Evoked Potentials in Acute Ischemic Stroke within the First 24 h: Possible Predictor of a Malignant Course

Abstract

This study shows that in patients suffering from large MCA infarction early assessment of EP within 24 h after onset of stroke may deliver useful information to select those patients who develop malignant edema.

Recommendations for the Management of Cerebral and Cerebellar Infarction With Swelling

“…29,61,62 Other descriptions include effacement of the ipsilateral sulci and lateral ventricle 63 and CT signs of elevated ICP. 64 Most commonly, the degree of midline shift is used as the benchmark for radiographic deterioration, either undefined 16,60,65 or specified as >5 mm at the level of septum pellucidum, 19,41,47,[66][67][68] >2 mm at the level of septum pellucidum or pineal gland, 69,70 or >10 mm. 71 Although all these arbitrary parameters are indicative of tissue shift, further development and validation of serial CT measures that identify patients at highest risk of clinical deterioration are required.…”

Malignant MCA Stroke: an Update on Surgical Decompression and Future Directions

“…Carotid occlusions with ipsilateral abnormal circle of Willis as well as marginal leptomeningeal collateral supply have also been suggested as risk factors [42]. Nonetheless, in several other cohorts, age and NIHSS do not seem to differ significantly regardless of a malignant course [3,45,46]. Interestingly, initial intracranial pressure (ICP) measurements do not significantly and uniformly differentiate those with and without malignant course [33].…”

“…Infarct volume size [6,34,37,38,40,41,44,47,48], intracranial volume reserve [6,43,49], infarct permeability area [40], severity of ischemia [34,50], collateral supply [39,48], clot burden [39,48], presence of a prominent anterior temporal artery on imaging [51], lower extracellular levels of nontransmitter amino acids in the perilesional tissue [33], multimodality monitoring to assess cerebral autoregulation [45,52], impairment of autonomic regulation [53], specific electroencephalographic patterns [54,55], and pathologic brainstem auditory evoked potential responses [46] have all been proposed as potential biomarkers of developing MMI. Several different studies strived to identify the most accurate methods for quantifying the infarct extent, collateral supply, and surrogates for pre-existing atrophy.…”

Somatosensory and Brainstem Auditory Evoked Potentials Assessed between 4 and 7 Days after Severe Stroke Onset Predict Unfavorable Outcome

“…Evoked potentials (EPs) have been widely utilized to predict the outcome of patients with acute severe strokes. Although previous studies have reviewed various timings, that is, within 7 days, 10 to 15 days, 30 days, 10 weeks, and 3 months after stroke onset [ 1 – 6 ], precise timing at early stage remains unclear. Physicians often prefer earlier predictions on prognosis in order to improve treatment strategies.…”