Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke: South Asian Experience

2017 ◽  
Vol 26 (10) ◽  
pp. 2306-2312
Author(s):  
Saadat Kamran ◽  
Naveed Akhtar ◽  
Abdul Salam ◽  
Ayman Alboudi ◽  
Hiba Rashid ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
South Asian ◽  
Cerebral Artery ◽  
Decompressive Hemicraniectomy ◽  
Middle Cerebral Artery Stroke

scholarly journals Malignant middle cerebral artery syndrome with thrombotic thrombocytopenia following vaccination against SARS-CoV-2

2021 ◽  
pp. 175114372110274
Author(s):  
Carmen Jacob ◽  
Khairil Amir Rani ◽  
Patrick James Holton ◽  
Sara Rosalind Boyce ◽  
Nicolas Ulrick Weir ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Perioperative Complications ◽  
Rare Condition ◽  
Intravenous Immunoglobulins ◽  
Care Staff ◽  
Heparin Induced Thrombocytopenia ◽  
Decompressive Hemicraniectomy ◽  
Middle Cerebral Artery Stroke ◽  
Venous Thromboses

Cases of thromboses at unusual sites with thrombocytopenia have been reported following vaccination against Sars-CoV-2. This new syndrome, christened vaccine-induced thrombotic thrombocytopenia (VITT), mainly results in venous thromboses. We report the case of a young woman with a right middle cerebral artery stroke following vaccination with ChAdOx1 nCoV-19. A diagnosis of VITT was made and platelet counts began to recover shortly after commencing treatment with argatroban, intravenous immunoglobulins and corticosteroids. On day 6 following admission, the patient deteriorated neurologically and decision made to proceed with decompressive hemicraniectomy. There were no perioperative complications and anticoagulation with argatroban was reinitiated on the first postoperative day. VITT is a rare condition resembling auto-immune heparin-induced thrombocytopenia. All critical care staff should be aware of the rare link between vaccination against SARS-CoV-2 and VITT and the need to rapidly commence both anticoagulation, using heparin alternatives, and immunomodulation.

Decompressive Hemicraniectomy for Middle Cerebral Artery Stroke: Indications and Perioperative Care

AORN Journal ◽  
2021 ◽  
Vol 114 (1) ◽  
pp. 34-46
Author(s):  
Beth Karasin ◽  
Monica Grzelak ◽  
Gina Rizzo ◽  
Tara Hardinge ◽  
Lauren Eskuchen ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Perioperative Care ◽  
Decompressive Hemicraniectomy ◽  
Middle Cerebral Artery Stroke

Abstract TP124: Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke: South Asian Experience

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Saadat Kamran ◽  
Naveed Akhtar ◽  
Zain A Bhutta ◽  
Abdul Salam ◽  
Aymen Alboudi ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Functional Outcome ◽  
South Asian ◽  
Cerebral Artery ◽  
Univariate Analysis ◽  
Septum Pellucidum ◽  
Published Data ◽  
Cross Sectional ◽  
Decompressive Hemicraniectomy ◽  
Time To Surgery

Objective: The randomized trials and pooled analysis showed improved outcome and reduced mortality in malignant middle cerebral artery [MMCA] undergoing decompressive hemicraniectomy (DHC) within 48 hours of stroke onset. This could be due to highly selective patient population in trials, not reflecting real world practice. Furthermore, with ischemic stroke being so common in the South Asian and Middle Eastern population, there still exists very little published data on DHC in MMCA stroke patients. Methods: Retrospective, multicenter cross-sectional study to measure outcome following DHC using the modified Rankin Scale [mRS] and dichotomized as favorable ≤4 or unfavorable >4, at three months. Results: In total 137 patients underwent DHC. At 90 days, mortality was 16.8%, 61.3% of patients survived with an mRS ≤4 and 38.7% had an mRS of >4. Age (55 years), diabetes [p=0.004], hypertension [p=0.021], pupillary abnormality [p=0.048], uncal herniation [p=0.007], temporal lobe involvement [p=0.016], additional infarction [MCA + ACA, PCA] [P=0.001], and infarction growth rates [P=0.025] was significantly higher in patients with unfavorable prognosis in univariate analysis. Multivariate analysis showed age, additional infarction, septum pellucidum deviation >1cm and uncal herniation to be associated with a significantly poor prognosis. Time to surgery had no impact on outcome [p=0.109]. Conclusions: Similar to the effects observed in the studies from the West, DHC improves functional outcome in predominantly South Asian patients with MMCA stroke. Increasing age, MCA with additional infarctions, septum pellucidum deviation 1cm and uncal herniation were significant predictors of disability and poor functional outcomes. Time to surgery had no impact on functional outcome.

scholarly journals Outcomes of Hypothermia in Addition to Decompressive Hemicraniectomy in Treatment of Malignant Middle Cerebral Artery Stroke

2019 ◽  
Vol 76 (5) ◽  
pp. 571 ◽  
Author(s):  
Hermann Neugebauer ◽  
Hauke Schneider ◽  
Julian Bösel ◽  
Carsten Hobohm ◽  
Sven Poli ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Decompressive Hemicraniectomy ◽  
Middle Cerebral Artery Stroke

Predictors of decompressive hemicraniectomy in malignant middle cerebral artery stroke

2018 ◽  
Vol 42 (1) ◽  
pp. 175-181 ◽  
Author(s):  
Saadat Kamran ◽  
Abdul Salam ◽  
Naveed Akhtar ◽  
Atlantic D’soza ◽  
Ashfaq Shuaib
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Decompressive Hemicraniectomy ◽  
Middle Cerebral Artery Stroke

scholarly journals Revisiting Hemicraniectomy: Late Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke and the Role of Infarct Growth Rate

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Saadat Kamran ◽  
Naveed Akhtar ◽  
Abdul Salam ◽  
Ayman Alboudi ◽  
Kainat Kamran ◽  
...  
Keyword(s):  
Growth Rate ◽  
Middle Cerebral Artery ◽  
Functional Outcome ◽  
Temporal Lobe ◽  
Cerebral Artery ◽  
Stroke Onset ◽  
Early Surgery ◽  
Cross Sectional ◽  
Decompressive Hemicraniectomy ◽  
Middle Cerebral Artery Stroke

Objective and Methods.The outcome in late decompressive hemicraniectomy in malignant middle cerebral artery stroke and the optimal timings of surgery has not been addressed by the randomized trials and pooled analysis. Retrospective, multicenter, cross-sectional study to measure outcome following DHC under 48 or over 48 hours using the modified Rankin scale [mRS] and dichotomized as favorable ≤4 or unfavorable >4 at three months.Results.In total, 137 patients underwent DHC. Functional outcome analyzed as mRS 0–4 versus mRS 5-6 showed no difference in this split between early and late operated on patients [P=0.140] and mortality [P=0.975]. Multivariate analysis showed that age ≥ 55 years, MCA with additional infarction, septum pellucidum deviation ≥1 cm, and uncal herniation were independent predictors of poor functional outcome at three months. In the “best” multivariate model, second infarct growth rate [IGR2] >7.5 ml/hr, MCA with additional infarction, and patients with temporal lobe involvement were independently associated with surgery under 48 hours. Both first infarct growth rate [IGR1] and second infarct growth rate [IGR2] were nearly double [P<0.001] in patients with early surgery [under 48 hours].Conclusions.The outcome and mortality in malignant middle cerebral artery stroke patients operated on over 48 hours of stroke onset were comparable to those of patients operated on less than 48 hours after stroke onset. Our data identifies IGR, temporal lobe involvement, and middle cerebral artery with additional infarct as independent predictors for early surgery.

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