Mass effect with cerebral infarction

Despite the intensive care management of patients with large cerebral infarcts, mortality rates remain high. Conservative medical management is largely ineffective in this population. Patients at high risk for the development of massive brain edema can be identified within the first few hours of onset. This is important to remember because therapeutic benefit may require early intervention, before the brain is displaced by edema. Induced moderate hypothermia (328C to 338C) and hemicraniectomy with durotomy or duroplasty are two promising therapeutic strategies that may reduce mortality rates and improve outcomes if they are performed before irreversible brain stem injury occurs.