London, United Kingdom 2013 12 Acute stroke: emergency management, stroke units and complications B 10:50 - 11:00 Surgical decompression for space-occupying hemispheric infarction: outcomes at three years in the randomised HAMLET trial M. Geurts1, H.B. van der Worp2, L.J. Kappelle3, G.J. Amelink4, A. Algra5, J. Hofmeijer6 for the HAMLET investigators University Medical Centre Utrecht, Utrecht, THE NETHERLANDS1,University Medical Centre Utrecht, Utrecht, THE NETHERLANDS2, University Medical Centre Utrecht, Utrecht, THE NETHERLANDS3, University Medical Centre Utrecht, Utrecht, THE NETHERLANDS4, Univeristy Medical Centre Utrecht, Utrecht, THE NETHERLANDS5, Rijnstate Hospital, Arn-hem, Cerebrovasc Dis 2013; 35 (suppl 3)1-854 113 THE NETHERLANDS6 Background: In selected patients with space-occupying hemispheric infarction, early surgical decompression after symptom onset reduces the risk of death or poor functional outcome at one year. We assessed whether the effects of surgery are sustained at three years. Methods: Patients with space-occupying hemispheric infarction who had been randomised to surgical decompression or best medical treatment in the Hemicraniectomy After Middle Ce-rebral Artery infarction with Life-threatening Edema Trial (HAMLET) within four days after stroke onset were followed-up until three years after randomisation. Outcome measures includ-ed functional outcome (modified Rankin Scale (mRS)), activities of daily living (Barthel Index (BI)), death, quality of life (short form-36 (SF-36)), and place of residence. The score on the mRS was dichotomised between good (0-3) and poor (4-6) functional outcome. Outcomes at three years were compared with those at one year. Results: Of 64 patients included in HAMLET, 32 were randomised to decompressive surgery. As had been the case at one year, surgical decompression initiated within 96 hours had no effect on the risk of poor functional outcome at three years (absolute risk reduction (ARR), 1%; 95% CI, -21 to 22), but did reduce case fatality (ARR, 37%; 95% CI 14 to 60). In contrast to con-trols, patients treated with surgical decompression had improvement in their scores on the BI between one and three years (medians, 55 vs. 70; p 0.016), as well as on the mean SF-36 phys-ical summary score. More surgically treated patients than controls lived at home at three years (absolute increase, 27%; 95% CI, 4 to 50). Results for the 39 patients randomised within 48 hours were comparable. Conclusion: In patients with space-occupying infarction the benefit of decompressive surgery for survival was sustained at three years. Patients treated with surgery improve between one and three years with regard to the level of disability and quality of life. 11 Acute stroke: emergency management, stroke units and complications B 10:40 - 10:50 Describing the Malignant Infarction of the Middle Cerebral Artery Syndrome (MIMCA) in the pediatric population. A. Andrader1, I. Yau2, G. deVeber3 The Hospital for Sick Children/University of Toronto, Toronto, CANADA1,The Hospital for Sick Children/University of Toronto, Toronto, CANADA2, The Hospital for Sick Children/ University of Toronto, Toronto, CANADA3 Background: Large hemispheric strokes have a high risk of fatal cerebral edema and brain herniation. This syndrome has been described as “Malignant infarction of the middle cerebral artery” (MIM-CA), this is a common complication of arterial ischemic stroke seen in the adult population. Recent studies have been done trying to identify clinical and radiological predictors for MIM-CA. The early recognition is associated with better outcome. The description of this syndrome in the pediatric population is very scarce. The goal for the study is to identify possible clinical, radiological and electrographic features associated with MIMCA syndrome in children. Patients and Methods: We identified patients with a definite diagnosis of arterial ischemic stroke of the middle cere-bral artery (MCA) and who developed cerebral edema requiring hemicraniectomy. Results: We identified 117 children carrying the diagnosis of stroke at the Stroke Program at the Hospi-tal for Sick Children, from January 2008 to September 2012. 68 (58%) had arterial ischemic stroke (AIS), and 30 (44%) had MCA AIS. We identified 8 patients that developed MIMCA. Amongst these, 6/8 were boys and 2/8 were girls. The mean age was 10 years (range from 3 to 15). The most common etiology was cardioembolic (5/8). The Neurological Institutes of Health Stroke Scale for pediatrics(PedsNIHSS) was applied retrospectively: a score equal or above 10 points was consider moderate to severe neurological deficit at presentation, a score less than 10 was considered mild deficit. (see table 1) The radiologic, electrographic and hemicraniectomy timing and neurological outcomes are summarized in table 2. Discussion Although MIMCA is rare in children, its early recognition and prompt surgical management could be related with a better neurological outcome. The presence of a hyperdense MCA sign on initial head CT, seizures and a score equal or higher than 10 at the PedsNHISS are frequent-ly seen in children with MIMCA.
Karger_ESC London_2013
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