Outcome after decompressive craniectomy in patients with dominant middle cerebral artery infarction: A preliminary report
Introduction: Life-threatening, space occupying, infarction develops in 10-15% of patients after middle cerebral artery infarction (MCAI). Though decompressive craniectomy (DC) is now standard of care in patients with non-dominant stroke, its role in dominant MCAI (DMCAI) is largely undefined. This...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2013-01-01
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| Series: | Annals of Indian Academy of Neurology |
| Subjects: | |
| Online Access: | http://www.annalsofian.org/article.asp?issn=0972-2327;year=2013;volume=16;issue=4;spage=509;epage=515;aulast=Kumar |
| _version_ | 1828282785261944832 |
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| author | Amandeep Kumar Manish Singh Sharma Bhawani Shanker Sharma Rohit Bhatia Manmohan Singh Ajay Garg Rajinder Kumar Ashish Suri Poodipedi Sarat Chandra Shashank Sharad Kale Ashok Kumar Mahapatra |
| author_facet | Amandeep Kumar Manish Singh Sharma Bhawani Shanker Sharma Rohit Bhatia Manmohan Singh Ajay Garg Rajinder Kumar Ashish Suri Poodipedi Sarat Chandra Shashank Sharad Kale Ashok Kumar Mahapatra |
| author_sort | Amandeep Kumar |
| collection | DOAJ |
| description | Introduction: Life-threatening, space occupying, infarction develops in 10-15% of patients after middle cerebral artery infarction (MCAI). Though decompressive craniectomy (DC) is now standard of care in patients with non-dominant stroke, its role in dominant MCAI (DMCAI) is largely undefined. This may reflect the ethical dilemma of saving life of a patient who may then remain hemiplegic and dysphasic. This study specifically addresses this issue. Materials and Methods: This retrospective analysis studied patients with DMCAI undergoing DC. Patient records, operation notes, radiology, and out-patient files were scrutinized to collate data. Glasgow outcome scale (GOS), Barthel index (BI) and improvement in language and motor function were evaluated to determine functional outcome. Results: Eighteen patients between 22 years and 72 years of age were included. 6 week, 3 month, 6 month and overall survival rates were 66.6% (12/18), 64% (11/17), 62.5% (10/16) and 62.5% (10/16) respectively. Amongst ten surviving patients with long-term follow-up, 60% showed improvement in GOS, 70% achieved BI score >60 while 30% achieved full functional independence. In this group, motor power and language function improved in 9 and 8 patients respectively. At last follow-up, 8 of 10 surviving patients were ambulatory with (3/8) or without (5/8) support. Age <50 years corresponded with better functional outcome amongst survivors (P value -0.0068). Conclusion: Language and motor outcomes after DC in patients with DMCAI are not as dismal as commonly perceived. Perhaps young patients (<50 years) with DMCAI should be treated with the same aggressiveness that non-DMCAI is currently dealt with. |
| first_indexed | 2024-04-13T08:34:49Z |
| format | Article |
| id | doaj.art-ae8592a8420c404eb19401d40f44306e |
| institution | Directory Open Access Journal |
| issn | 0972-2327 1998-3549 |
| language | English |
| last_indexed | 2024-04-13T08:34:49Z |
| publishDate | 2013-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Annals of Indian Academy of Neurology |
| spelling | doaj.art-ae8592a8420c404eb19401d40f44306e2022-12-22T02:54:08ZengWolters Kluwer Medknow PublicationsAnnals of Indian Academy of Neurology0972-23271998-35492013-01-0116450951510.4103/0972-2327.120445Outcome after decompressive craniectomy in patients with dominant middle cerebral artery infarction: A preliminary reportAmandeep KumarManish Singh SharmaBhawani Shanker SharmaRohit BhatiaManmohan SinghAjay GargRajinder KumarAshish SuriPoodipedi Sarat ChandraShashank Sharad KaleAshok Kumar MahapatraIntroduction: Life-threatening, space occupying, infarction develops in 10-15% of patients after middle cerebral artery infarction (MCAI). Though decompressive craniectomy (DC) is now standard of care in patients with non-dominant stroke, its role in dominant MCAI (DMCAI) is largely undefined. This may reflect the ethical dilemma of saving life of a patient who may then remain hemiplegic and dysphasic. This study specifically addresses this issue. Materials and Methods: This retrospective analysis studied patients with DMCAI undergoing DC. Patient records, operation notes, radiology, and out-patient files were scrutinized to collate data. Glasgow outcome scale (GOS), Barthel index (BI) and improvement in language and motor function were evaluated to determine functional outcome. Results: Eighteen patients between 22 years and 72 years of age were included. 6 week, 3 month, 6 month and overall survival rates were 66.6% (12/18), 64% (11/17), 62.5% (10/16) and 62.5% (10/16) respectively. Amongst ten surviving patients with long-term follow-up, 60% showed improvement in GOS, 70% achieved BI score >60 while 30% achieved full functional independence. In this group, motor power and language function improved in 9 and 8 patients respectively. At last follow-up, 8 of 10 surviving patients were ambulatory with (3/8) or without (5/8) support. Age <50 years corresponded with better functional outcome amongst survivors (P value -0.0068). Conclusion: Language and motor outcomes after DC in patients with DMCAI are not as dismal as commonly perceived. Perhaps young patients (<50 years) with DMCAI should be treated with the same aggressiveness that non-DMCAI is currently dealt with.http://www.annalsofian.org/article.asp?issn=0972-2327;year=2013;volume=16;issue=4;spage=509;epage=515;aulast=KumarCraniectomydominantmiddle cerebral arteryoutcomestroke |
| spellingShingle | Amandeep Kumar Manish Singh Sharma Bhawani Shanker Sharma Rohit Bhatia Manmohan Singh Ajay Garg Rajinder Kumar Ashish Suri Poodipedi Sarat Chandra Shashank Sharad Kale Ashok Kumar Mahapatra Outcome after decompressive craniectomy in patients with dominant middle cerebral artery infarction: A preliminary report Annals of Indian Academy of Neurology Craniectomy dominant middle cerebral artery outcome stroke |
| title | Outcome after decompressive craniectomy in patients with dominant middle cerebral artery infarction: A preliminary report |
| title_full | Outcome after decompressive craniectomy in patients with dominant middle cerebral artery infarction: A preliminary report |
| title_fullStr | Outcome after decompressive craniectomy in patients with dominant middle cerebral artery infarction: A preliminary report |
| title_full_unstemmed | Outcome after decompressive craniectomy in patients with dominant middle cerebral artery infarction: A preliminary report |
| title_short | Outcome after decompressive craniectomy in patients with dominant middle cerebral artery infarction: A preliminary report |
| title_sort | outcome after decompressive craniectomy in patients with dominant middle cerebral artery infarction a preliminary report |
| topic | Craniectomy dominant middle cerebral artery outcome stroke |
| url | http://www.annalsofian.org/article.asp?issn=0972-2327;year=2013;volume=16;issue=4;spage=509;epage=515;aulast=Kumar |
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