20-hydroxyeiscosatetraenoic acid may be as a predictor of malignant middle cerebral artery infarction in patients with massive middle cerebral artery infarction

Abstract Background Early identification of massive middle cerebral artery infarction (MCAI) at risk for malignant MCAI (m-MCAI) may be useful in selecting patients for aggressive therapies. The aim of this study was to determine whether CYP metabolites may help to predict impending m-MCAI. Methods This is a prospective, two-center observational study in 256 patients with acute massive MCAI. Plasma levels of 20-hydroxyeicosatetraenoic acid (20-HETE), epoxyeicosatrienoic acids, and dihydroxyeicosatrienoic acids were measured at admission. Brain computed tomography (CT) was performed at admission and repeated between day 3 and 7, or earlier if there was neurological deterioration. The primary outcome was m-MCAI. The m-MCAI was diagnosed when follow-up brain CT detected a more than two-thirds space-occupying MCAI with midline shift, compression of the basal cisterns, and neurological worsening. Results In total of 256 enrolled patients, 77 (30.1%) patients developed m-MCAI. Among the 77 patients with m-MCAI, 60 (77.9%) patients died during 3 months of stroke onset. 20-HETE level on admission was significantly higher in patients with m-MCAI than those without m-MCAI. There was an increase in the risk of m-MCAI with increase of 20-HETE levels. The third and fourth quartiles of 20-HETE levels were independent predictors of m-MCAI (OR: 2.86; 95% CI: 1.16 – 6.68; P = 0.025, and OR: 4.23; 95% CI: 1.35 – 8.26; P = 0.002, respectively). Conclusions Incidence of m-MCAI was high in patients with massive MCAI and the prognosis of m-MCAI is very poor. Elevated plasma 20-HETE may be as a predictor for m-MCAI in acute massive MCAI, and it might useful in clinical practice in therapeutic decision making.

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20-Hydroxyeiscosatetraenoic Acid May Be as a Predictor of Malignant Middle Cerebral Artery Infarction in Patients With Massive Middle Cerebral Artery Infarction

10.21203/rs.3.rs-148346/v1 ◽

2021 ◽

Author(s):

Xingyang Yi ◽

Qiang Zhou ◽

Ting Qing ◽

Bing Ming ◽

Jing Lin ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Primary Outcome ◽

Epoxyeicosatrienoic Acids ◽

Therapeutic Decision ◽

Elevated Plasma ◽

Midline Shift ◽

Middle Cerebral Artery Infarction ◽

Therapeutic Decision Making

Abstract BackgroundEarly identification of massive middle cerebral artery infarction (MCAI) at risk for malignant MCAI (m-MCAI) may be useful in selecting patients for aggressive therapies. The aim of this study was to determine whether CYP metabolites may help to predict impending m-MCAI.MethodsThis is a prospective, two-center observational study in 256 patients with acute massive MCAI. Plasma levels of 20-hydroxyeicosatetraenoic acid (20-HETE), epoxyeicosatrienoic acids, and dihydroxyeicosatrienoic acids were measured at admission. Brain computed tomography (CT) was performed at admission and repeated between days 3 and 7, or earlier if there was neurological deterioration. The primary outcome was m-MCAI. m-MCAI was diagnosed when follow-up brain CT detected a more than two-thirds space-occupying MCAI with midline shift, compression of the basal cisterns, and neurological worsening.ResultsAmong 256 patients, 77 (30.1%) developed m-MCAI, 60 (77.9%) patients with m-MCAI died during 3 months of stroke onset. 20-HETE level on admission was significantly higher in patients with m-MCAI than those without m-MCAI. There was an increase in the risk of m-MCAI with increase of 20-HETE levels. The third and fourth quartiles of 20-HETE levels were independent predictors of m-MCAI (OR: 2.86; 95% CI: 1.16 – 6.68; P=0.025, and OR: 4.23; 95% CI: 1.35 – 8.26; P=0.002, respectively).ConclusionsIncidence of m-MCAI was high in patients with massive MCAI and the prognosis of m-MCAI is very poor. Elevated plasma 20-HETE may be as a predictor for m-MCAI in acute massive MCAI, and it might useful in clinical practice in therapeutic decision making.

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Association Between Preoperative Midline Shift Growing Rate and Outcomes of Decompressive Craniectomy in Patients with Malignant Middle Cerebral Artery Infarction

Current Neurovascular Research ◽

10.2174/1567202617666200207125552 ◽

2020 ◽

Vol 17 (2) ◽

pp. 131-139

Author(s):

Ruozhen Yuan ◽

Simiao Wu ◽

Yajun Cheng ◽

Kaili Ye ◽

Zilong Hao ◽

...

