Management of malignant cerebral infarction

ABSTRACT

Malignant cerebral infarction had a fatal outcome in the majority of cases. The associated brain edema with subsequent rise of intracranial pressure [ICP] and transtentorial herniation is the most leading cause of death in those patients. So we used mechanical hyperventilation to verify its effect in management of those patients by its effect in lowering the ICP. Prospective descriptive study was done in Intensive care unit of Mansoura Emergency Hospital, 20 patients with malignant cerebral infarction were subjected to the maximum conservative measures without controlled hyperventilation, were compared to the same number of patients under the same measures but with controlled hyperventilation for 24 hours [maintain PaCO[2] 28-32 mmHg]. We found that no one with GCS < 9 survived without hyperventilation, while 4 [66.7%] of the survivors of hyperventilated group were semi-comatosed with GCS < 9. None of the unventilated patients who showed deterioration of their initial consciousness survived, while 3 [17.6%] of deteriorated patients in hyperventilated group survived. None of patients with pan-hemispheric infarction and/or with mid-line shift and compression on perimesencephalic cistern survived without hyperventilation, while 2 [25%] of patients with hemispheric infarction and also 3 [23%] of patients with mid-line shift and compression on perimesencephalic cistern survived in hyperventilated group