Reinforce the awareness of prevention of critical cerebral infarction by categories and phases_West China Medical Journal

Authors：

GUO Wen , WU Simiao ,  LIU Ming

Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LIU Ming, Email: wyplmh@hotmail.com

Keywords：

Critical cerebral infarction; Malignant brain edema; Massive cerebral infarction; Severe cerebral infarction; Prevention by categories and phases

DOI：

10.7507/1002-0179.202105120

Video：

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Massive and severe cerebral infarction can lead to a high mortality and disability rate, and it is the bottleneck of preventing and treating cerebrovascular disease. Once the malignant brain edema of massive cerebral infarction or the critical status of severe cerebral infarction occurs, the treatment effect is very poor. Therefore, we should not only focus on the treatment of critical cerebral infarction, but also prevent its occurrence. It is clinically important to prevent the occurrence of this critical condition in advance and to prevent the occurrence of massive cerebral infarction and severe cerebral infarction. This article points out that some patients with massive or severe cerebral infarction can be prevented from becoming critically ill. The definition, key risk factors and corresponding prevention and treatment strategies of critical cerebral infarction have also been proposed. Critical cerebral infarction can be divided into two categories with or without malignant brain edema, and the risk factors and prediction and prevention strategies by categories andphases can be studied separately.

Citation： GUO Wen, WU Simiao, LIU Ming. Reinforce the awareness of prevention of critical cerebral infarction by categories and phases. West China Medical Journal, 2021, 36(6): 701-706. doi: 10.7507/1002-0179.202105120 Copy

