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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

Neurocritical Care volume 22, pages 146–164 (2015)Cite this article

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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References

  1. Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R. ‘Malignant’ middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol. 1996;53(4):309–15.

    CAS  PubMed  Google Scholar 

  2. Morgenstern LB, Hemphill JC 3rd, Anderson C, Becker K, Broderick JP, Connolly ES Jr, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2010;41(9):2108–29.

    PubMed  Google Scholar 

  3. Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870–947.

    PubMed  Google Scholar 

  4. Wijdicks EF, Sheth KN, Carter BS, Greer DM, Kasner SE, Kimberly WT, et al. Recommendations for the management of cerebral and cerebellar infarction with swelling: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(4):1222–38.

    PubMed  Google Scholar 

  5. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. Grading quality of evidence and strength of recommendations. BMJ. 2004;328(7454):1490.

    PubMed  Google Scholar 

  6. Brozek JL, Akl EA, Alonso-Coello P, Lang D, Jaeschke R, Williams JW, et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines. Part 1 of 3. An overview of the GRADE approach and grading quality of evidence about interventions. Allergy. 2009;64(5):669–77.

    CAS  PubMed  Google Scholar 

  7. Steiner T, Mendoza G, De Georgia M, Schellinger P, Holle R, Hacke W. Prognosis of stroke patients requiring mechanical ventilation in a neurological critical care unit. Stroke. 1997;28(4):711–5.

    CAS  PubMed  Google Scholar 

  8. Berrouschot J, Rossler A, Koster J, Schneider D. Mechanical ventilation in patients with hemispheric ischemic stroke. Crit Care Med. 2000;28(8):2956–61.

    CAS  PubMed  Google Scholar 

  9. Burtin P, Bollaert PE, Feldmann L, Nace L, Lelarge P, Bauer P, et al. Prognosis of stroke patients undergoing mechanical ventilation. Intensive Care Med. 1994;20(1):32–6.

    CAS  PubMed  Google Scholar 

  10. el-Ad B, Bornstein NM, Fuchs P, Korczyn AD. Mechanical ventilation in stroke patients: is it worthwhile? Neurology. 1996;47(3):657–9.

    CAS  PubMed  Google Scholar 

  11. Wijdicks EF, Scott JP. Causes and outcome of mechanical ventilation in patients with hemispheric ischemic stroke. Mayo Clin Proc. 1997;72(3):210–3.

    CAS  PubMed  Google Scholar 

  12. Mayer SA, Copeland D, Bernardini GL, Boden-Albala B, Lennihan L, Kossoff S, et al. Cost and outcome of mechanical ventilation for life-threatening stroke. Stroke. 2000;31(10):2346–53.

    CAS  PubMed  Google Scholar 

  13. Santoli F, De Jonghe B, Hayon J, Tran B, Piperaud M, Merrer J, et al. Mechanical ventilation in patients with acute ischemic stroke: survival and outcome at one year. Intensive Care Med. 2001;27(7):1141–6.

    CAS  PubMed  Google Scholar 

  14. Milhaud D, Popp J, Thouvenot E, Heroum C, Bonafe A. Mechanical ventilation in ischemic stroke. J Stroke Cerebrovasc Dis. 2004;13(4):183–8.

    PubMed  Google Scholar 

  15. Esteban A, Alia I, Gordo F, Fernandez R, Solsona JF, Vallverdu I, et al. Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. The Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med. 1997;156(2 Pt 1):459–65.

    CAS  PubMed  Google Scholar 

  16. Ko R, Ramos L, Chalela JA. Conventional weaning parameters do not predict extubation failure in neurocritical care patients. Neurocrit Care. 2009;10(3):269–73.

    PubMed  Google Scholar 

  17. Coplin WM, Pierson DJ, Cooley KD, Newell DW, Rubenfeld GD. Implications of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med. 2000;161(5):1530–6.

    CAS  PubMed  Google Scholar 

  18. Wendell LC, Raser J, Kasner S, Park S. Predictors of extubation success in patients with middle cerebral artery acute ischemic stroke. Stroke Res Treat. 2011;2011:248789.

    PubMed Central  PubMed  Google Scholar 

  19. Rabinstein AA, Wijdicks EF. Outcome of survivors of acute stroke who require prolonged ventilatory assistance and tracheostomy. Cerebrovasc Dis. 2004;18(4):325–31.

    PubMed  Google Scholar 

  20. Bosel J, Schiller P, Hook Y, Andes M, Neumann JO, Poli S, et al. Stroke-related early tracheostomy versus prolonged orotracheal intubation in neurocritical care trial (SETPOINT): A Randomized Pilot Trial. Stroke. 2012.

  21. Huttner HB, Kohrmann M, Berger C, Georgiadis D, Schwab S. Predictive factors for tracheostomy in neurocritical care patients with spontaneous supratentorial hemorrhage. Cerebrovasc Dis. 2006;21(3):159–65.

    PubMed  Google Scholar 

  22. Szeder V, Ortega-Gutierrez S, Ziai W, Torbey MT. The TRACH score: clinical and radiological predictors of tracheostomy in supratentorial spontaneous intracerebral hemorrhage. Neurocrit Care. 2010;13(1):40–6.

    PubMed  Google Scholar 

  23. Yundt KD, Diringer MN. The use of hyperventilation and its impact on cerebral ischemia in the treatment of traumatic brain injury. Crit Care Clin. 1997;13(1):163–84.

    CAS  PubMed  Google Scholar 

  24. Stringer WA, Hasso AN, Thompson JR, Hinshaw DB, Jordan KG. Hyperventilation-induced cerebral ischemia in patients with acute brain lesions: demonstration by xenon-enhanced CT. Am J Neuroradiol. 1993;14(2):475–84.

