The earliest warning signs for developing malignant infarction include involvement of an area larger than 50% of the MCA territory and an infarct extending also to the anterior or posterior cerebral artery territories.
Because of an increasing number of young patients suffering from brain infarction (a group of patients at particular danger of malignant infarction), finding an optimal treatment solution has made this a most urgent topic in neurointensive care medicine during the last decade.
There is also some evidence that other factors such as blood brain barrier breakdown may be instrumental in the development of malignant infarction [ 99].
Indeed, a plasmatic S100β level >1.03 μg/l at 24 hours after the onset of stroke predicts malignant infarction in patients with proximal middle cerebral artery occlusion, with a sensitivity of 94% and a specificity of 83% [ 95].
In fact, patients with malignant infarction syndrome have to be aggressively treated, regardless of any quantitative element we could measure.
Imaging studies are the mainstay for identification of people at higher risk for malignant infarction among the ischemic stroke population.
Malignant infarction, characterized by life-threatening cerebral edema, occurs in 1 10 % of patients with supratentorial infarctions, usually within 2 5 days of the ictus, and is associated with a mortality rate of almost 80%% [ 2– 4].
Complications following DC after malignant infarction include haematomas, meningitis, seizures and wound infections.
In malignant infarctions, there are large areas where the blood-brain barrier is significantly disrupted.
Cerebral edema is also associated with poor patient outcomes, even in the context of non-malignant infarction volumes [ 5].
