Cerebral infarction

see Acute ischemic stroke.

see Watershed cerebral infarction.

Large hemispheric infarctions (LHIs) lead to significant disability and mortality. Harvey Cushing in the early 1900s described primary and secondary brain injury as occurring during immediate (direct injury of vessels), intermediate (during which there is often a lucid period of consciousness), and late (when cerebral edema develops) phases after traumatic brain injury 1). A similar progression of disease can be seen in LHI, defined as an ischemic stroke affecting all or most of the middle cerebral artery (MCA) territory, with or without involvement of the anterior cerebral artery or posterior cerebral artery territory 2)

Between 10 and 30% of patients who suffer from an aneurysmal subarachnoid hemorrhage (aSAH) will develop cerebral infarctions (CIs) that are unrelated to aneurysm exclusion procedures. Infarctions that occur during the so-called period of cerebral vasospasm (between 3 and 14 days after bleeding) represent one of the main causes of disability and permanent sequelae in aSAH 3).

Cushing H. I. Subtemporal decompressive operations for the intracranial complications associated with bursting fractures of the skull.Ann Surg. 1908; 47:641–644.1. doi: 10.1097/00000658-190805000-00001
Torbey MT, Bösel J, Rhoney DH, Rincon F, Staykov D, Amar AP, Varelas PN, Jüttler E, Olson D, Huttner HB, et al.. 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.Neurocrit Care. 2015; 22:146–164. doi: 10.1007/s12028-014-0085-6
Rowland MJ, Hadjipavlou G, Kelly M, Westbrook J, Pattinson KT. Delayed cerebral ischaemia after subarachnoid haemorrhage: looking beyond vasospasm. Br J Anaesth. 2012 Sep;109(3):315-29. doi: 10.1093/bja/aes264. PMID: 22879655.
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