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Evidence-Based Guidelines for the Management of Large Hemispheric Infarction

A Statement for Health Care Professionals from the Neurocritical Care Society and the German Society for Neuro-Intensive Care and Emergency Medicine

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Abstract

Large hemispheric infarction (LHI), also known as malignant middle cerebral infarction, is a devastating disease associated with significant disability and mortality. Clinicians and family members are often faced with a paucity of high quality clinical data as they attempt to determine the most appropriate course of treatment for patients with LHI, and current stroke guidelines do not provide a detailed approach regarding the day-to-day management of these complicated patients. To address this need, the Neurocritical Care Society organized an international multidisciplinary consensus conference on the critical care management of LHI. Experts from neurocritical care, neurosurgery, neurology, interventional neuroradiology, and neuroanesthesiology from Europe and North America were recruited based on their publications and expertise. The panel devised a series of clinical questions related to LHI, and assessed the quality of data related to these questions using the Grading of Recommendation Assessment, Development and Evaluation guideline system. They then developed recommendations (denoted as strong or weak) based on the quality of the evidence, as well as the balance of benefits and harms of the studied interventions, the values and preferences of patients, and resource considerations.

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Acknowledgments

We would like to thank Mathias Luedcke for his help with literature search and the neurocritical care society administrative staff for their administrative support.

Conflict of interest

Michel T Torbey has received speaker honorarium from Genentech, support from NIH. Julian Bösel has received speaker honoraria and travel support from Covidien, Sedana Medical, and Orion Pharma. Denise H. Rhoney declares that she has no conflict of interest. Fred Rincon declares that he has research and salary Support from the American Heart Association (12CRP12050342). He has also received consultant fees from Bard Medical Inc. Dimitre Staykov declares that he has no conflict of interest. Arun Amar declares that he has no conflict of interest. Panayiotis Varelas have participated in Advisory Boards of Pfizer and UCB. Eric Jüttler has received a speaker´s honorarium from BMS/Pfizer, a consultant´s honorarium from Boehringer Ingelheim, and a research grant from the German Research Foundation (Deutsche Forschungsgemeinschaft). DaiWai Wilson declares that he has no conflict of interest. Hagen B. Huttner declares that he has no conflict of interest. Klaus Zweckberger declares that he has no conflict of interest. Kevin N Sheth declares that he received research support from Remedy Pharmaceuticals, Inc for GAMES-RP. Christian Dohmen declares that he has no conflict of interest. Ansgar M Brambrink is Co-PI on an investigator-initiated multicenter trial that is funded by Karl Storz America, Culver City, CA. He also receives research funds from the International Anesthesia Research Society (PI; laboratory experiments), the National Institutes of Health (Site PI; laboratory experiments). Stephan Mayer declares that he has no conflict of interest. Osama O. Zaidat declares that he is on advisory board/consultant/speaker: Stryker, Covidien, and Penumbra, Co-Investigator for Therapy Ischemic Stroke Trial. Werner Hacke declares that he has no conflict of interest. Stefan Schwab declares that he has no conflict of interest.

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Authors and Affiliations

  1. Cerebrovascular and Neurocritical Care Division, Department of Neurology and Neurosurgery, The Ohio State University Wexner Medical Center Comprehensive Stroke Center, 395 W. 12th Avenue, 7th Floor, Columbus, OH, 43210, USA

    Michel T. Torbey

  2. Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Julian Bösel

  3. Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, 115 Beard Hall, Campus Box 7574, Chapel Hill, NC, 27599-7574, USA

    Denise H. Rhoney

  4. Division of Critical Care and Neurotrauma, Department of Neurological Surgery, Thomas Jefferson University, 909 Walnut Street, 3rd Floor, Philadelphia, PA, 19107, USA

    Fred Rincon

  5. Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany

    Dimitre Staykov

  6. Department of Neurosurgery, University of Southern California, 1200 North State Street Suite 3300, Los Angeles, CA, 90033, USA

    Arun P. Amar

  7. Neurocritical Care Division, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI, 48202, USA

    Panayiotis N. Varelas

  8. University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390-8897, USA

    DaiWai Olson

  9. Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany

    Hagen B. Huttner

  10. Department of Neurosurgery, University of Heidelberg, INF 400, 69120, Heidelberg, Germany

    Klaus Zweckberger

  11. Division of Neurocritical Care and Emergency Neurology, Department of Neurology, and Neurosciences Intensive Care Unit, Yale School of Medicine & Yale New Haven Hospital, 15 York Street, LLCI 7th floor, Room 710A, P.O. Box 208018, New Haven, CT, 06520, USA

    Kevin N. Sheth

  12. Department of Neurology, University of Cologne, 50937, Cologne, Germany

    Christian Dohmen

  13. Department of Anesthesiology and Perioperative Medicine, Neurology and Neurological Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Parkway, Portland, OR, 97239, USA

    Ansgar M. Brambrink

  14. Institute for Critical Care Medicine, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1522, New York, NY, 10029-6574, USA

    Stephan A. Mayer

  15. Neurointerventional Program, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA

    Osama O. Zaidat

  16. Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Werner Hacke

  17. Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany

    Stefan Schwab

  18. Department of Neurology, Ostalb-Klinikum Aalen, Im Kalblesrain 1, 73430, Aalen, Germany

    Eric Jüttler

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  1. Michel T. Torbey
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  18. Stefan Schwab
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Correspondence to Michel T. Torbey.

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Torbey, M.T., Bösel, J., Rhoney, D.H. et al. Evidence-Based Guidelines for the Management of Large Hemispheric Infarction. Neurocrit Care 22, 146–164 (2015). https://doi.org/10.1007/s12028-014-0085-6

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