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Editorial commentary
Big strokes can cause big problems
  1. Karen L Furie1,
  2. Kevin N Sheth2
  1. 1 Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
  2. 2 Neurology, Yale University, New Haven, Connecticut, USA
  1. Correspondence to Dr Karen L Furie, Neurology, Brown University Warren Alpert Medical School, Providence, RI 02903, USA; KFurie{at}lifespan.org

https://doi.org/10.1136/jnnp-2020-322964

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    There are new elements to consider for improving quality of life in survivors of massive stroke

    Large cerebral infarctions can result in malignant cerebral oedema leading horizontal tissue swelling, transtentorial herniation and death. Multiple studies have demonstrated the utility of decompressive hemicraniectomy as a life sustaining measure.1 The procedure remains controversial because of concern that in a non-selected population, survivors may be left with severe disability and diminished quality of life.2

    The current study by Casolla, et al, identified a single centre case series of 212 patients with large middle cerebral artery infarcts who underwent decompressive craniectomy.3 Although the centre treated all patients irrespective of age after DESTINY II was published in 2014, approximately 87% of patients were aged 60 or younger.4 The 30-day mortality was 16.5%. A particular strength of their …

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    Footnotes

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Commissioned; internally peer reviewed.

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