    CAS  PubMed  Google Scholar 

  25. Marion DW, Puccio A, Wisniewski SR, Kochanek P, Dixon CE, Bullian L, et al. Effect of hyperventilation on extracellular concentrations of glutamate, lactate, pyruvate, and local cerebral blood flow in patients with severe traumatic brain injury. Crit Care Med. 2002;30(12):2619–25.

    CAS  PubMed  Google Scholar 

  26. Nariai T, Senda M, Ishii K, Wakabayashi S, Yokota T, Toyama H, et al. Posthyperventilatory steal response in chronic cerebral hemodynamic stress: a positron emission tomography study. Stroke. 1998;29(7):1281–92.

    CAS  PubMed  Google Scholar 

  27. Muizelaar JP, Marmarou A, Ward JD, Kontos HA, Choi SC, Becker DP, et al. Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomized clinical trial. J Neurosurg. 1991;75(5):731–9.

    CAS  PubMed  Google Scholar 

  28. Simard D, Paulson OB. Artifical hyperventilation in stroke. Trans Am Neurol Assoc. 1973;98:309–10.

    CAS  PubMed  Google Scholar 

  29. Christensen MS, Paulson OB, Olesen J, Alexander SC, Skinhoj E, Dam WH, et al. Cerebral apoplexy (stroke) treated with or without prolonged artificial hyperventilation. 1. Cerebral circulation, clinical course, and cause of death. Stroke. 1973;4(4):568–631.

    CAS  PubMed  Google Scholar 

  30. Teitelbaum JS, Ayoub O, Skrobik Y. A critical appraisal of sedation, analgesia and delirium in neurocritical care. Can J Neurol Sci. 2011;38(6):815–25.

    PubMed  Google Scholar 

  31. Egerod I, Jensen MB, Herling SF, Welling KL. Effect of an analgo-sedation protocol for neurointensive patients: a two-phase interventional non-randomized pilot study. Crit Care. 2010;14(2):R71.

    PubMed Central  PubMed  Google Scholar 

  32. Karabinis A, Mandragos K, Stergiopoulos S, Komnos A, Soukup J, Speelberg B, et al. Safety and efficacy of analgesia-based sedation with remifentanil versus standard hypnotic-based regimens in intensive care unit patients with brain injuries: a randomised, controlled trial (ISRCTN50308308). Crit Care. 2004;8(4):R268–80.

    PubMed Central  PubMed  Google Scholar 

  33. Olson DM, Thoyre SM, Auyong DB. Perspectives on sedation assessment in critical care. AACN Adv Crit Care. 2007;18(4):380–95.

    PubMed  Google Scholar 

  34. Olson DM, Thoyre SM, Peterson ED, Graffagnino C. A randomized evaluation of bispectral index-augmented sedation assessment in neurological patients. Neurocrit Care. 2009;11(1):20–7.

    PubMed Central  PubMed  Google Scholar 

  35. Kress JP, Pohlman AS, O’Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000;342(20):1471–7.

    CAS  PubMed  Google Scholar 

  36. Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD, Pun BT, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (awakening and breathing controlled trial): a randomised controlled trial. Lancet. 2008;371(9607):126–34.

    PubMed  Google Scholar 

  37. Hooper MH, Girard TD. Sedation and weaning from mechanical ventilation: linking spontaneous awakening trials and spontaneous breathing trials to improve patient outcomes. Crit Care Clin. 2009;25(3):515–25 viii.

    PubMed  Google Scholar 

  38. Mehta S, Burry L, Cook D, Fergusson D, Steinberg M, Granton J, et al. Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial. JAMA. 2012;308(19):1985–92.

    CAS  PubMed  Google Scholar 

  39. Skoglund K, Enblad P, Marklund N. Effects of the neurological wake-up test on intracranial pressure and cerebral perfusion pressure in brain-injured patients. Neurocrit Care. 2009;11(2):135–42.

    PubMed  Google Scholar 

  40. Skoglund K, Enblad P, Hillered L, Marklund N. The neurological wake-up test increases stress hormone levels in patients with severe traumatic brain injury. Crit Care Med. 2012;40(1):216–22.

    CAS  PubMed  Google Scholar 

  41. Yeh SJ, Huang KY, Wang TG, Chen YC, Chen CH, Tang SC, et al. Dysphagia screening decreases pneumonia in acute stroke patients admitted to the stroke intensive care unit. J Neurol Sci. 2011;306(1–2):38–41.

    PubMed  Google Scholar 

  42. Trapl M, Enderle P, Nowotny M, Teuschl Y, Matz K, Dachenhausen A, et al. Dysphagia bedside screening for acute-stroke patients: the gugging swallowing screen. Stroke. 2007;38(11):2948–52.

    PubMed  Google Scholar 

  43. Warnecke T, Teismann I, Meimann W, Olenberg S, Zimmermann J, Kramer C, et al. Assessment of aspiration risk in acute ischaemic stroke: evaluation of the simple swallowing provocation test. J Neurol Neurosurg Psychiatry. 2008;79(3):312–4.

    CAS  PubMed  Google Scholar 

  44. Dziewas R, Warnecke T, Olenberg S, Teismann I, Zimmermann J, Kramer C, et al. Towards a basic endoscopic assessment of swallowing in acute stroke: development and evaluation of a simple dysphagia score. Cerebrovasc Dis. 2008;26(1):41–7.

    PubMed  Google Scholar 

  45. Warnecke T, Teismann I, Oelenberg S, Hamacher C, Ringelstein EB, Schabitz WR, et al. The safety of fiberoptic endoscopic evaluation of swallowing in acute stroke patients. Stroke. 2009;40(2):482–6.

    PubMed  Google Scholar 

  46. Dennis MS, Lewis SC, Warlow C. Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial. Lancet. 2005;365(9461):764–72.

    CAS  PubMed  Google Scholar 

  47. Davalos A, Ricart W, Gonzalez-Huix F, Soler S, Marrugat J, Molins A, et al. Effect of malnutrition after acute stroke on clinical outcome. Stroke. 1996;27(6):1028–32.

