Department of Neurosurgery, University of Maryland School of Medicine, 22 S. Greene St., Suite S12D, Baltimore, MD, 21201-1595, USA.
Curr Treat Options Neurol. 2011 Apr;13(2):217-29. doi: 10.1007/s11940-010-0110-9.
Managing patients with malignant cerebral infarction remains one of the foremost challenges in medicine. These patients are at high risk for progressive neurologic deterioration and death due to malignant cerebral edema, and they are best cared for in the intensive care unit of a comprehensive stroke center. Careful initial assessment of neurologic function and of findings on MRI, coupled with frequent reassessment of clinical and radiologic findings using CT or MRI are mandatory to promote the prompt initiation of treatments that will ensure the best outcome in these patients. Significant deterioration in either neurologic function or radiologic findings or both demand timely treatment using the best medical management, which may include osmotherapy (mannitol or hypertonic saline), endotracheal intubation, and mechanical ventilation. Under appropriate circumstances, decompressive craniectomy may be warranted to improve outcome or to prevent death.
管理恶性脑梗死患者仍然是医学领域面临的首要挑战之一。这些患者由于恶性脑水肿而存在进行性神经功能恶化和死亡的高风险，最好在综合卒中中心的重症监护病房中进行治疗。仔细评估初始神经功能和 MRI 结果，结合使用 CT 或 MRI 频繁重新评估临床和影像学发现，这对于促进及时开始治疗至关重要，可确保这些患者获得最佳结局。神经功能或影像学发现的显著恶化或两者均需要及时使用最佳的医学治疗，包括渗透性治疗（甘露醇或高渗盐水）、气管插管和机械通气。在适当的情况下，可能需要去骨瓣减压术以改善结局或预防死亡。