Keyword(s):

Computed Tomography ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Decompressive Craniectomy ◽

Mass Effect ◽

Midline Shift ◽

Middle Cerebral Artery Infarction ◽

West China Hospital ◽

Computed Tomography Scans ◽

Adequate Decompression

Background: Whether preoperative midline shift and its growing rate are associated with outcomes of decompressive craniectomy in patients with malignant middle cerebral artery infarction is unknown. Methods: We retrospectively included patients: 1) who underwent decompressive craniectomy for malignant middle cerebral artery infarction in West China Hospital from August 2010 to December 2, 2018) who had at least two brain computed tomography scans before decompressive craniectomy. Midline shift was measured on the first and last preoperative computed tomography scans. Midline shift growing rate was calculated by dividing Δmidline shift value using Δ time. The primary outcome was inadequate decompression of the mass effect. Secondary outcomes were 3 month death and unfavorable outcomes. Results: Sixty-one patients (mean age 53.7 years, 57.4% (35/61) male) were included. Median time from onset to decompressive craniectomy was 51.8 h (interquartile range: 39.7-77.8). Rates of inadequate decompression, 3 month death, 3 month modified Rankin Scale 5-6 and 4-6 were 50.8% (31/61), 50.9% (29/57), 64.9% (37/57) and 84.2% (48/57), respectively. The inadequate decompression group had a higher midline shift growing rate than the adequate decompression group (median: 2.7 mm/8 h vs. 1.4 mm/8 h, P=0.041). No intergroup difference of 3 month outcomes was found in terms of preoperative midline shift growing rate. Conclusion: Higher preoperative midline shift growing rate was associated with inadequate decompression of decompressive craniectomy in patients with malignant middle cerebral artery infarction.

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Intracranial Pressure Soon After Hemicraniectomy in Malignant Middle Cerebral Artery Infarction

Journal of Intensive Care Medicine ◽

10.1177/0885066616675598 ◽

2016 ◽

Vol 33 (5) ◽

pp. 310-316 ◽

Cited By ~ 3

Author(s):

Sang-Beom Jeon ◽

Jung Cheol Park ◽

Sun U. Kwon ◽

Yeon-Jung Kim ◽

Seungjoo Lee ◽

...

Keyword(s):

Intracranial Pressure ◽

Glasgow Coma Scale ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Secondary Brain Injury ◽

Midline Shift ◽

Middle Cerebral Artery Infarction ◽

Term Survival ◽

Coma Scale ◽

Decompressive Hemicraniectomy

Background: Decompressive hemicraniectomy reduces secondary brain injury related to brain edema and increased intracranial pressure (ICP) in patients with malignant middle cerebral artery infarction (MMI). However, a substantial proportion of patients still die despite hemicraniectomy due to refractory brain swelling. Objective: We aim to investigate whether ICP measured immediately after hemicraniectomy may indicate decompression effects and predict survival in patients with MMI. Methods: We included 25 patients with MMI who underwent ICP monitoring and brain computed tomography within the first hour of hemicraniectomy. Midline shifts were measured as radiological surrogates of decompression. The Glasgow Coma Scale and pupillary enlargements during the first day after hemicraniectomy were assessed as clinical surrogates of decompression. Long-term survival status at 6 months was used as the final outcome. We analyzed the relationships between early ICP and findings of midline shift, Glasgow Coma Scale, pupillary enlargement, and survival. Results: Initial ICP was correlated with mean ICP ( P < .001) and maximal ICP ( P < .001) during the first postoperative day. Intracranial pressure was associated with midline shifts ( P = .009), lower Glasgow Coma Scale scores ( P = .025), and the pupillary enlargement ( P = .015). Sixteen (64.0%) patients survived at 6 months. In a Cox proportional hazard model, elevated ICP was associated with mortality at 6 months (hazard ratio: 1.13; 95% confidence interval: 1.03-1.24; P = .008). Conclusion: Increase in ICP soon after hemicraniectomy was associated with midline shift, poor neurological status, and mortality in patients with MMI. Measurements of ICP soon after hemicraniectomy may permit earlier interventions as well as more refined clinical assessments.