    CAS  PubMed  Google Scholar 

  48. Panos MZ, Reilly H, Moran A, Reilly T, Wallis PJ, Wears R, et al. Percutaneous endoscopic gastrostomy in a general hospital: prospective evaluation of indications, outcome, and randomised comparison of two tube designs. Gut. 1994;35(11):1551–6.

    CAS  PubMed Central  PubMed  Google Scholar 

  49. Kumar S, Langmore S, Goddeau RP Jr, Alhazzani A, Selim M, Caplan LR, et al. Predictors of percutaneous endoscopic gastrostomy tube placement in patients with severe dysphagia from an acute-subacute hemispheric infarction. J Stroke Cerebrovasc Dis. 2012;21(2):114–20.

    PubMed Central  PubMed  Google Scholar 

  50. Alshekhlee A, Ranawat N, Syed TU, Conway D, Ahmad SA, Zaidat OO. National Institutes of Health stroke scale assists in predicting the need for percutaneous endoscopic gastrostomy tube placement in acute ischemic stroke. J Stroke Cerebrovasc Dis. 2010;19(5):347–52.

    PubMed  Google Scholar 

  51. Graffagnino C, Gurram AR, Kolls B, Olson DM. Intensive insulin therapy in the neurocritical care setting is associated with poor clinical outcomes. Neurocrit Care. 2010;13(3):307–12.

    CAS  PubMed  Google Scholar 

  52. Kramer AH, Roberts DJ, Zygun DA. Optimal glycemic control in neurocritical care patients: a systematic review and meta-analysis. Crit Care. 2012;16(5):R203.

    PubMed Central  PubMed  Google Scholar 

  53. Tanne D, Molshatzki N, Merzeliak O, Tsabari R, Toashi M, Schwammenthal Y. Anemia status, hemoglobin concentration and outcome after acute stroke: a cohort study. BMC Neurol. 2010;10:22.

    PubMed Central  PubMed  Google Scholar 

  54. Kellert L, Martin E, Sykora M, Bauer H, Gussmann P, Diedler J, et al. Cerebral oxygen transport failure?: decreasing hemoglobin and hematocrit levels after ischemic stroke predict poor outcome and mortality: STroke: RelevAnt Impact of hemoGlobin, Hematocrit and Transfusion (STRAIGHT)—an observational study. Stroke. 2011;42(10):2832–7.

    CAS  PubMed  Google Scholar 

  55. Zygun DA, Nortje J, Hutchinson PJ, Timofeev I, Menon DK, Gupta AK. The effect of red blood cell transfusion on cerebral oxygenation and metabolism after severe traumatic brain injury. Crit Care Med. 2009;37(3):1074–8.

    CAS  PubMed  Google Scholar 

  56. Smith MJ, Stiefel MF, Magge S, Frangos S, Bloom S, Gracias V, et al. Packed red blood cell transfusion increases local cerebral oxygenation. Crit Care Med. 2005;33(5):1104–8.

    PubMed  Google Scholar 

  57. Desjardins P, Turgeon AF, Tremblay MH, Lauzier F, Zarychanski R, Boutin A, et al. Hemoglobin levels and transfusions in neurocritically ill patients: a systematic review of comparative studies. Crit Care. 2012;16(2):R54.

    PubMed Central  PubMed  Google Scholar 

  58. Douds GL, Hellkamp AS, Olson DM, Fonarow GC, Smith EE, Schwamm LH, et al. Venous thromboembolism in the get with the guidelines-stroke acute ischemic stroke population: incidence and patterns of prophylaxis. J Stroke Cerebrovasc Dis. 2012.

  59. Dennis M, Mordi N, Graham C, Sandercock P. The timing, extent, progression and regression of deep vein thrombosis in immobile stroke patients: observational data from the CLOTS multicenter randomized trials. J Thromb Haemost. 2011;9(11):2193–200.

    CAS  PubMed  Google Scholar 

  60. Dennis M, Sandercock PA, Reid J, Graham C, Murray G, Venables G, et al. Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial. Lancet. 2009;373(9679):1958–65.

    PubMed  Google Scholar 

  61. CLOTS. Thigh-length versus below-knee stockings for deep venous thrombosis prophylaxis after stroke: a randomized trial. Ann Intern Med. 2010;153(9):553–62.

  62. Collaboration CT, Dennis M, Sandercock P, Reid J, Graham C, Forbes J, et al. Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomised controlled trial. Lancet. 2013;382(9891):516–24.

    Google Scholar 

  63. Sandercock PA, van den Belt AG, Lindley RI, Slattery J. Antithrombotic therapy in acute ischaemic stroke: an overview of the completed randomised trials. J Neurol Neurosurg Psychiatry. 1993;56(1):17–25.

    CAS  PubMed Central  PubMed  Google Scholar 

  64. Hillbom M, Erila T, Sotaniemi K, Tatlisumak T, Sarna S, Kaste M. Enoxaparin vs heparin for prevention of deep-vein thrombosis in acute ischaemic stroke: a randomized, double-blind study. Acta Neurol Scand. 2002;106(2):84–92.

    CAS  PubMed  Google Scholar 

  65. Diener HC, Ringelstein EB, von Kummer R, Landgraf H, Koppenhagen K, Harenberg J, et al. Prophylaxis of thrombotic and embolic events in acute ischemic stroke with the low-molecular-weight heparin certoparin: results of the PROTECT Trial. Stroke. 2006;37(1):139–44.

    CAS  PubMed  Google Scholar 

  66. Sandercock PA, Counsell C, Tseng MC. Low-molecular-weight heparins or heparinoids versus standard unfractionated heparin for acute ischaemic stroke. Cochrane Database Syst Rev. 2008(3):CD000119.

  67. Boeer A, Voth E, Henze T, Prange HW. Early heparin therapy in patients with spontaneous intracerebral haemorrhage. J Neurol Neurosurg Psychiatry. 1991;54(5):466–7.

