TY - JOUR T1 - Big strokes can cause big problems JF - Journal of Neurology, Neurosurgery & Psychiatry JO - J Neurol Neurosurg Psychiatry DO - 10.1136/jnnp-2020-322964 SP - jnnp-2020-322964 AU - Karen L Furie AU - Kevin N Sheth Y1 - 2020/03/12 UR - http://jnnp.bmj.com/content/early/2020/03/12/jnnp-2020-322964.abstract N2 - 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.2The 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 … ER -