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Malignant middle cerebral artery (MCA) infarction is a devastating condition leading to early death in nearly 80% of cases due to the rapid rise of intracranial pressure despite maximum medical management of the ischaemic brain oedema.1 Decompressive craniectomy (DC) has been proposed to prevent brain herniation in malignant MCA infarction, but it remains controversial in the absence of randomised controlled trials and because of the fear of a severe residual disability after surgery.1–4 We present herein the results of a quality of life assessment using patient and proxy versions of the Stroke Impact Scale (SIS) in eight patients 12–30 months after craniectomy for malignant MCA infarcts.
Methods
Between March 1999 and November 2000, all consecutive patients with malignant MCA infarction were treated by DC and durotomy at Lariboisière Hospital if they were younger than 55 years of age, had a complete MCA infarct as defined by complete MCA territory CT ischaemic changes, and a severe hemiplegia with altered level of consciousness with further neurological deterioration due to brain oedema, and if a close family member gave informed consent. Exclusion criteria were: prestroke moderate to severe disability defined by a modified Rankin scale (mRS)⩾2, haemorrhagic transformation involving more than 50% of the MCA territory, and significant contralateral ischaemia.
Disability was assessed …
Footnotes
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Competing interests: none declared