    CAS  PubMed Central  PubMed  Google Scholar 

  68. Berge E, Abdelnoor M, Nakstad PH, Sandset PM. Low molecular-weight heparin versus aspirin in patients with acute ischaemic stroke and atrial fibrillation: a double-blind randomised study. HAEST Study Group. Heparin in Acute Embolic Stroke Trial. Lancet. 2000;355(9211):1205–10.

    CAS  PubMed  Google Scholar 

  69. Guidelines for management of ischaemic stroke and transient ischaemic attack. 2008. Cerebrovasc Dis. 2008;25(5):457–507.

  70. Adams HP Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007;38(5):1655–711.

    PubMed  Google Scholar 

  71. Phan TG, Koh M, Wijdicks EF. Safety of discontinuation of anticoagulation in patients with intracranial hemorrhage at high thromboembolic risk. Arch Neurol. 2000;57(12):1710–3.

    CAS  PubMed  Google Scholar 

  72. Ananthasubramaniam K, Beattie JN, Rosman HS, Jayam V, Borzak S. How safely and for how long can warfarin therapy be withheld in prosthetic heart valve patients hospitalized with a major hemorrhage? Chest. 2001;119(2):478–84.

    CAS  PubMed  Google Scholar 

  73. Segal JB, McNamara RL, Miller MR, Kim N, Goodman SN, Powe NR, et al. Prevention of thromboembolism in atrial fibrillation. A meta-analysis of trials of anticoagulants and antiplatelet drugs. J Gen Intern Med. 2000;15(1):56–67.

    CAS  PubMed Central  PubMed  Google Scholar 

  74. Stead LG, Gilmore RM, Vedula KC, Weaver AL, Decker WW, Brown RD Jr. Impact of acute blood pressure variability on ischemic stroke outcome. Neurology. 2006;66(12):1878–81.

    CAS  PubMed  Google Scholar 

  75. Delgado-Mederos R, Ribo M, Rovira A, Rubiera M, Munuera J, Santamarina E, et al. Prognostic significance of blood pressure variability after thrombolysis in acute stroke. Neurology. 2008;71(8):552–8.

    CAS  PubMed  Google Scholar 

  76. Sandercock PA, Soane T. Corticosteroids for acute ischaemic stroke. Cochrane Database Syst Rev. 2011(9):CD000064.

  77. Norris JW, Hachinski VC. High dose steroid treatment in cerebral infarction. Brit Med J. 1986;292(6512):21–3.

    CAS  Google Scholar 

  78. Schwab S, Spranger M, Schwarz S, Hacke W. Barbiturate coma in severe hemispheric stroke: useful or obsolete? Neurology. 1997;48(6):1608–13.

    CAS  PubMed  Google Scholar 

  79. De Georgia MA, Krieger DW, Abou-Chebl A, Devlin TG, Jauss M, Davis SM, et al. Cooling for acute ischemic brain damage (COOL AID): a feasibility trial of endovascular cooling. Neurology. 2004;63(2):312–7.

    PubMed  Google Scholar 

  80. Georgiadis D, Schwarz S, Kollmar R, Schwab S. Endovascular cooling for moderate hypothermia in patients with acute stroke: first results of a novel approach. Stroke. 2001;32(11):2550–3.

    CAS  PubMed  Google Scholar 

  81. Su J, Qiu YM, Chen ZH, Tang YY, Chen Y. Clinical analysis of massive hemispheric infarction treated with moderate hypothermia. Chin J Traumatol. 2003;6(5):318–20.

    PubMed  Google Scholar 

  82. Krieger DW, De Georgia MA, Abou-Chebl A, Andrefsky JC, Sila CA, Katzan IL, et al. Cooling for acute ischemic brain damage (cool aid): an open pilot study of induced hypothermia in acute ischemic stroke. Stroke. 2001;32(8):1847–54.

    CAS  PubMed  Google Scholar 

  83. Els T, Oehm E, Voigt S, Klisch J, Hetzel A, Kassubek J. Safety and therapeutical benefit of hemicraniectomy combined with mild hypothermia in comparison with hemicraniectomy alone in patients with malignant ischemic stroke. Cerebrovasc Dis. 2006;21(1–2):79–85.

    PubMed  Google Scholar 

  84. Milhaud D, Thouvenot E, Heroum C, Escuret E. Prolonged moderate hypothermia in massive hemispheric infarction: clinical experience. J Neurosurg Anesthesiol. 2005;17(1):49–53.

    PubMed  Google Scholar 

  85. Schwab S, Schwarz S, Aschoff A, Keller E, Hacke W. Moderate hypothermia and brain temperature in patients with severe middle cerebral artery infarction. Acta Neurochir Suppl. 1998;71:131–4.

    CAS  PubMed  Google Scholar 

  86. Steiner T, Friede T, Aschoff A, Schellinger PD, Schwab S, Hacke W. Effect and feasibility of controlled rewarming after moderate hypothermia in stroke patients with malignant infarction of the middle cerebral artery. Stroke. 2001;32(12):2833–5.

    CAS  PubMed  Google Scholar 

  87. Keller E, Steiner T, Fandino J, Schwab S, Hacke W. Changes in cerebral blood flow and oxygen metabolism during moderate hypothermia in patients with severe middle cerebral artery infarction. Neurosurg Focus. 2000;8(5):e4.

    CAS  PubMed  Google Scholar 

  88. Georgiadis D, Schwarz S, Aschoff A, Schwab S. Hemicraniectomy and moderate hypothermia in patients with severe ischemic stroke. Stroke. 2002;33(6):1584–8.

    CAS  PubMed  Google Scholar 

  89. Rosner MJ, Coley IB. Cerebral perfusion pressure, intracranial pressure, and head elevation. J Neurosurg. 1986;65(5):636–41.

