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'Malignant'Middle Cerebral Artery Territory Infarction Arch Neurol 53:309-315, Macke,W.,et al, 1996 See this aricle in Pubmed Article Abstract Fifty-five patients with complete middle cerebral artery territory infarction caused by occlusion of either the distal intracranial carotid artery or the proximal middle cerebral artery trunk were studied.In all patients,emoblic infarction was presumed.The mean Scandinavian Stroke Scale score on admission was 20,and the time course of deterioration varied between 2 and 5 days.Forty-nine patients required ventilator assistance during the acute stage of disease.Only 12 patients(22%)survived the infarct.The cause of death was transtentorial herniation with subsequent brain death in 43 patients.Survivors had a mean Barthel index score of 60(range,45 to 70).The prognosis of complete middle cerebral artery territory stroke is very poor and can be estimated by early clinical and neuroradiological data within the first few hours after the onset of symptoms.A space-occupying mass effect develops rapidly and predictably over the initial 5 days after presentation.Herniation occurred as an end point in 43(78%)of these patients.

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