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In most cases clinical deterioration started on the third day after stroke,and a comatose state was reached within 24 hours.Sixteen patients were treated medically,and 30 by suboccipital craniectomy(22 plus ventriculostomy,12 plus tonsillectomy).Ten patients primarily had ventriculostomy which in 4 patients was supplemented by craniotomy because of continuing deterioration.Twenty-nine patients made a good recovery,15 remained disabled and 8 died.Even comatose patients had a 38%chance of a good recovery with decompressive surgery.Age older than 60 years(P=.0043) and probably initial brain stem signs(P=.0816)and a late clinical stage (P=.0893)were linked with a fatal or disabling outcome.Decompressive surgery should be the treatment of choice for massive cerebellar infarction causing progressive brain stem signs or impairment of consciousness. |
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