    CAS  PubMed  Google Scholar 

  90. Meixensberger J, Baunach S, Amschler J, Dings J, Roosen K. Influence of body position on tissue-pO2, cerebral perfusion pressure and intracranial pressure in patients with acute brain injury. Neurol Res. 1997;19(3):249–53.

    CAS  PubMed  Google Scholar 

  91. Schwarz S, Georgiadis D, Aschoff A, Schwab S. Effects of body position on intracranial pressure and cerebral perfusion in patients with large hemispheric stroke. Stroke. 2002;33(2):497–501.

    PubMed  Google Scholar 

  92. Berger C, Sakowitz OW, Kiening KL, Schwab S. Neurochemical monitoring of glycerol therapy in patients with ischemic brain edema. Stroke. 2005;36(2):e4–6.

    CAS  PubMed  Google Scholar 

  93. Sakamaki M, Igarashi H, Nishiyama Y, Hagiwara H, Ando J, Chishiki T, et al. Effect of glycerol on ischemic cerebral edema assessed by magnetic resonance imaging. J Neurol Sci. 2003;209(1–2):69–74.

    CAS  PubMed  Google Scholar 

  94. Hauer EM, Stark D, Staykov D, Steigleder T, Schwab S, Bardutzky J. Early continuous hypertonic saline infusion in patients with severe cerebrovascular disease. Crit Care Med. 2011;39(7):1766–72.

    CAS  PubMed  Google Scholar 

  95. Koenig MA, Bryan M, Lewin JL, Mirski MA, Geocadin RG, Stevens RD. Reversal of transtentorial herniation with hypertonic saline. Neurology. 2008;70(13):1023–9.

    CAS  PubMed  Google Scholar 

  96. Manno EM, Adams RE, Derdeyn CP, Powers WJ, Diringer MN. The effects of mannitol on cerebral edema after large hemispheric cerebral infarct. Neurology. 1999;52(3):583–7.

    CAS  PubMed  Google Scholar 

  97. von Kummer R, Meyding-Lamade U, Forsting M, Rosin L, Rieke K, Hacke W, et al. Sensitivity and prognostic value of early CT in occlusion of the middle cerebral artery trunk. Am J Neuroradiol. 1994;15(1):9–15 discussion 6-8.

    Google Scholar 

  98. Krieger DW, Demchuk AM, Kasner SE, Jauss M, Hantson L. Early clinical and radiological predictors of fatal brain swelling in ischemic stroke. Stroke. 1999;30(2):287–92.

    CAS  PubMed  Google Scholar 

  99. Kasner SE, Demchuk AM, Berrouschot J, Schmutzhard E, Harms L, Verro P, et al. Predictors of fatal brain edema in massive hemispheric ischemic stroke. Stroke. 2001;32(9):2117–23.

    CAS  PubMed  Google Scholar 

  100. Manno EM, Nichols DA, Fulgham JR, Wijdicks EF. Computed tomographic determinants of neurologic deterioration in patients with large middle cerebral artery infarctions. Mayo Clin Proc. 2003;78(2):156–60.

    PubMed  Google Scholar 

  101. Ryoo JW, Na DG, Kim SS, Lee KH, Lee SJ, Chung CS, et al. Malignant middle cerebral artery infarction in hyperacute ischemic stroke: evaluation with multiphasic perfusion computed tomography maps. J Comput Assist Tomogr. 2004;28(1):55–62.

    PubMed  Google Scholar 

  102. Kucinski T, Koch C, Grzyska U, Freitag HJ, Kromer H, Zeumer H. The predictive value of early CT and angiography for fatal hemispheric swelling in acute stroke. Am J Neuroradiol. 1998;19(5):839–46.

    CAS  PubMed  Google Scholar 

  103. Maramattom BV, Bahn MM, Wijdicks EF. Which patient fares worse after early deterioration due to swelling from hemispheric stroke? Neurology. 2004;63(11):2142–5.

    PubMed  Google Scholar 

  104. Lee SJ, Lee KH, Na DG, Byun HS, Kim YB, Shon YM, et al. Multiphasic helical computed tomography predicts subsequent development of severe brain edema in acute ischemic stroke. Arch Neurol. 2004;61(4):505–9.

    PubMed  Google Scholar 

  105. Mori K, Aoki A, Yamamoto T, Horinaka N, Maeda M. Aggressive decompressive surgery in patients with massive hemispheric embolic cerebral infarction associated with severe brain swelling. Acta Neurochir (Wien). 2001;143(5):483–91 discussion 91–2.

    CAS  Google Scholar 

  106. Park J, Goh DH, Sung JK, Hwang YH, Kang DH, Kim Y. Timely assessment of infarct volume and brain atrophy in acute hemispheric infarction for early surgical decompression: strict cutoff criteria with high specificity. Acta Neurochir (Wien). 2012;154(1):79–85.

    Google Scholar 

  107. Barber PA, Demchuk AM, Zhang J, Kasner SE, Hill MD, Berrouschot J, et al. Computed tomographic parameters predicting fatal outcome in large middle cerebral artery infarction. Cerebrovasc Dis. 2003;16(3):230–5.

    PubMed  Google Scholar 

  108. Thomalla GJ, Kucinski T, Schoder V, Fiehler J, Knab R, Zeumer H, et al. Prediction of malignant middle cerebral artery infarction by early perfusion- and diffusion-weighted magnetic resonance imaging. Stroke. 2003;34(8):1892–9.

    PubMed  Google Scholar 

  109. Thomalla G, Hartmann F, Juettler E, Singer OC, Lehnhardt FG, Kohrmann M, et al. Prediction of malignant middle cerebral artery infarction by magnetic resonance imaging within 6 hours of symptom onset: a prospective multicenter observational study. Ann Neurol. 2010;68(4):435–45.

