Intensive Care Medicine

, 24:620

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


  • J. Berrouschot
    • Department of NeurologyUniversity of Leipzig
  • M. Sterker
    • Department of NeurologyUniversity of Leipzig
  • S. Bettin
    • Department of Nuclear MedicineUniversity of Leipzig
  • J. Köster
    • Department of NeurologyUniversity of Leipzig
  • D. Schneider
    • Department of NeurologyUniversity of Leipzig
Brief Report

DOI: 10.1007/s001340050625

Cite this article as:
Berrouschot, J., Sterker, M., Bettin, S. et al. Intensive Care Med (1998) 24: 620. doi:10.1007/s001340050625


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 ± 1 points. The deceased patients had a significantly higher body temperature on admission than the surviving patients (36.8 °C vs 36.3 °C).

Conclusions: The mortality of patients with ‘malignant’ MCA infarction is very high despite maximum conservative intensive care.

Key words

Space-occupying middle cerebral artery infarctionStroke mortalityStroke prognosisIntensive care of strokeBrain edema

Copyright information

© Springer-Verlag 1998