BACKGROUND: Malignant middle cerebral @entity1188 is a devastating condition, with up to 80% mortality in conservatively treated @entity1 . The pathophysiology of this @entity64 is characterized by a large core of severe @entity63 and only a relatively small rim of penumbra. Due to the fast development of irreversible morphological damage, cytotoxic @entity4 occurs immediately in a large portion of the @entity63 territory. The subsequent damage of the tight junctions leads to the @entity1503 barrier and @entity2657 , resulting in space-occupying @entity4 . The progressive vasogenic @entity4 reaches its maximum after 1 to several days and exerts a mechanical force on surrounding tissue structures leading to midline shift and transtentorial @entity2850 and @entity204 . SUMMARY: Early severe @entity16 - @entity1269 , gaze deviation, higher cortical signs - followed by @entity10 , @entity391 , papillo @entity4 and @entity1662 may predict the deleterious course. Imaging supports the suspected diagnosis with hypodense changes on CT extending beyond 50% of the MCA territory. The size of the probably infarcted tissue and a midline shift on CT as well as the size of the lesion on diffusion-weighted MRI are predictive of a malignant course. Reduction of cerebral blood flow below a critical value and volume of irreversible tissue damage detected by positron emission tomography in the early hours after the @entity64 are indicative of progression to malignant @entity1188 with @entity428 ( @entity428 ) and decreased tissue @entity26 tension observed by multimodal neuromonitoring in the later course. Treatment options of malignant @entity1188 include general measures to limit the extent of space-occupying @entity4 , but these therapies have not been efficacious. Only surgical intervention with decompressive hemicraniectomy (DHC) was successful in relieving the effects of @entity428 and of the deleterious shifts of brain tissue. Several controlled clinical trials have proven the efficacy of DHC with a significant decrease in mortality and improved functional outcome. However, DHC must be performed early and with a large diameter, regardless of the age of @entity1 , but in @entity1 beyond 60 years, the higher likelihood of resulting severe disability should be taken into consideration. Key Messages: Malignant @entity2500 can be predicted early with a high sensitivity by neuroimaging. The early diagnosis is mandatory for DHC, which was shown to reduce mortality and improve functional outcome in several controlled clinical trials.

XXXX : Pathophysiology and Imaging for Early Diagnosis and Management Decisions.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity64 :: ('MESH:D020521', 'Disease') :: ['stroke'] @entity2657 :: ('MESH:D001929', 'Disease') :: ['vasogenic brain edema'] @entity63 :: ('MESH:D007511', 'Disease') :: ['ischemia', 'ischemic'] @entity1269 :: ('MESH:D010291', 'Disease') :: ['hemiparesis'] @entity4 :: ('MESH:D004487', 'Disease') :: ['brain swelling', 'edema'] @entity16 :: ('MESH:D009422', 'Disease') :: ['neurological symptoms'] @entity391 :: ('MESH:D014839', 'Disease') :: ['vomiting'] @entity428 :: ('MESH:D019586', 'Disease') :: ['ICP', 'increased intracranial pressure', 'increased ICP'] @entity26 :: ('MESH:D010100', 'Chemical') :: ['oxygen'] @entity2500 :: ('MESH:D020244', 'Disease') :: ['MCA infarction'] @entity2850 :: ('MESH:D009408', 'Disease') :: ['herniation and finally brain stem compression'] @entity1503 :: ('MESH:D006402', 'Disease') :: ['breakdown of the blood brain'] @entity1188 :: ('MESH:D007238', 'Disease') :: ['infarction', 'artery infarction'] @entity1662 :: ('MESH:D003244', 'Disease') :: ['reduced consciousness'] @entity10 :: ('MESH:D006261', 'Disease') :: ['headache'] @entity204 :: ('MESH:D003643', 'Disease') :: ['death']
@entity2500 :: (MESH:D020244,Disease) :: ['Malignant MCA Infarction']