    PubMed  Google Scholar 

  110. Oppenheim C, Samson Y, Manai R, Lalam T, Vandamme X, Crozier S, et al. Prediction of malignant middle cerebral artery infarction by diffusion-weighted imaging. Stroke. 2000;31(9):2175–81.

    CAS  PubMed  Google Scholar 

  111. Foerch C, Lang JM, Krause J, Raabe A, Sitzer M, Seifert V, et al. Functional impairment, disability, and quality of life outcome after decompressive hemicraniectomy in malignant middle cerebral artery infarction. J Neurosurg. 2004;101(2):248–54.

    PubMed  Google Scholar 

  112. Bektas H, Wu TC, Kasam M, Harun N, Sitton CW, Grotta JC, et al. Increased blood-brain barrier permeability on perfusion CT might predict malignant middle cerebral artery infarction. Stroke. 2010;41(11):2539–44.

    PubMed Central  PubMed  Google Scholar 

  113. Gerriets T, Stolz E, Konig S, Babacan S, Fiss I, Jauss M, et al. Sonographic monitoring of midline shift in space-occupying stroke: an early outcome predictor. Stroke. 2001;32(2):442–7.

    CAS  PubMed  Google Scholar 

  114. Gerriets T, Stolz E, Modrau B, Fiss I, Seidel G, Kaps M. Sonographic monitoring of midline shift in hemispheric infarctions. Neurology. 1999;52(1):45–9.

    CAS  PubMed  Google Scholar 

  115. Horstmann S, Koziol JA, Martinez-Torres F, Nagel S, Gardner H, Wagner S. Sonographic monitoring of mass effect in stroke patients treated with hypothermia. Correlation with intracranial pressure and matrix metalloproteinase 2 and 9 expression. J Neurol Sci. 2009;276(1–2):75–8.

    CAS  PubMed  Google Scholar 

  116. Bertram M, Khoja W, Ringleb P, Schwab S. Transcranial colour-coded sonography for the bedside evaluation of mass effect after stroke. Eur J Neurol. 2000;7(6):639–46.

    CAS  PubMed  Google Scholar 

  117. Burghaus L, Liu WC, Dohmen C, Bosche B, Haupt WF. Evoked potentials in acute ischemic stroke within the first 24 h: possible predictor of a malignant course. Neurocrit Care. 2008;9(1):13–6.

    PubMed  Google Scholar 

  118. Burghaus L, Hilker R, Dohmen C, Bosche B, Winhuisen L, Galldiks N, et al. Early electroencephalography in acute ischemic stroke: prediction of a malignant course? Clin Neurol Neurosurg. 2007;109(1):45–9.

    PubMed  Google Scholar 

  119. Diedler J, Sykora M, Bast T, Poli S, Veltkamp R, Mellado P, et al. Quantitative EEG correlates of low cerebral perfusion in severe stroke. Neurocrit Care. 2009;11(2):210–6.

    PubMed  Google Scholar 

  120. Diedler J, Sykora M, Juttler E, Veltkamp R, Steiner T, Rupp A. EEG power spectrum to predict prognosis after hemicraniectomy for space-occupying middle cerebral artery infarction. Cerebrovasc Dis. 2010;29(2):162–9.

    PubMed  Google Scholar 

  121. van Putten MJ, Tavy DL. Continuous quantitative EEG monitoring in hemispheric stroke patients using the brain symmetry index. Stroke. 2004;35(11):2489–92.

    PubMed  Google Scholar 

  122. Dohmen C, Bosche B, Graf R, Reithmeier T, Ernestus RI, Brinker G, et al. Identification and clinical impact of impaired cerebrovascular autoregulation in patients with malignant middle cerebral artery infarction. Stroke. 2007;38(1):56–61.

    PubMed  Google Scholar 

  123. Dohmen C, Bosche B, Graf R, Staub F, Kracht L, Sobesky J, et al. Prediction of malignant course in MCA infarction by PET and microdialysis. Stroke. 2003;34(9):2152–8.

    PubMed  Google Scholar 

  124. Berger C, Kiening K, Schwab S. Neurochemical monitoring of therapeutic effects in large human MCA infarction. Neurocrit Care. 2008;9(3):352–6.

    CAS  PubMed  Google Scholar 

  125. Berger C, Schabitz WR, Georgiadis D, Steiner T, Aschoff A, Schwab S. Effects of hypothermia on excitatory amino acids and metabolism in stroke patients: a microdialysis study. Stroke. 2002;33(2):519–24.

    CAS  PubMed  Google Scholar 

  126. Frank JI. Large hemispheric infarction, deterioration, and intracranial pressure. Neurology. 1995;45(7):1286–90.

    CAS  PubMed  Google Scholar 

  127. Poca MA, Benejam B, Sahuquillo J, Riveiro M, Frascheri L, Merino MA, et al. Monitoring intracranial pressure in patients with malignant middle cerebral artery infarction: is it useful? J Neurosurg. 2010;112(3):648–57.

    PubMed  Google Scholar 

  128. Schneweis S, Grond M, Staub F, Brinker G, Neveling M, Dohmen C, et al. Predictive value of neurochemical monitoring in large middle cerebral artery infarction. Stroke. 2001;32(8):1863–7.

    CAS  PubMed  Google Scholar 

  129. Schwarz S, Georgiadis D, Aschoff A, Schwab S. Effects of induced hypertension on intracranial pressure and flow velocities of the middle cerebral arteries in patients with large hemispheric stroke. Stroke. 2002;33(4):998–1004.

    PubMed  Google Scholar 

  130. Steiner T, Pilz J, Schellinger P, Wirtz R, Friederichs V, Aschoff A, et al. Multimodal online monitoring in middle cerebral artery territory stroke. Stroke. 2001;32(11):2500–6.

    CAS  PubMed  Google Scholar 

  131. Bosche B, Dohmen C, Graf R, Neveling M, Staub F, Kracht L, et al. Extracellular concentrations of non-transmitter amino acids in peri-infarct tissue of patients predict malignant middle cerebral artery infarction. Stroke. 2003;34(12):2908–13.

