Clinical Course Of Massive Cerebral Infarction

Clinically, the most common cause of malignant MCA infarction is when there is a large clot burden (carotid-T occlusion) that involves the terminal internal carotid artery, MCA, and anterior cerebral artery, which produces ischemia of the MCA territory and, quite often, the anterior cerebral artery or anterior choroidal artery territories. Neurologic findings include homony-mous hemianopsia due to anterior choroidal artery involvement or flaccid hemiplegia that equally involves the leg and arm due to anterior cerebral artery involvement. Often, these patients exhibit head turning and gaze deviation to the affected hemisphere secondary to involvement of frontal eye fields. Global aphasia due to involvement of the dominant hemisphere or hemispatial neglect due to the involvement of the nondominant hemisphere can all be highly disabling (3,4). Early identification of patients who are susceptible to malignant MCA infarction is crucial for appropriate selection of medical and surgical interventions.

The clinical symptoms of worsening neurologic status following a large hemisphere infarction are mainly due to focal ischemic brain edema and focal displacement of brain, rather

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