Deans' stroke musings: Net Water Uptake Calculated in Standardized and Blindly Outlined Regions of the Middle Cerebral Artery Territory Predicts the Development of Malignant Edema in Patients With Acute Large Hemispheric Infarction

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.

Thursday, March 18, 2021

Net Water Uptake Calculated in Standardized and Blindly Outlined Regions of the Middle Cerebral Artery Territory Predicts the Development of Malignant Edema in Patients With Acute Large Hemispheric Infarction

Useless. You described a problem, offered NO SOLUTION.

Net Water Uptake Calculated in Standardized and Blindly Outlined Regions of the Middle Cerebral Artery Territory Predicts the Development of Malignant Edema in Patients With Acute Large Hemispheric Infarction

Hai-Bin Xu¹,

Yu-Fei Sun¹,

Na Luo¹,

Jia-Qi Wang¹,

Guo-Can Chang¹,

Lin Tao¹,

Ben-Qiang Yang² and

Hui-Sheng Chen¹^*

¹Department of Neurology, General Hospital of Northern Theater Command, ShenYang, China
²Department of Radiology, General Hospital of Northern Theater Command, ShenYang, China

Background and purpose: Previous studies have demonstrated that Net Water Uptake (NWU) is associated with the development of malignant edema (ME). The current study aimed to investigate whether NWU calculated in standardized and blindly outlined regions of the middle cerebral artery can predict the development of ME.

Methods: We retrospectively included 119 patients suffering from large hemispheric infarction within onset of 24 h. The region of the middle cerebral artery territory was blindly outlined in a standard manner to calculate NWU. Patients were divided into two groups according to the occurrence of ME, which is defined as space-occupying infarct requiring decompressive craniotomy or death due to cerebral hernia in 7 days from onset. The clinical characteristics were analyzed, and the receiver operating characteristic curve (ROC curve) was used to assess the predictive ability of NWU and other factors for ME.

Results: Multivariable analysis showed that NWU was an independent predictor of ME (OR 1.168, 95% CI 1.041–1.310). According to the ROC curve, NWU≥8.127% identified ME with good predictive power (AUC 0.734, sensitivity 0.656, specificity 0.862).

Conclusions: NWU calculated in standardized and blindly outlined regions of the middle cerebral artery territory is also a good predictor for the development of ME in patients with large hemispheric infarction.

Introduction

Stroke has become a leading cause of mortality and disability worldwide, and it brings huge economic costs and family burdens (1). Acute ischemic stroke accounts for about 80% of all types of stroke (2). Large hemispheric infarction (LHI) is defined as affecting the majority of or complete middle cerebral artery (MCA) territory with or without anterior cerebral artery and posterior cerebral artery involvement (3). It is a disastrous subtype of acute ischemic stroke, which may lead to life-threatening swelling (4). Furthermore, LHI patients with malignant edema (ME) develop a mortality rate of nearly 40 ~ 80% under standard treatment, while mortality of those without ME is nearly 5 ~ 25% (3, 5, 6). It has been demonstrated by previous studies that timely decompressive craniotomy may reduce the mortality of LHI patients with ME (7, 8). Thus, early identification of LHI patients at risk for ME should be anticipated (3, 9).

There have been several studies exploring valid predictors of ME in LHI patients, such as the National Institutes of Health Stroke Scale (NIHSS), presence of hyperdense artery sign, a higher level of blood glucose, decreased level of consciousness, early infarct signs, intracranial cerebrospinal fluid volume, fluid balance variations, collateral circulation (10–17).

Interestingly, in 2018, Broocks' team found that Net Water Uptake (NWU) on baseline Computed Tomography (CT) was an important predictor of ME in LHI patients (9). Since then, accumulating evidence demonstrates that NWU can be used as an important qualified biomarker of edema in ischemic stroke. For example, NWU was used to estimate final infarction volumes (18), which serves as an indicator of “tissue clock” instead of the real “time clock” (19), and predicted the effect of recanalization (20) and early bleeding risk after endovascular treatment, especially with low ASPECTS (21). However, the measurement of NWU in previous studies mainly depends on CT perfusion (CTP) (9, 18–21). However, not all stroke centers have access to CTP in clinical practice. In this study, we aimed to investigate, whether NWU calculated in standardized and blindly outlined regions of the MCA territory is a reliable predictor of ME in patients with LHI.