Deans' stroke musings: Stroke-related complications in large hemisphere infarction: incidence and influence on unfavorable outcome

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, September 3, 2019

Stroke-related complications in large hemisphere infarction: incidence and influence on unfavorable outcome

Useless, describes a problem but offers NO SOLUTION.

Stroke-related complications in large hemisphere infarction: incidence and influence on unfavorable outcome

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Jie Li

, Ping Zhang, Simiao Wu, ...

First Published August 30, 2019 Research Article

Abstract

Objective:

Neurological and medical complications are major causes of morbidity and mortality after ischemic stroke. This study aimed to identify the incidence of stroke-related complications following large hemisphere infarction (LHI) and to explore their influence on unfavorable outcome in LHI patients.

Methods:

We prospectively enrolled consecutive patients with LHI. The unfavorable outcome was defined as an modified Rankin Scale (mRS) score of 4–6 at 3 months. Multivariate logistic regression analysis was employed to identify the stroke-related complications associated with unfavorable outcome.

Results:

Of the 256 cases with LHI included, 41 (16.0%) died during hospitalization, 94 (36.7%) died and 140 (55.3%) patients had unfavorable outcome at 3 months. A total of 194 (75.8%) had at least one complication. The three most common medical complications were pneumonia (53.5%), electrolyte disorder (30.9%), and urinary incontinence (18.4%), and the three most common neurological complications were malignant brain edema (31.2%), hemorrhagic transformation (27.7%), and poststroke seizures (7.0%). Overall, LHI patients with unfavorable outcome had more frequent stroke-related complications (91.4% versus 55.8%, p < 0.001) than patients with favorable outcome. After adjusting for age, baseline National Institutes of Health Stroke Scale score, and other confounders, only malignant brain edema [odds ratios (OR) 19.76, 95% confidence interval (CI) 4.73–82.45] and pneumonia (OR 2.45, 95% CI 1.11–5.40) were independently associated with 3-month unfavorable outcome in patients with LHI.

Conclusions:

More than three-quarters of LHI patients have at least one stroke-related complication. LHI patients with the unfavorable outcome had stroke-related complications more frequently, whereas only malignant brain edema and pneumonia are independently associated with 3-month unfavorable outcome.

Keywords complications, large hemispheric infarction, outcome

Introduction

Large hemispheric infarction (LHI), which constitutes up to 10% of all supratentorial ischemic strokes,¹ is a devastating condition with high mortality and poor functional outcome in most conservatively treated patients.² Several pharmacological strategies have been proposed, but none has been proved by adequate evidence from clinical trials. Until recently, treatment of LHI remained a major unsolved problem in neurocritical care.³ On account of the limitations of medical therapies, decompressive hemicraniectomy (DHC) within 48 h after stroke onset has been proposed as a therapeutic choice for LHI patients with malignant brain edema that is characterized as malignant middle cerebral artery infarction (mMCAI).⁴
It is known that poststroke complications are the leading cause of death, constituting 23–50% of total deaths in ischemic stroke patients.⁵ It has also been reported that poststroke medical and neurological complications may influence not only mortality but also functional outcome.^6,7 Roth and colleagues have indicated that greater neurological deficit is closely related to a higher frequency of complications in stroke patients, and neurological impairment level is the most substantial factor predicting the rate of complications.⁸ As a result, it is reasonable to suspect that stroke-related complications might play an important role in the development of unfavorable outcome in LHI patients.
Nowadays, limited data exist regarding the incidence of stroke-related complications after LHI, and the relationship between stroke-related complications and unfavorable outcome in patients with LHI has not been systematically investigated. One of our published studies mainly discussed the factors associated with favorable outcome in LHI patients.⁹ The present study is a follow-up study aimed at describing the incidence of medical and neurological complications in an LHI cohort, and exploring the impact of these complications on unfavorable outcome in LHI patients.