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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Veröffentlicht in:Scientific reports Jg. 15; H. 1; S. 11738 - 10
Hauptverfasser: Song, Jonathan J., Stafford, Rebecca A., Pohlmann, Jack E., Kim, Ivy So Yeon, Cheekati, Maanyatha, Dennison, Sydney, Brush, Benjamin, Chatzidakis, Stefanos, Huang, Qiuxi, Smirnakis, Stelios M., Gilmore, Emily J., Mohammed, Shariq, Abdalkader, Mohamad, Benjamin, Emelia J., Dupuis, Josée, Greer, David M., Ong, Charlene J.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: London Nature Publishing Group UK 05.04.2025
Nature Publishing Group
Nature Portfolio
Schlagworte:
692/617/375/1345
692/617/375/1370
692/617/375/534
Aged
Brain Edema - etiology
Brain Edema - surgery
Cerebral blood flow
Cerebral edema
Decompressive Craniectomy
Edema
Female
Humanities and Social Sciences
Humans
Infarction, Middle Cerebral Artery - complications
Infarction, Middle Cerebral Artery - pathology
Infarction, Middle Cerebral Artery - surgery
Ischemia
Male
Mass effect
Middle Aged
Middle cerebral artery
Midline shift
multidisciplinary
Patient Discharge
Retrospective Studies
Science
Science (multidisciplinary)
Stroke
Swelling
Time Factors
Timing
Timing
Swelling
Cerebral edema
Mass effect
Midline shift
Middle cerebral artery
ISSN:2045-2322, 2045-2322
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Zusammenfassung: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.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:2045-2322
2045-2322
DOI:10.1038/s41598-025-95954-3