gms | German Medical Science

Objective: Malignant brain edema (MBE) due to hemispheric infarction can result in brain herniation, poor outcomes, and death; outcome may be improved if certain interventions, such as decompressive craniectomy, are performed early. We sought to generate a prediction score to easily identify those patients at high risk for MBE.

Method: 121 patients with large MCA infarcts (2011 to 2014) were included. Patients were divided into two groups: those who developed malignant brain edema and those who did not. Independent predictors of MBE were identified by logistic regression analysis and a score for the development of MBE (MBES) was generated.

Results: Four factors were independently associated with MBE: baseline National Institutes of Health Stroke Scale (NIHSS) score (p = 0.009), Alberta Stroke Program Early CT Score (ASPECTS) (p = 0.01), collateral score (CS) (p < 0.001) and recanalization success (p = 0.01). Points were assigned for each factor as follows: NIHSS = 8 (= 0), 9-17 (= 1), = 18 (=2); ASPECTS = 7 (= 1), >8 (= 0); CS < 2 (= 1), = 2 (= 0); recanalization failure (= 1), success (= 0). The MBES represented the sum of these individual points. Of 26 patients with a MBES of 0 to 1, none developed MBE. All patients with a MBES of 6 developed MBE. Both MBE development and functional outcomes were strongly associated with the MBES (p = 0.007 and 0.002, respectively).

Conclusions: This report of MBES is a preliminary and is the first simple, reliable grading scale for prediction of MBE progression and outcome. The MBES can easily be used in clinical practice and may help decision making in early aggressive treatment such as DC in patients with severe MCA stroke. Also decision making of this should be considered the patient's clinical status and the quality of life of family and patients.