    CAS  PubMed  Google Scholar 

  132. Schwab S, Spranger M, Aschoff A, Steiner T, Hacke W. Brain temperature monitoring and modulation in patients with severe MCA infarction. Neurology. 1997;48(3):762–7.

    CAS  PubMed  Google Scholar 

  133. Schwab S, Aschoff A, Spranger M, Albert F, Hacke W. The value of intracranial pressure monitoring in acute hemispheric stroke. Neurology. 1996;47(2):393–8.

    CAS  PubMed  Google Scholar 

  134. Scarcella G. Encephalomalacia simulating the clinical and radiological aspects of brain tumor; a report of 6 cases. J Neurosurg. 1956;13(4):278–92.

    CAS  PubMed  Google Scholar 

  135. Chen CC, Cho DY, Tsai SC. Outcome and prognostic factors of decompressive hemicraniectomy in malignant middle cerebral artery infarction. J Chin Med Assoc. 2007;70(2):56–60.

    PubMed  Google Scholar 

  136. Curry WT Jr, Sethi MK, Ogilvy CS, Carter BS. Factors associated with outcome after hemicraniectomy for large middle cerebral artery territory infarction. Neurosurgery. 2005;56(4):681–92 discussion 92.

    PubMed  Google Scholar 

  137. Harscher S, Reichart R, Terborg C, Hagemann G, Kalff R, Witte OW. Outcome after decompressive craniectomy in patients with severe ischemic stroke. Acta Neurochir (Wien). 2006;148(1):31–7 discussion 7.

    CAS  Google Scholar 

  138. Holtkamp M, Buchheim K, Unterberg A, Hoffmann O, Schielke E, Weber JR, et al. Hemicraniectomy in elderly patients with space occupying media infarction: improved survival but poor functional outcome. J Neurol Neurosurg Psychiatry. 2001;70(2):226–8.

    CAS  PubMed Central  PubMed  Google Scholar 

  139. Leonhardt G, Wilhelm H, Doerfler A, Ehrenfeld CE, Schoch B, Rauhut F, et al. Clinical outcome and neuropsychological deficits after right decompressive hemicraniectomy in MCA infarction. J Neurol. 2002;249(10):1433–40.

    PubMed  Google Scholar 

  140. Malm J, Bergenheim AT, Enblad P, Hardemark HG, Koskinen LO, Naredi S, et al. The Swedish Malignant Middle cerebral artery Infarction Study: long-term results from a prospective study of hemicraniectomy combined with standardized neurointensive care. Acta Neurol Scand. 2006;113(1):25–30.

    CAS  PubMed  Google Scholar 

  141. Pillai A, Menon SK, Kumar S, Rajeev K, Kumar A, Panikar D. Decompressive hemicraniectomy in malignant middle cerebral artery infarction: an analysis of long-term outcome and factors in patient selection. J Neurosurg. 2007;106(1):59–65.

    PubMed  Google Scholar 

  142. Walz B, Zimmermann C, Bottger S, Haberl RL. Prognosis of patients after hemicraniectomy in malignant middle cerebral artery infarction. J Neurol. 2002;249(9):1183–90.

    PubMed  Google Scholar 

  143. Yao Y, Liu W, Yang X, Hu W, Li G. Is decompressive craniectomy for malignant middle cerebral artery territory infarction of any benefit for elderly patients? Surg Neurol. 2005;64(2):165–9 discussion 9.

    PubMed  Google Scholar 

  144. Gupta R, Connolly ES, Mayer S, Elkind MS. Hemicraniectomy for massive middle cerebral artery territory infarction: a systematic review. Stroke. 2004;35(2):539–43.

    PubMed  Google Scholar 

  145. Arac A, Blanchard V, Lee M, Steinberg GK. Assessment of outcome following decompressive craniectomy for malignant middle cerebral artery infarction in patients older than 60 years of age. Neurosurg Focus. 2009;26(6):E3.

    PubMed  Google Scholar 

  146. Hofmeijer J, Kappelle LJ, Algra A, Amelink GJ, van Gijn J, van der Worp HB. Surgical decompression for space-occupying cerebral infarction [the hemicraniectomy after middle cerebral artery infarction with life-threatening edema trial (HAMLET)]: a multicentre, open, randomised trial. Lancet Neurol. 2009;8(4):326–33.

    PubMed  Google Scholar 

  147. Juttler E, Schwab S, Schmiedek P, Unterberg A, Hennerici M, Woitzik J, et al. Decompressive surgery for the treatment of malignant infarction of the middle cerebral artery (DESTINY): a randomized, controlled trial. Stroke. 2007;38(9):2518–25.

    PubMed  Google Scholar 

  148. Vahedi K, Vicaut E, Mateo J, Kurtz A, Orabi M, Guichard JP, et al. Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke. 2007;38(9):2506–17.

    PubMed  Google Scholar 

  149. Juttler E, Unterberg A, Woitzik J, Bosel J, Amiri H, Sakowitz OW, et al. Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke. N Engl J Med. 2014;370(12):1091–100.

    PubMed  Google Scholar 

  150. Frank JI. Hemicraniectomy and durotomy upon deterioration from infarction related swelling trial (HeADDFIRST): first public presentation of the primary study findings. [abstract]. In: Presentations at the 55th Annual Meeting of the American Academy of Neurology; 3 April 2003; Honolulu. American Academy of Neurology; 2003. Neurology. 2003;60(Suppl 1):S52.004.

  151. Vahedi K, Hofmeijer J, Juettler E, Vicaut E, George B, Algra A, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol. 2007;6(3):215–22.

    PubMed  Google Scholar 

  152. Rincon F, Mayer SA. Decompressive surgery in malignant infarction of the middle cerebral artery. Curr Neurol Neurosci Rep. 2007;7(6):511–2.

