Abstract
Malignant cerebral artery strokes have a poor prognosis, with nearly 80% of mortality in some series despite intensive care. After a large randomized trial, decompressive hemicraniectomy has been performed more often in stroke patients. Here, we describe patients in a tertiary teaching hospital in Brazil, emphasizing the impact of age on outcomes. A retrospective cohort of patients, with malignant strokes which received a decompressive hemicraniectomy, from paper and electronic medical records, from January 2010 to December 2013 was divided into two groups according to age. The final analysis included 60 patients. The overall mortality was higher among patients older than 60 yrs (67% vs. 41%; p = 0.039), whose group also had a worse outcome (76% with mRS 5 or 6) at 90 days (OR 3.91 CI95% 1.30-11.74), whereas only 24% had mRS of 0-4 (p = 0.015). All patients who presented with sepsis died (p = 0.003). The incidence of pulmonary infection was very high in the elderly group (76%) with significant intergroup differences (p = 0.027, OR 8.32 CI95% 0.70-98.48). Older patients present more commonly with infections, more disabilities and a higher mortality, highlighting very poor results in elderly population. These results should be pr...Continue Reading
References
Jul 1, 1995·Neurology·J I Frank
Jun 1, 1997·Neurology·S SchwabW Hacke
Jul 29, 1998·Intensive Care Medicine·J BerrouschotD Schneider
Sep 10, 1998·Stroke; a Journal of Cerebral Circulation·S SchwabW Hacke
Feb 11, 2003·Critical Care Medicine·Jeannette HofmeijerL Jaap Kappelle
Feb 17, 2007·Lancet Neurology·Katayoun VahediUNKNOWN DECIMAL, DESTINY, and HAMLET investigators
Aug 11, 2007·Stroke; a Journal of Cerebral Circulation·Eric JüttlerUNKNOWN DESTINY Study Group
Aug 11, 2007·Stroke; a Journal of Cerebral Circulation·Katayoun VahediUNKNOWN DECIMAL Investigators
Sep 4, 2007·Journal of Neurology, Neurosurgery, and Psychiatry·Steff C LewisMartin S Dennis
Mar 10, 2009·Lancet Neurology·Jeannette HofmeijerUNKNOWN HAMLET investigators
Jul 6, 2010·Arquivos de neuro-psiquiatria·João Paulo MattosEvandro de Oliveira
Jan 6, 2011·International Journal of Stroke : Official Journal of the International Stroke Society·Eric JüttlerUNKNOWN DESTINY II Study Group
Nov 5, 2011·Stroke; a Journal of Cerebral Circulation·João José Freitas de CarvalhoGisele Sampaio Silva
Dec 20, 2011·Circulation·Véronique L RogerUNKNOWN American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Apr 17, 2012·Clinical Neurology and Neurosurgery·Satoru TakeuchiYoshio Takasato
May 23, 2013·International Journal of Stroke : Official Journal of the International Stroke Society·Sheila Cristina Ouriques MartinsUNKNOWN Brazilian Stroke Network
May 29, 2013·Journal of Neurology·Patrick SchussErdem Güresir
Jul 23, 2013·Stroke; a Journal of Cerebral Circulation·Marjolein GeurtsUNKNOWN HAMLET Steering Committee
Nov 14, 2013·The Journal of Craniofacial Surgery·Anwen ShaoJianmin Zhang
Jan 16, 2014·Stroke; a Journal of Cerebral Circulation·Jeffrey I FrankUNKNOWN HeADDFIRST Trialists
Mar 13, 2014·Neurology India·Vinod Kumar RaiAshish Suri
Mar 22, 2014·The New England Journal of Medicine·Eric JüttlerUNKNOWN DESTINY II Investigators
Mar 25, 2014·Intensive Care Medicine·Matthew A KirkmanMartin Smith
Oct 29, 2015·Cerebrovascular Diseases·Andreas Ragoschke-SchummKlaus Fassbender
Citations
Mar 14, 2019·Frontiers in Neurology·Angélica ClavijoAndrés M Rubiano
Jul 2, 2020·Arquivos de neuro-psiquiatria·Isaac Holanda Mendes MaiaFernanda Martins Maia
Dec 14, 2017·Arquivos de neuro-psiquiatria·Pedro Tadao Hamamoto FilhoMarco Antônio Zanini
Dec 29, 2019·World Neurosurgery·Pedro Tadao Hamamoto FilhoRodrigo Bazan