同側(cè)腦靜脈流出道梗阻致大腦中動脈區(qū)腦梗死的致命性水腫ppt課件

1、Wengui Yu, Joanna Rives, Babu Welch, Jonathan White, and Duke Samson UT Southwestern Medical Center, Dallas, TXIpsilateral Cerebral Venous Outflow Obstruction Is Associated with Fatal Edema of MCA Infarction Introduction MCA infarction accounts for 10 % of ischemic stroke Approximately 40% of patien

2、ts with large MCA infarction develop fatal edema. Mortality rate of malignant MCA infarction was reported to be 88% with medical therapy.Hemicraniectomy improves outcome of malignant MCA stroke3 clinical trials: DECIMAL, HAMLET, and DESTINY.93 patients randomized to surgical or medical therapy.Patie

3、nts 60 years of age.The timing of surgery 20 on admission, elevated white blood cell counts, hypertension, heart failure, ipsilateral abnormal circle of Willis, and carotid occlusion. Infarct size is the major determinant, but its predictive value is only moderate. Aim of Our StudyTo investigate the

4、 relevance of the ipsilateral cerebral venous sinuses in the development of fatal edema. Methods A retrospective study All consecutive patients with large MCA infarction admitted to our Neurointensive Care Unit from January 2007 to October 2021 were included. Medical records, laboratory data, and im

5、aging studies were analyzed. Patients with malignant MCA infarction were compared with those with non-malignant MCA infarction. Results Table 1. Demographics and Clinical FeaturesPtAgeSexInfarctionEtiologyMaximal midline shift (mm)Ipsilateral transverseSinuses (TS)Ipsilateral internal jugular vein (

6、IJ)mRS at discharge167mR-MCAEmbolic2dominantdominant3281fR-MCAEmbolic3.4dominantNA4369mL-MCAICA occlusion16.1hypoplasticNA6460mL-MCAEmbolic4.6NANA5538mL-MCAICA occlusion6.4NANA3637mR-MCAVasculitis 1NANP6764mR-MCAICA dissection16.8NAoccluded6846mL-MCAICA dissection1.9dominantdominant3970fR-MCA/ACAICA

7、 occlusion24.3atresichypoplastic61054mR-MCAEmbolic7.2NANP31160fR-MCAICA occlusion9.8NANP5Note: NA, normal appearance. Table 2. Clinical features of malignant and non-malignant MCA infarctionNon-malignant MCA InfarctionMalignant MCA Infarction# of patients95Age (y)54.4 14.958.8 10 (p=0.422)Female, n

8、(%) 2 (22.2%)2 (40%)R MCA, n (%) 6 (66.7%)4 (80%)Infarction volume196 70327 36 (p0.001)Maximal midline shift4.7 3.117.3 4.9 (p0.001)Ipilateral TS or IJ Atresia or occlusion02 (40%) Hypoplasia02 (40%Mortality rate (%)0%80%Non-malignant MCA infarctionDay 1 2 4 5 Bilateral TS and IJ Day 1 2 3 5 Ipsilateral hypoplasia of TS and IJ Day 1 2 3 4 Ipsilateral atresia of TS Malignant MCA infarctionConclusions Our preliminary findings suggest that occlusive disease of the ipsilateral cerebral venous sinuses is associated with early fatal edema of MCA infar