Kasner et al identified risk factors for fatal (malignant) brain edema following massive hemispheric stroke involving the middle cerebral artery (MCA). These can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Pennsylvania.

Patient selection: ischemic stroke involving the middle cerebral artery (MCA)


Outcome: fatal cerebral edema


Risk factors for brain edema from multivariate analysis:

(1) history of hypertension (odds ratio 3.0)

(2) history of heart failure (odds ratio 2.1)

(3) elevated baseline white blood cell count (odds ratio 1.08 per 1000 WBC per µL)

(4) CT hypodensity > 50% of the MCA territory (odds ratio 6.3)

(5) involvement of additional vascular territories - anterior cerebral artery, posterior cerebral artery, anterior choroidal artery (odds ratio 3.3)


The risk of brain edema increases with the number of risk factors present.

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