1.	Wu S, Wu B, Liu M, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management. Lancet Neurol, 2019, 18(4): 394-405.
2.	Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2019, 394(10204): 1145-1158.
3.	Wang Y, Liao X, Zhao X, et al. Using recombinant tissue plasminogen activator to treat acute ischemic stroke in China: analysis of the results from the Chinese National Stroke Registry (CNSR). Stroke, 2011, 42(6): 1658-1664.
4.	王璐, 畅雪丽, 袁若圳, 等. 重症脑梗死临床特点及相关影响因素研究. 华西医学, 2018, 33(6): 665-672.
5.	吴思缈, 吴波, 郭富强, 等. 重症脑梗死优化诊治方案及流程建议草案. 华西医学, 2019, 34(10): 1096-1108.
6.	吴思缈, 袁若圳, 刘鸣. 应当提倡大面积脑梗死后恶性脑水肿的预防理念及其研究. 中华神经科杂志, 2020, 53(4): 244-249.
7.	郭睿, 于志渊, 吴思缈, 等. 大面积脑梗死恶性脑水肿外科减压术规范化循证治疗建议草案. 中国循证医学杂志, 2021, 21(5): 503-513.
8.	Wu S, Yuan R, Wang Y, et al. Early prediction of malignant brain edema after ischemic stroke. Stroke, 2018, 49(12): 2918-2927.
9.	Volny O, Cimflova P, Lee TY, et al. Permeability surface area product analysis in malignant brain edema prediction - a pilot study. J Neurol Sci, 2017, 376: 206-210.
10.	Wang L, Guo W, Wang C, et al. Dynamic change of neutrophil to lymphocyte ratios and infection in patients with acute ischemic stroke. Curr Neurovasc Res, 2020, 17(3): 294-303.
11.	李昱晓, 周红青, 刘鸣. 大面积脑梗死发生和预后相关因素研究. 华西医学, 2018, 33(6): 684-690.
12.	Bai X, Wang C, Wang L, et al. Association between neutrophil to lymphocyte ratio and malignant brain edema in patients with large hemispheric infarction. Curr Neurovasc Res, 2020, 17(4): 429-436.
13.	Cheng Y, Wu S, Wang Y, et al. External validation and modification of the EDEMA score for predicting malignant brain edema after acute ischemic stroke. Neurocrit Care, 2020, 32(1): 104-112.
14.	Ong CJ, Gluckstein J, Laurido-Soto O, et al. Enhanced detection of Edema in Malignant Anterior Circulation Stroke (EDEMA) score: a risk prediction tool. Stroke, 2017, 48(7): 1969-1972.
15.	Walcott BP, Kuklina EV, Nahed BV, et al. Craniectomy for malignant cerebral infarction: prevalence and outcomes in US hospitals. PLoS One, 2011, 6(12): e29193.
16.	Yuan R, Wu S, Cheng Y, et al. Association between preoperative midline shift growing rate and outcomes of decompressive craniectomy in patients with malignant middle cerebral artery infarction. Curr Neurovasc Res, 2020, 17(2): 131-139.
17.	Maramattom BV, Bahn MM, Wijdicks EF. Which patient fares worse after early deterioration due to swelling from hemispheric stroke?. Neurology, 2004, 63(11): 2142-2145.
18.	Malm J, Bergenheim AT, Enblad P, et al. The Swedish Malignant Middle cerebral artery Infarction Study: long-term results from a prospective study of hemicraniectomy combined with standardized neurointensive care. Acta Neurol Scand, 2006, 113(1): 25-30.
19.	Skoglund TS, Eriksson-Ritzén C, Sörbo A, et al. Health status and life satisfaction after decompressive craniectomy for malignant middle cerebral artery infarction. Acta Neurol Scand, 2008, 117(5): 305-310.
20.	Kimberly WT, Bevers MB, von Kummer R, et al. Effect of IV glyburide on adjudicated edema endpoints in the GAMES-RP trial. Neurology, 2018, 91(23): e2163-e2169.
21.	Sheth KN, Kimberly WT, Elm JJ, et al. Exploratory analysis of glyburide as a novel therapy for preventing brain swelling. Neurocrit Care, 2014, 21(1): 43-51.
22.	Bereczki D, Fekete I, Prado GF, et al. Mannitol for acute stroke. Cochrane Database Syst Rev, 2007, 2007(3): CD001153.
23.	Wu S, Yuan R, Xiong Y, et al. Clinical features, management and outcomes of severe ischaemic stroke in tertiary hospitals in China: protocol for a prospective multicentre registry-based observational study. BMJ Open, 2018, 8(10): e024900.
24.	Sandercock PA, Soane T. Corticosteroids for acute ischaemic stroke. Cochrane Database Syst Rev, 2011, 2011(9): CD000064.
25.	中华医学会神经病学分会神经重症协作组, 中国医师协会神经内科医师分会神经重症专委会. 大脑半球大面积梗死监护与治疗中国专家共识. 中华医学杂志, 2017, 97(9): 645-652.
26.	Li J, Zhang P, Wu S, et al. Impaired consciousness at stroke onset in large hemisphere infarction: incidence, risk factors and outcome. Sci Rep, 2020, 10(1): 13170.
27.	Li J, Zhang P, Wu S, et al. Stroke-related complications in large hemisphere infarction: incidence and influence on unfavorable outcome. Ther Adv Neurol Disord, 2019, 12: 1756286419873264.
28.	Chumbler NR, Williams LS, Wells CK, et al. Derivation and validation of a clinical system for predicting pneumonia in acute stroke. Neuroepidemiology, 2010, 34(4): 193-199.
29.	Masrur S, Smith EE, Saver JL, et al. Dysphagia screening and hospital-acquired pneumonia in patients with acute ischemic stroke: findings from get with the guidelines--stroke. J Stroke Cerebrovasc Dis, 2013, 22(8): e301-e309.
30.	Titsworth WL, Abram J, Fullerton A, et al. Prospective quality initiative to maximize dysphagia screening reduces hospital-acquired pneumonia prevalence in patients with stroke. Stroke, 2013, 44(11): 3154-3160.
31.	张全超, 唐林军, 陈旭华. 肺部感染合并多器官功能衰竭患者的危险因素分析. 白求恩医学杂志, 2017, 15(4): 440-441.
32.	Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults. Circulation, 2017, 135(8): 759-771.
33.	Wang Y, Li Z, Zhao X, et al. Effect of a multifaceted quality improvement intervention on hospital personnel adherence to performance measures in patients with acute ischemic stroke in China: a randomized clinical trial. JAMA, 2018, 320(3): 245-254.
34.	Chen Y, Wright N, Guo Y, et al. Mortality and recurrent vascular events after first incident stroke: a 9-year community-based study of 0.5 million Chinese adults. Lancet Glob Health, 2020, 8(4): e580-e590.
35.	Cheng Y, Liu J, Zhang S, et al. Prior antithrombotic therapy is associated with cerebral microbleeds in ischemic stroke patients with atrial fibrillation and/or rheumatic heart disease. Front Neurol, 2019, 9: 1184.
36.	国家卫生健康委员会脑卒中防治专家委员会房颤卒中防治专业委员会, 中华医学会心电生理和起搏分会, 中国医师协会心律学专业委员会. 中国心源性卒中防治指南(2019). 中华心律失常学杂志, 2019, 23(6): 463-484.
37.	中华医学会外科学分会血管外科学组. 颈动脉狭窄诊治指南. 中国血管外科杂志(电子版), 2017, 9(3): 169-175.
38.	Li J, Zhang P, Tao W, et al. Age-specific clinical characteristics and outcome in patients over 60 years old with large hemispheric infarction. Brain Behav, 2018, 8(12): e01158.
39.	王拥军. 缺血性卒中的二级预防. 中华神经科杂志, 2021, 54(2): 139-148.
40.	Bai Y, Wang YL, Shantsila A, et al. The global burden of atrial fibrillation and stroke: a systematic review of the clinical epidemiology of atrial fibrillation in Asia. Chest, 2017, 152(4): 810-820.
41.	黄从新, 张澍, 黄德嘉, 等. 心房颤动: 目前的认识和治疗建议(2018). 中华心律失常学杂志, 2018, 22(4): 279-346.
42.	符伟国, 王利新, 王玉琦. 颅外段颈动脉狭窄治疗指南. 中国实用外科杂志, 2008(11): 913-915.
43.	吴淼, 杨宏, 鲁杨, 等. 颈动脉不稳定斑块转归的临床观察及随访. 中国老年学杂志, 2016, 36(6): 1349-1351.
44.	胡大一. 重视全民高血压预防. 中华高血压杂志, 2013(1): 1.

