCA territory infarct and MLS. We constructed a multivariable model to test the association of subacute peak edema and favorable discharge status, adjusting for various confounders. Of 321 eligible patients, 32%, 36%, and 32% experienced acute, average, and subacute peak edema. Subacute peak edema was significantly associated with higher odds of favorable discharge than acute peak edema (aOR, 2.05; 95% CI, 1.03-4.11). Subacute peak edema after large MCA stroke is associated with better discharge status compared to acute peak edema courses. Understanding how the timing of cerebral edema affects risk of unfavorable discharge has important implications for treatment decisions and prognostication. Abstract Space occupying cerebral edema is a feared complication after large ischemic stroke, occurring in up to 30% of patients with middle cerebral artery (MCA) occlusion and peaking 2–4 days after injury. Little is known about the factors and outcomes associated with peak edema timing, especially after 96 h. We aimed to characterize differences and compare discharge status between patients who experienced maximum midline shift (MLS) or decompressive hemicraniectomy (DHC) in the acute (< 48 h), average (48–96 h), and subacute (> 96 h) groups. We performed a two-center, retrospective study of patients with ≥ 1/2 MCA territory infarct and MLS. We constructed a multivariable model to test the association of subacute peak edema and favorable discharge status, adjusting for various confounders. Of 321 eligible patients, 32%, 36%, and 32% experienced acute, average, and subacute peak edema. Subacute peak edema was significantly associated with higher odds of favorable discharge than acute peak edema (aOR, 2.05; 95% CI, 1.03–4.11). Subacute peak edema after large MCA stroke is associated with better discharge status compared to acute peak edema courses. Understanding how the timing of cerebral edema affects risk of unfavorable discharge has important implications for treatment decisions and prognostication. |
| ArticleNumber | 11738 |
| Author | Greer, David M. Chatzidakis, Stefanos Mohammed, Shariq Stafford, Rebecca A. Smirnakis, Stelios M. Abdalkader, Mohamad Huang, Qiuxi Pohlmann, Jack E. Brush, Benjamin Song, Jonathan J. Cheekati, Maanyatha Dennison, Sydney Kim, Ivy So Yeon Gilmore, Emily J. Dupuis, Josée Benjamin, Emelia J. Ong, Charlene J. |
| Author_xml | – sequence: 1 givenname: Jonathan J. surname: Song fullname: Song, Jonathan J. organization: Department of Neurology, Boston University Chobanian and Avedisian School of Medicine – sequence: 2 givenname: Rebecca A. surname: Stafford fullname: Stafford, Rebecca A. organization: Department of Neurology, Boston Medical Center – sequence: 3 givenname: Jack E. surname: Pohlmann fullname: Pohlmann, Jack E. organization: Department of Neurology, Boston Medical Center, Department of Epidemiology, Boston University School of Public Health – sequence: 4 givenname: Ivy So Yeon surname: Kim fullname: Kim, Ivy So Yeon organization: Department of Neurology, Boston Medical Center – sequence: 5 givenname: Maanyatha surname: Cheekati fullname: Cheekati, Maanyatha organization: Department of Biostatistics, School of Public Health, Boston University – sequence: 6 givenname: Sydney surname: Dennison fullname: Dennison, Sydney organization: Department of Biostatistics, School of Public Health, Boston University – sequence: 7 givenname: Benjamin surname: Brush fullname: Brush, Benjamin organization: Department of Neurology, NYU Langone Medical Center – sequence: 8 givenname: Stefanos surname: Chatzidakis fullname: Chatzidakis, Stefanos organization: Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School – sequence: 9 givenname: Qiuxi surname: Huang fullname: Huang, Qiuxi organization: Department of Biostatistics, School of Public Health, Boston University – sequence: 10 givenname: Stelios M. surname: Smirnakis fullname: Smirnakis, Stelios M. organization: Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Department of Neurology, Jamaica Plain Veterans Administration Medical Center – sequence: 11 givenname: Emily J. surname: Gilmore fullname: Gilmore, Emily J. organization: Department of Neurology, Yale School of Medicine, Department of Neurology, Yale-New Haven Hospital – sequence: 12 givenname: Shariq surname: Mohammed fullname: Mohammed, Shariq organization: Department of Biostatistics, School of Public Health, Boston University – sequence: 13 givenname: Mohamad surname: Abdalkader fullname: Abdalkader, Mohamad organization: Department of Radiology, Boston Medical Center – sequence: 14 givenname: Emelia J. surname: Benjamin fullname: Benjamin, Emelia J. organization: Department of Epidemiology, Boston University School of Public Health, Department of Medicine, Cardiovascular Medicine, Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine – sequence: 15 givenname: Josée surname: Dupuis fullname: Dupuis, Josée organization: Department of Biostatistics, School of Public Health, Boston University, Department of Epidemiology, Biostatistics and Occupational Health, McGill University – sequence: 16 givenname: David M. surname: Greer fullname: Greer, David M. organization: Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Department of Neurology, Boston Medical Center – sequence: 17 givenname: Charlene J. surname: Ong fullname: Ong, Charlene J. email: cjong@bu.edu organization: Department of Neurology, Boston University Chobanian and Avedisian School of Medicine, Department of Neurology, Boston Medical Center, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School |
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| Keywords | Timing Swelling Cerebral edema Mass effect Midline shift Middle cerebral artery |
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| Title | Later midline shift is associated with better post-hospitalization discharge status after large middle cerebral artery stroke |
| URI | https://link.springer.com/article/10.1038/s41598-025-95954-3 https://www.ncbi.nlm.nih.gov/pubmed/40188256 https://www.proquest.com/docview/3186676949 https://www.proquest.com/docview/3186783226 https://pubmed.ncbi.nlm.nih.gov/PMC11972405 https://doaj.org/article/1c4994e81bd343bf9936b1bbe5058790 |
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