Some strokes are called “malignant” because they can be rapidly progressive and life-threatening.


Features of a malignant stroke:

(1) It usually is in the distribution of the middle cerebral artery.

(2) It is usually a large stroke that is associated with cerebral edema and a marked increase in intracranial pressure.

(3) The increased intracerebral pressure adversely affects one or more vital structures, especially when there is transtentorial herniation.

(4) Relief of the pressure by a procedure such as hemicraniectomy can be life-saving.


Criteria of Wartenberg for changes seen on imaging studies associated with a malignant stroke involving the middle cerebral artery in an adult:

(1) hypodensity > 50% in the MCA territory on CT scan

(2) stroke volume > 145 mL on diffusion weighted imagng


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