, Volume 59, Issue 5, pp 477–484 | Cite as

Radiological imaging features of the basal ganglia that may predict progression to hemicraniectomy in large territory middle cerebral artery infarct

  • Asim Z. MianEmail author
  • David Edasery
  • Osamu Sakai
  • M. Mustafa Qureshi
  • James Holsapple
  • Thanh Nguyen
Diagnostic Neuroradiology



Predicting which patients are at risk for hemicraniectomy can be helpful for triage and can help preserve neurologic function if detected early. We evaluated basal ganglia imaging predictors for early hemicraniectomy in patients with large territory anterior circulation infarct.


This retrospective study evaluated patients with ischemic infarct admitted from January 2005 to July 2011. Patients with malignant cerebral edema refractory to medical therapy or with herniating signs such as depressed level of consciousness, anisocoria, and contralateral leg weakness were triaged to hemicraniectomy. Admission images were reviewed for presence of caudate, lentiform nucleus (putamen and globus pallidus), or basal ganglia (caudate + lentiform nucleus) infarction.


Thirty-one patients with large territory MCA infarct, 10 (32%), underwent hemicraniectomy. Infarction of the caudate nucleus (9/10 vs 6/21, p = 0.002) or basal ganglia (5/10 vs 2/21, p = 0.02) predicted progression to hemicraniectomy. Infarction of the lentiform nucleus only did not predict progression to hemicraniectomy. Sensitivity for patients who did and did not have hemicraniectomy were 50% (5/10) and 90.5% (19/21). For caudate nucleus and caudate plus lentiform nucleus infarcts, the crude- and age-adjusted odds of progression to hemicraniectomy were 9.5 (1.4–64.3) and 6.6 (0.78–55.4), respectively.


Infarction of the caudate nucleus or basal ganglia correlated with patients progressing to hemicraniectomy. Infarction of the lentiform nucleus alone did not.


Stroke Basal ganglia Hemicraniectomy CT MRI 


Compliance with ethical standards


No funding was received for this study.

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

Statement of informed consent was not applicable since the manuscript does not contain any patient data.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Asim Z. Mian
    • 1
    Email author
  • David Edasery
    • 1
  • Osamu Sakai
    • 1
  • M. Mustafa Qureshi
    • 1
  • James Holsapple
    • 2
  • Thanh Nguyen
    • 3
  1. 1.Department of Radiology, Boston Medical CenterBoston University School of MedicineBostonUSA
  2. 2.Department of Neurosurgery, Boston Medical CenterBoston University School of MedicineBostonUSA
  3. 3.Department of Neurology, Boston Medical CenterBoston University School of MedicineBostonUSA

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