Current Treatment Options in Neurology

, Volume 13, Issue 2, pp 217–229 | Cite as

Managing Malignant Cerebral Infarction

  • J. Marc Simard
  • Juan Sahuquillo
  • Kevin N. Sheth
  • Kristopher T. Kahle
  • Brian P. Walcott
Critical Care Neurology

Opinion statement

Managing patients with malignant cerebral infarction remains one of the foremost challenges in medicine. These patients are at high risk for progressive neurologic deterioration and death due to malignant cerebral edema, and they are best cared for in the intensive care unit of a comprehensive stroke center. Careful initial assessment of neurologic function and of findings on MRI, coupled with frequent reassessment of clinical and radiologic findings using CT or MRI are mandatory to promote the prompt initiation of treatments that will ensure the best outcome in these patients. Significant deterioration in either neurologic function or radiologic findings or both demand timely treatment using the best medical management, which may include osmotherapy (mannitol or hypertonic saline), endotracheal intubation, and mechanical ventilation. Under appropriate circumstances, decompressive craniectomy may be warranted to improve outcome or to prevent death.


Hypertonic Saline Decompressive Craniectomy Hemorrhagic Transformation Midline Shift Malignant Evolution 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No potential conflicts of interest relevant to this article were reported.

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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • J. Marc Simard
    • 1
  • Juan Sahuquillo
    • 2
  • Kevin N. Sheth
    • 3
  • Kristopher T. Kahle
    • 4
  • Brian P. Walcott
    • 4
  1. 1.Department of NeurosurgeryUniversity of Maryland School of MedicineBaltimoreUSA
  2. 2.Department of Neurosurgery, Hospital Universitario Vall d’HebronUniversitat Autònoma de BarcelonaBarcelonaSpain
  3. 3.Department of NeurologyUniversity of Maryland School of MedicineBaltimoreUSA
  4. 4.Department of NeurosurgeryMassachusetts General Hospital, Harvard Medical SchoolBostonUSA

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