Top Things to Know: Recommendations for the Management of Cerebral and Cerebellar Infarction with Swelling

Published: January 30, 2014

This statement explores the concepts and potential treatments for persons with large territory ischemic strokes.
Brain swelling as one complication from this syndrome can become a critical area for treatment in this illness.
The pathophysiology and timeframe of the formation of brain edema are discussed.
The true estimate of frequency with which brain swelling occurs is difficult to ascertain due to variations in the definition. Standardized definitions are recommended.
Identifying patients at high risk for the development of brain swelling should include clinical and neuroimaging information.
Care of these complex patients included the following:
- Medical management
  i. Management of airway and mechanical ventilation
  ii. Control of blood pressure
  iii. Management of fluids
  iv. Glucose control
  v. Temperature control
This statement discusses the role of intracranial pressure (ICP) monitoring and cerebral spinal fluid (CSF) diversion.
Decompressive craniectomy is discussed in the setting of neurological deterioration.
This statement discusses the role of decompressive craniectomy in persons with cerebellar infarction.
Functional outcomes after are addressed after decompressive craniectomy.

View the summary for Recommendations for the Management of Cerebral and Cerebellar Infarction with Swelling

Citation

Wijdicks EFM, Sheth KN, Carter BS, Greer DM, Kasner SE, Kimberly WT, Schwab S, Smith EE, Tamargo RJ, Wintermark M; on behalf of the American Heart Association Stroke Council. Recommendations for the management of cerebral and cerebellar infarction with swelling: a statement for healthcare professionals from the American Heart Association/American Stroke Association. [published online ahead of print January 30, 2014]. Stroke. doi: 10.1161/str.0000441965.15164.d6.
http://stroke.ahajournals.org/content/45/4/1222