    PubMed  Google Scholar 

  153. Schwab S, Steiner T, Aschoff A, Schwarz S, Steiner HH, Jansen O, et al. Early hemicraniectomy in patients with complete middle cerebral artery infarction. Stroke. 1998;29(9):1888–93.

    CAS  PubMed  Google Scholar 

  154. Wang KW, Chang WN, Ho JT, Chang HW, Lui CC, Cheng MH, et al. Factors predictive of fatality in massive middle cerebral artery territory infarction and clinical experience of decompressive hemicraniectomy. Eur J Neurol. 2006;13(7):765–71.

    PubMed  Google Scholar 

  155. Skoglund TS, Eriksson-Ritzen C, Sorbo A, Jensen C, Rydenhag B. Health status and life satisfaction after decompressive craniectomy for malignant middle cerebral artery infarction. Acta Neurol Scand. 2008;117(5):305–10.

    CAS  PubMed  Google Scholar 

  156. Wagner S, Schnippering H, Aschoff A, Koziol JA, Schwab S, Steiner T. Suboptimum hemicraniectomy as a cause of additional cerebral lesions in patients with malignant infarction of the middle cerebral artery. J Neurosurg. 2001;94(5):693–6.

    CAS  PubMed  Google Scholar 

  157. Park J, Kim E, Kim GJ, Hur YK, Guthikonda M. External decompressive craniectomy including resection of temporal muscle and fascia in malignant hemispheric infarction. J Neurosurg. 2009;110(1):101–5.

    PubMed  Google Scholar 

  158. Hofmeijer J, Kappelle LJ, Algra A, Amelink GJ, van Gijn J, van der Worp HB, et al. Surgical decompression for space-occupying cerebral infarction (the hemicraniectomy after middle cerebral artery infarction with life-threatening edema trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol. 2009;8(4):326–33.

    PubMed  Google Scholar 

  159. Juttler E, Bosel J, Amiri H, Schiller P, Limprecht R, Hacke W, et al. DESTINY II: decompressive surgery for the treatment of malignant infarction of the middle cerebral artery II. International journal of stroke : official journal of the International Stroke Society. 2011;6(1):79–86.

    Google Scholar 

  160. Weil AG, Rahme R, Moumdjian R, Bouthillier A, Bojanowski MW. Quality of life following hemicraniectomy for malignant MCA territory infarction. Can J Neurol Sci. 2011;38(3):434–8.

    PubMed  Google Scholar 

  161. Robertson SC, Lennarson P, Hasan DM, Traynelis VC. Clinical course and surgical management of massive cerebral infarction. Neurosurgery. 2004;55(1):55–61.

    PubMed  Google Scholar 

  162. Guresir E, Vatter H, Schuss P, Oszvald A, Raabe A, Seifert V, et al. Rapid closure technique in decompressive craniectomy. J Neurosurg. 2011;114(4):954–60.

    PubMed  Google Scholar 

  163. Kiphuth IC, Kohrmann M, Lichy C, Schwab S, Huttner HB. Hemicraniectomy for malignant middle cerebral artery infarction: retrospective consent to decompressive surgery depends on functional long-term outcome. Neurocrit Care. 2010;13(3):380–4.

    PubMed  Google Scholar 

  164. Mitchell P, Gregson BA, Crossman J, Gerber C, Jenkins A, Nicholson C, et al. Reassessment of the HAMLET study. Lancet Neurol. 2009;8(7):602–3 author reply 3-4.

    PubMed  Google Scholar 

  165. Benejam B, Sahuquillo J, Poca MA, Frascheri L, Solana E, Delgado P, et al. Quality of life and neurobehavioral changes in survivors of malignant middle cerebral artery infarction. J Neurol. 2009;256(7):1126–33.

    PubMed  Google Scholar 

  166. Ware JE, Sherbourne CD. The MOS 36 ItemShort Form Health Survey (SF-36). 1. Conceptual framework and item selection. Med Care. 1992;30:473–83.

    PubMed  Google Scholar 

  167. Indredavik B, Bakke F, Slordahl SA, Rokseth R, Haheim LL. Stroke unit treatment improves long-term quality of life: a randomized controlled trial. Stroke. 1998;29(5):895–9.

    CAS  PubMed  Google Scholar 

  168. Duncan PW, Wallace D, Lai SM, Johnson D, Embretson S, Laster LJ. The stroke impact scale version 2.0. Evaluation of reliability, validity, and sensitivity to change. Stroke. 1999;30(10):2131–40.

    CAS  PubMed  Google Scholar 

  169. Vahedi K, Benoist L, Kurtz A, Mateo J, Blanquet A, Rossignol M, et al. Quality of life after decompressive craniectomy for malignant middle cerebral artery infarction. J Neurol Neurosurg Psychiatry. 2005;76(8):1181–2.

    CAS  PubMed Central  PubMed  Google Scholar 

  170. Woertgen C, Erban P, Rothoerl RD, Bein T, Horn M, Brawanski A. Quality of life after decompressive craniectomy in patients suffering from supratentorial brain ischemia. Acta Neurochir (Wien). 2004;146(7):691–5.

    CAS  Google Scholar 

  171. Gilson BS, Gilson JS, Bergner M, Bobbit RA, Kressel S, Pollard WE, et al. The sickness impact profile. Development of an outcome measure of health care. Am J Public Health. 1975;65(12):1304–10.

    CAS  PubMed Central  PubMed  Google Scholar 

  172. Dorman PJ, Waddell F, Slattery J, Dennis M, Sandercock P. Is the EuroQol a valid measure of health-related quality of life after stroke? Stroke. 1997;28(10):1876–82.

    CAS  PubMed  Google Scholar 

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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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Keywords

  • Large malignant stroke
  • Large hemispheric infarction
  • Cerebral edema
  • Hemicraniectomy
  • Critical care management