Mortality of space-occupying ('malignant') middle cerebral artery infarction under conservative intensive care

Intensive Care Med. 1998 Jun;24(6):620-3. doi: 10.1007/s001340050625.


Objective: To find what the mortality rate of space-occupying ('malignant') middle cerebral artery (MCA) infarction is under maximum conservative intensive care. To establish whether any early indicators of survival exist.

Design: Prospective descriptive study.

Setting: Neuro-critical care unit of a university hospital.

Patients: Fifty-three patients (mean age 64 +/- 10 years) with 'malignant' MCA infarction.

Interventions: Maximum conservative intensive care using a standardized protocol (heparin, osmotherapy, tromethamol, mild hyperventilation). The start of therapy was within 12 h after the onset of symptoms.

Measurements and results: The Glasgow Coma Scale (GCS) and Scandinavian Stroke Scale (SSS) were recorded daily. A computed tomography (CT) scan was performed on admission, on day 3 and on day 7. SSS, Barthel Index and Rankin Scale of the surviving patients were recorded after 3 months. On admission, the mean GCS was 13 +/- 3 points and mean SSS 18 +/- 7 points. All patients had to undergo mechanical ventilation (23 +/- 26 h after the onset of symptoms) and were comatose after 28 +/- 30 h. Of 53 patients, 37 (70%) suffered brain death in the intensive care unit (ICU) after an average of 90 +/- 59 h. After 3 months 42/53 (79 %) patients had died. The Barthel Index of the surviving patients was 54 +/- 12 points, the SSS 25 +/- 9 points and the Rankin Scale 3 +/- 1 points. The deceased patients had a significantly higher body temperature on admission than the surviving patients (36.8 degrees C vs 36.3 degrees C).

Conclusions: The mortality of patients with 'malignant' MCA infarction is very high despite maximum conservative intensive care.

MeSH terms

  • Adult
  • Aged
  • Body Temperature
  • Brain / diagnostic imaging
  • Cerebral Infarction / diagnosis
  • Cerebral Infarction / mortality*
  • Cerebral Infarction / therapy
  • Chi-Square Distribution
  • Critical Care / methods
  • Critical Care / statistics & numerical data*
  • Disease Progression
  • Female
  • Germany / epidemiology
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Tomography, X-Ray Computed
  • Treatment Outcome