Specific clinical presentation of malignant ischemic infarction in the territory supplied by the middle cerebral artery

Malignant ischemic infarction in the territory supplied by the middle cerebral artery (MCA) is manifested by development of a massive postischemic edema of the affected cerebral hemisphere, resulting in dislocation syndrome.

OBJECTIVE. The aim is to study the specific clinical presentation of malignant ischemic infarction.

MATERIALS AND METHODS: Case histories of 34 patients presented with malignant ischemic infarction in the middle cerebral artery territory were analyzed.

RESULTS. A dominant clinical feature of the disease in this category of patients presented with malignant ischemic infarction is development of the general cerebral syndrome manifested as depressed level of consciousness, which is decisive for the choice of the surgical technique. Another characteristic is development of marked focal symptoms, predominantly function loss symptoms. Irritation symptoms such as Jacksonian march are not typical. Postischemic edema of a cerebral hemisphere was progressing in 8.8 % starting from the first day of admission to hospital, and in 91.2 % of patients starting from the second day from the onset of infarction. The maximum aggravation of postinschemic edema was observed at Day 7. Stabilization of the status of postischemic edema of the cerebral hemisphere occurred in the period from Day 7 through Day 15 after the onset of infarction; regression of the postischemic cerebral edema in the patients was noted starting from Day 15.

CONCLUSION. Malignant ischemic infarction in the MCA territory is the most severe form of ischemic infarction resulting in constant disability of patients; the clinical presentation is dominated by general cerebral syndrome manifested as depression of consciousness.

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