NDLI: Clinical review: Therapy for refractory intracranial hypertension in ischaemic stroke

Content Provider	Springer Nature : BioMed Central
Author	Jüttler, Eric Schellinger, Peter D Aschoff, Alfred Zweckberger, Klaus Unterberg, Andreas Hacke, Werner
Abstract	The treatment of patients with large hemispheric ischaemic stroke accompanied by massive space-occupying oedema represents one of the major unsolved problems in neurocritical care medicine. Despite maximum intensive care, the prognosis of these patients is poor, with case fatality rates as high as 80%. Therefore, the term 'malignant brain infarction' was coined. Because conservative treatment strategies to limit brain tissue shift almost consistently fail, these massive infarctions often are regarded as an untreatable disease. The introduction of decompressive surgery (hemicraniectomy) has completely changed this point of view, suggesting that mortality rates may be reduced to approximately 20%. However, critics have always argued that the reduction in mortality may be outweighed by an accompanying increase in severe disability. Due to the lack of conclusive evidence of efficacy from randomised trials, controversy over the benefit of these treatment strategies remained, leading to large regional differences in the application of this procedure. Meanwhile, data from randomised trials confirm the results of former observational studies, demonstrating that hemicraniectomy not only significantly reduces mortality but also significantly improves clinical outcome without increasing the number of completely dependent patients. Hypothermia is another promising treatment option but still needs evidence of efficacy from randomised controlled trials before it may be recommended for clinical routine use. This review gives the reader an integrated view of the current status of treatment options in massive hemispheric brain infarction, based on the available data of clinical trials, including the most recent data from randomised trials published in 2007.
Related Links	https://ccforum.biomedcentral.com/counter/pdf/10.1186/cc6087.pdf
Ending Page	14
Page Count	14
Starting Page	1
File Format	HTM / HTML
ISSN	13648535
DOI	10.1186/cc6087
Journal	Critical Care
Issue Number	5
Volume Number	11
Language	English
Publisher	BioMed Central
Publisher Date	2007-10-25
Access Restriction	Open
Subject Keyword	Intensive Critical Care Medicine Emergency Medicine Ischaemic Stroke Cerebral Perfusion Pressure Anterior Cerebral Artery Decompressive Surgery Bone Flap
Content Type	Text
Resource Type	Review
Subject	Critical Care and Intensive Care Medicine
Journal Impact Factor	8.8/2023
5-Year Journal Impact Factor	10.4/2023

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