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The effect of brain atrophy on outcome after a large cerebral infarction
  1. Sang Hyung Lee1,
  2. Chang Wan Oh2,
  3. Jung Ho Han2,
  4. Chae-Yong Kim2,
  5. O-Ki Kwon2,
  6. Young-Je Son1,
  7. Hee-Joon Bae3,
  8. Moon-Ku Han3,
  9. Young Seob Chung1
  1. 1Department of Neurosurgery, Seoul National University Boramae Medical Center, Seoul, Korea
  2. 2Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
  3. 3Neurology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
  1. Correspondence to Young Seob Chung, Department of Neurosurgery, Seoul National University Boramae Medical Center, 28 Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea; yschung{at}


Purpose We retrospectively evaluated the effect of brain atrophy on the outcome of patients after a large cerebral infarct.

Methods Between June 2003 and Oct 2008, 134 of 2975 patients with stroke were diagnosed as having a large cerebral infarct. The mean age of the patients was 70 (21–95) y. The mean infarct volume was 223.6±95.2 cm3 (46.0–491.0). The inter-caudate distance (ICD) was calculated as an indicator of brain atrophy by measuring the hemi-ICD of the intact side and then multiplying by two to account for brain swelling at the infarct site. The mean ICD was 18.0±4.8 mm (9.6–37.6).

Results Forty-nine (36.6%) patients experienced a malignant clinical outcome (MCO) during management in the hospital. Thirty-one (23.1%) patients had a favourable functional outcome (FO) (modified Rankin scale (mRS) ≤3) and 49 (36.6%) had an acceptable functional outcome (AO) (mRS≤4) at 6 months after stroke onset. In the multivariate analysis, brain atrophy (ICD≥20 mm) had a significant and independent protective effect on MCO (p=0.003; OR=0.137; 95% CI 0.037 to 0.503). With respect to FO, the age and infarct volume reached statistical significance (p<0.001, OR=0.844, 95% CI 0.781 to 0.913; p=0.006, OR=0.987, 95% CI 0.977 to 0.996, respectively). Brain atrophy (ICD≥20 mm) was negatively associated only with AO (p=0.022; OR=0.164; 95% CI 0.035 to 0.767).

Conclusions Brain atrophy may have an association with clinical outcome after a large stroke by a trend of saving patients from an MCO but also by interfering with their functional recovery.

  • Brain atrophy
  • cerebral infarction
  • fatal outcome
  • functional outcome
  • hemicraniectomy
  • image analysis
  • neurosurgery
  • stroke

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  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Seoul National University Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.