Mortality of space-occupying ('malignant') middle cerebral artery infarction under conservative intensive care

Objective: To find what the mortality rate of space-occupying ('malignant') middle cerebral artery (MCA) infarction is under maximum conservative intensive care. To establish whether any early indicators of survival exist. Design: Prospective descriptive study. Setting: Neuro-critical care unit of a university hospital. Patients: Fifty-three patients (mean age 64 +/- 10 years) with 'malignant' MCA infarction. Interventions: Maximum conservative intensive care using a standardized protocol (heparin, osmotherapy tromethamol, mild hyperventilation). The start of therapy was within 12 h after the onset of symptoms. Measurements and results: The Glasgow Coma Scale (GCS) and Scandinavian Stroke Scale (SSS) were recorded daily A computed tomography (CT) scan was performed on admission, on day 3 and on day 7. SSS, Barthel Index and Rankin Scale of the surviving patients were recorded after 3 months. On admission, the mean GCS was 13 +/- 3 points and mean SSS 18 +/- 7 points. All patients had to undergo mechanical ventilation (23 +/- 26 h after the onset of symptoms) and were comatose after 28 +/- 30 h. Of 53 patients, 37 (70 %) suffered brain death in the intensive care unit (ICU) after an average of 90 +/- 59 h. After 3 months 42/53 (79 %) patients had died. The Barthel Index of the surviving patients was 54 +/- 12 points, the SSS 25 +/- 9 points and the Rankin Scale 3 Fl points. The deceased patients had a significantly higher body temperature on admission than the surviving patients (36.5 degrees C vs 36.3 degrees C). Conclusions: The mortality of patients with 'malignant' MCA infarction is very high despite maximum conservative intensive care.