Management of large hemispheric strokes in the neurological intensive care unit

Venkatesh Aiyagari, Michael N. Diringer

Research output: Contribution to journalReview article

13 Scopus citations

Abstract

BACKGROUND- Patients with large hemispheric strokes frequently develop neurologic deterioration secondary to cerebral edema. Despite supportive care in the intensive care unit and traditional forms of therapy for cerebral edema, they have a high morbidity and mortality. New forms of therapy are being investigated to improve outcome in these patients. REVIEW SUMMARY- This article begins with a discussion of the clinical and radiologic features of large hemispheric strokes. The role of increased intracranial pressure in neurologic deterioration and the predictors of outcome in these patients are reviewed. The various therapeutic options for management of cerebral edema in these patients, including the role of osmotic therapy, hypothermia, and hemicraniectomy, are explored. CONCLUSIONS- Neurologic deterioration in patients with large hemispheric strokes necessitates admission to the intensive care unit for management of the airway, blood pressure, and cerebral edema. New promising therapies, such as hemicraniectomy and hypothermia, need to be further evaluated to define their role in the management of these patients.

Original languageEnglish (US)
Pages (from-to)152-162
Number of pages11
JournalNeurologist
Volume8
Issue number3
DOIs
StatePublished - Jan 1 2002

Keywords

  • Brain edema
  • Cerebral infarction
  • Critical care
  • Hemicraniectomy
  • Hypothermia
  • Mannitol
  • Stroke outcome

ASJC Scopus subject areas

  • Clinical Neurology

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