STROKE-MALIGNANT MCA INFARCTION

SUMMARY

1. Malignant middle cerebral artery (MCA) infarction is a life-threatening form of cerebrovascular accident where the area supplied by the MCA is completely infarcted.

2. It occurs in up to 10% of all stroke patients^[1].

3. Patients suffering from malignant MCA infarction usually present clinically with severe hemispheric stroke syndrome including hemiplegia, forced eye and head deviation and progressive deterioration of consciousness within the first 2 days.

4. Symptoms of transtentorial herniation can then occur within 2 to 4 days after the onset of the stroke. This presentation is then followed by early CT signs of major infarcts during the first 12 hours after the stroke^[2].

5. The prognosis is extremely poor and the mortality rate for patients who undergo conservative management can be as high as 80%^[3].

6. The treatment of malignant MCA is targeted towards decreasing the ICP which is raised as a result of the infarction: conservative medical management vs. surgical decompression.

Reference(s)

↑ Moulin DE, Lo R, Chiang J, Barrett HJM. Prognosis in middle cerebral artery occlusion. Stroke. 1985. 16: 282 – 284.
↑ Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R. Malignant middle cerebral artery infarction: Clinical course and prognostic signs. Arch Neurol. 1996. 53: 309 – 315.
↑ Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R. Malignant middle cerebral artery infarction: Clinical course and prognostic signs. Arch Neurol. 1996. 53: 309 – 315.

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Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].

[1] Moulin DE, Lo R, Chiang J, Barrett HJM. Prognosis in middle cerebral artery occlusion. Stroke. 1985. 16: 282 – 284.

[2] Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R. Malignant middle cerebral artery infarction: Clinical course and prognostic signs. Arch Neurol. 1996. 53: 309 – 315.

[3] Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R. Malignant middle cerebral artery infarction: Clinical course and prognostic signs. Arch Neurol. 1996. 53: 309 – 315.

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