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Combining Magnetic Resonance Imaging within Six-Hours of Symptom Onset with Clinical Follow-Up at 24 h Improves Prediction of ‘malignant’ Middle Cerebral Artery Infarction

International Journal of Stroke ◽

10.1111/ijs.12060 ◽

2013 ◽

Vol 9 (2) ◽

pp. 210-214 ◽

Cited By ~ 15

Author(s):

Anna Kruetzelmann ◽

Frank Hartmann ◽

Christoph Beck ◽

Eric Juettler ◽

Oliver C. Singer ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Symptom Onset ◽

Resonance Imaging ◽

Middle Cerebral Artery Infarction

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Reduction of Midline Shift Following Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Infarction

Journal of Stroke ◽

10.5853/jos.2016.00262 ◽

2016 ◽

Vol 18 (3) ◽

pp. 328-336 ◽

Cited By ~ 14

Author(s):

Sang-Beom Jeon ◽

Sun U. Kwon ◽

Jung Cheol Park ◽

Deok Hee Lee ◽

Sung-Cheol Yun ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Midline Shift ◽

Middle Cerebral Artery Infarction ◽

Decompressive Hemicraniectomy

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Hemicraniectomy for Massive Middle Cerebral Artery Infarction: A Review

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s031716710000932x ◽

2008 ◽

Vol 35 (5) ◽

pp. 544-550 ◽

Cited By ~ 12

Author(s):

Dulka Manawadu ◽

Ahmed Quateen ◽

J. Max Findlay

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Surgical Intervention ◽

Middle Cranial Fossa ◽

Midline Shift ◽

Middle Cerebral Artery Infarction ◽

Randomized Controlled ◽

Life Saving ◽

Cranial Fossa ◽

Saving Measure

Hemicraniectomy and opening underlying dura mater permits the expansion of infarcted, swollen brain outwards, reversing dangerous intracranial pressure elevations and the risk of fatal transtentorial temporal lobe or diencephalic herniation. Recently published randomized controlled trials have proven this procedure a powerful life-saving measure in the setting of malignant middle cerebral artery infarction and allayed concerns that a reduction in mortality is accompanied by an unacceptable increase in patients suffering severe neurological impairments. Appropriate patients are relatively young, in the first five decades of life, suffering infarction of a majority of the middle cerebral artery (MCA) territory in either hemisphere, and decompression should be performed prior to progression to coma or two dilated, fixed pupils. Lethargy combined with midline shift and uncal herniation on neuroimaging is an appropriate trigger to consider and discuss surgical intervention. Families and, when possible, patients themselves, should be informed of the certainty of at least moderate to mild permanent deficits, and the possibility of worse. To be successful decompression must be extensive, targeting a bone flap measuring 14 cm from front to back, and extending 1 to 2 cms lateral to the midline sagittal suture to the floor of the middle cranial fossa at the level of the coronal suture. An augmentation duraplasty is mandatory.

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Crossed cerebellar diaschisis in patients with acute middle cerebral artery infarction: Occurrence and perfusion characteristics

Journal of Cerebral Blood Flow & Metabolism ◽

10.1177/0271678x15617953 ◽

2015 ◽

Vol 36 (4) ◽

pp. 743-754 ◽

Cited By ~ 30

Author(s):

Wieland H Sommer ◽

Christine Bollwein ◽

Kolja M Thierfelder ◽

Alena Baumann ◽

Hendrik Janssen ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Symptom Onset ◽

Ct Perfusion ◽

Clinical Factors ◽

Middle Cerebral Artery Infarction ◽

Whole Brain ◽

Crossed Cerebellar Diaschisis ◽

Brain Ct ◽

Cerebellar Diaschisis

We aimed to investigate the overall prevalence and possible factors influencing the occurrence of crossed cerebellar diaschisis after acute middle cerebral artery infarction using whole-brain CT perfusion. A total of 156 patients with unilateral hypoperfusion of the middle cerebral artery territory formed the study cohort; 352 patients without hypoperfusion served as controls. We performed blinded reading of different perfusion maps for the presence of crossed cerebellar diaschisis and determined the relative supratentorial and cerebellar perfusion reduction. Moreover, imaging patterns (location and volume of hypoperfusion) and clinical factors (age, sex, time from symptom onset) resulting in crossed cerebellar diaschisis were analysed. Crossed cerebellar diaschisis was detected in 35.3% of the patients with middle cerebral artery infarction. Crossed cerebellar diaschisis was significantly associated with hypoperfusion involving the left hemisphere, the frontal lobe and the thalamus. The degree of the relative supratentorial perfusion reduction was significantly more pronounced in crossed cerebellar diaschisis-positive patients but did not correlate with the relative cerebellar perfusion reduction. Our data suggest that (i) crossed cerebellar diaschisis is a common feature after middle cerebral artery infarction which can robustly be detected using whole-brain CT perfusion, (ii) its occurrence is influenced by location and degree of the supratentorial perfusion reduction rather than infarct volume (iii) other clinical factors (age, sex and time from symptom onset) did not affect the occurrence of crossed cerebellar diaschisis.

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