BACKGROUND: Large middle cerebral artery (MCA) @entity64 when associated with extensive mass effect can result in @entity75 and @entity16 . As yet there are few guidelines to aid the selection of @entity1 for aggressive interventional therapies, such as decompression hemicraniectomy and/or @entity2332 . METHODS: We studied a cohort of @entity1 from seven centres with @entity2500 requiring neurocritical care. The purpose of this analysis was to assess the use of early radiological signs on follow-up computed tomographic (CT) signs performed within 48 h of @entity64 onset for predicting mortality at 30 days. The CT parameters assessed included horizontal displacement of the septum pellucidum, pineal shift, complete or partial @entity1188 of the temporal lobe, involvement of additional vascular territories, and the presence of @entity1276 . The primary outcome measure was in-hospital @entity204 within 30 days. RESULTS: One hundred and thirty-five @entity1 who had follow-up CT scans within 48 h were identified from a total of 201 @entity1 with @entity2500 that received conventional medical therapy alone. The median age was 68 (range 29-99), 56% were female, and the median NIHSS category was 26-30 at 48 h. Among CT variables in univariable analysis, anteroseptal shift >/=5 mm, pineal shift >/=2 mm, complete temporal lobe @entity1188 , involvement beyond the MCA territory, and moderate or severe @entity1276 were equally predictive of @entity204 . Multivariable analysis adjusting for time to CT scan revealed the following predictors of @entity3329 : anteroseptal shift >/=5 mm (OR 10.9; 95% CI 3.2-37.6), NIHSS within 48 h >20 (OR 6.6; 95% CI 2.3-19.3), and @entity1188 beyond the MCA territory (OR 4.9; 95% CI 1.6-15.0). CONCLUSIONS: We identified the role of early CT signs in predicting @entity204 following massive @entity2500 . The CT parameters anteroseptal shift (>5 versus </=5 mm), pineal shift >/=2 mm, @entity1276 , temporal lobe @entity1188 , and other vascular territory @entity1188 if present were predictive of @entity3329 . These CT parameters require prospective validation before they should be considered reliable markers for decision-making.

Computed tomographic parameters predicting @entity3329 in large XXXX .

@entity1 :: ('9606', 'Species') :: ['patients'] @entity3329 :: ('MESH:D008206', 'Disease') :: ['fatal outcome'] @entity64 :: ('MESH:D020521', 'Disease') :: ['ischaemic stroke', 'stroke'] @entity1276 :: ('MESH:D006849', 'Disease') :: ['hydrocephalus'] @entity75 :: ('MESH:D001927', 'Disease') :: ['brain herniation'] @entity2500 :: ('MESH:D020244', 'Disease') :: ['MCA infarction', 'large MCA infarction'] @entity16 :: ('MESH:D009422', 'Disease') :: ['neurological death'] @entity1188 :: ('MESH:D007238', 'Disease') :: ['infarction'] @entity204 :: ('MESH:D003643', 'Disease') :: ['death'] @entity2332 :: ('MESH:D007035', 'Disease') :: ['hypothermia']
@entity2500 :: (MESH:D020244,Disease) :: ['middle cerebral artery infarction']
