Space-Occupying Cerebral Infarction: Current Treatment Options

Space-occupying supratentorial ischaemic strokes are associated with high lethality and disability, especially in younger patients. This type of stroke is characterised by a large, early increasing brain oedema. Swelling causes secondary injury to other brain regions and subsequent brain herniation and increases in intracranial pressure. If untreated, space-occupying strokes lead to early clinical deterioration and to death in 80-90% of patients. Therefore these strokes are described as "malignant" strokes. The high mortality is only slightly reduced by medical therapies and intensive care treatment. For many years, the high proportion of severely disabled patients surviving large strokes led to therapeutic reluctance by treating physicians. During the last decade this attitude has changed, mainly due to several randomised studies showing the efficiency of hemicraniectomy in younger patients with malignant stroke. Early hemicraniectomy not only increases the number of surviving patients but also reduces the level of disability in surviving patients. Current clinical trials are investigating whether the recent study results for hemicraniectomy can be confirmed under clinical routine conditions. Ongoing studies will also evaluate the quality of life in surviving stroke patients and evaluate their care situation. Another focus of clinical research is the application of therapeutic hypothermia to treat malignant stroke oedema.