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Stroke
Published in Henry J. Woodford, Essential Geriatrics, 2022
Decompressive hemicraniectomy is used for people with malignant middle cerebral artery syndrome. In this condition there is excessive oedema of a cerebral hemisphere due to extensive infarction in the MCA territory. It more commonly affects younger adults (cerebral atrophy probably protects frail older people).
Evidence-based management
Published in Christos Tziotzios, Jesse Dawson, Matthew Walters, Kennedy R Lees, Stroke in Practice, 2017
Christos Tziotzios, Jesse Dawson, Matthew Walters, Kennedy R Lees
Complete MCA infarction can be associated with massive brain oedema and increased intracranial pressure; the so-called malignant middle cerebral artery syndrome. When this occurs, mortality can be as high as 80% and medical therapy has little effect. Decompressive hemicraniectomy reduces the associated mortality and improves functional outcome in those aged under 60 years.9 Compared to best medical treatment, numbers needed to treat to prevent death, severe disability, or moderate disability are 2, 2, and 4, respectively. Surgery has not yet been shown to be effective in unselected patients with ICH although is often considered to avoid or treat hydrocephalus in those with cerebellar haematoma and may be effective in those with peripheral lobar haematoma. Surgical treatment for those with raised intracranial pressure and hydrocephalus may be considered in those with acute stroke. Clinical trials are currently underway to further evaluate the role of surgery.
A combined therapy for limb apraxia and related anosognosia
Published in Neuropsychological Rehabilitation, 2020
Ilka Buchmann, Lisa Finkel, Mareike Dangel, Dorothee Erz, Kathi Maren Harscher, Moritz Kaupp-Merkle, Joachim Liepert, Brigitte Rockstroh, Jennifer Randerath
Case 2 was a 56-year old woman with subacute left hemisphere stroke. The CT scan showed the presence of a left middle cerebral artery syndrome including basal ganglia (with putamen, pallidum, caudate nucleus, omitting the insula) and semioval centre. The scan additionally revealed lesions in the anterior horn of the lateral ventricle caused by a prior right embolic infarction. The brain scan is depicted in Figure 1.