1. Wu S, Wu B, Liu M, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management. Lancet Neurol, 2019, 18(4): 394-405.
2. Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2019, 394(10204): 1145-1158.
3. Wang Y, Liao X, Zhao X, et al. Using recombinant tissue plasminogen activator to treat acute ischemic stroke in China: analysis of the results from the Chinese National Stroke Registry (CNSR). Stroke, 2011, 42(6): 1658-1664.
4. 王璐, 畅雪丽, 袁若圳, 等. 重症脑梗死临床特点及相关影响因素研究. 华西医学, 2018, 33(6): 665-672.
5. 吴思缈, 吴波, 郭富强, 等. 重症脑梗死优化诊治方案及流程建议草案. 华西医学, 2019, 34(10): 1096-1108.
6. 吴思缈, 袁若圳, 刘鸣. 应当提倡大面积脑梗死后恶性脑水肿的预防理念及其研究. 中华神经科杂志, 2020, 53(4): 244-249.
7. 郭睿, 于志渊, 吴思缈, 等. 大面积脑梗死恶性脑水肿外科减压术规范化循证治疗建议草案. 中国循证医学杂志, 2021, 21(5): 503-513.
8. Wu S, Yuan R, Wang Y, et al. Early prediction of malignant brain edema after ischemic stroke. Stroke, 2018, 49(12): 2918-2927.
9. Volny O, Cimflova P, Lee TY, et al. Permeability surface area product analysis in malignant brain edema prediction - a pilot study. J Neurol Sci, 2017, 376: 206-210.
10. Wang L, Guo W, Wang C, et al. Dynamic change of neutrophil to lymphocyte ratios and infection in patients with acute ischemic stroke. Curr Neurovasc Res, 2020, 17(3): 294-303.
11. 李昱晓, 周红青, 刘鸣. 大面积脑梗死发生和预后相关因素研究. 华西医学, 2018, 33(6): 684-690.
12. Bai X, Wang C, Wang L, et al. Association between neutrophil to lymphocyte ratio and malignant brain edema in patients with large hemispheric infarction. Curr Neurovasc Res, 2020, 17(4): 429-436.
13. Cheng Y, Wu S, Wang Y, et al. External validation and modification of the EDEMA score for predicting malignant brain edema after acute ischemic stroke. Neurocrit Care, 2020, 32(1): 104-112.
14. Ong CJ, Gluckstein J, Laurido-Soto O, et al. Enhanced detection of Edema in Malignant Anterior Circulation Stroke (EDEMA) score: a risk prediction tool. Stroke, 2017, 48(7): 1969-1972.
15. Walcott BP, Kuklina EV, Nahed BV, et al. Craniectomy for malignant cerebral infarction: prevalence and outcomes in US hospitals. PLoS One, 2011, 6(12): e29193.
16. Yuan R, Wu S, Cheng Y, et al. Association between preoperative midline shift growing rate and outcomes of decompressive craniectomy in patients with malignant middle cerebral artery infarction. Curr Neurovasc Res, 2020, 17(2): 131-139.
17. Maramattom BV, Bahn MM, Wijdicks EF. Which patient fares worse after early deterioration due to swelling from hemispheric stroke?. Neurology, 2004, 63(11): 2142-2145.
18. Malm J, Bergenheim AT, Enblad P, et al. The Swedish Malignant Middle cerebral artery Infarction Study: long-term results from a prospective study of hemicraniectomy combined with standardized neurointensive care. Acta Neurol Scand, 2006, 113(1): 25-30.
19. Skoglund TS, Eriksson-Ritzén C, Sörbo A, et al. Health status and life satisfaction after decompressive craniectomy for malignant middle cerebral artery infarction. Acta Neurol Scand, 2008, 117(5): 305-310.
20. Kimberly WT, Bevers MB, von Kummer R, et al. Effect of IV glyburide on adjudicated edema endpoints in the GAMES-RP trial. Neurology, 2018, 91(23): e2163-e2169.
21. Sheth KN, Kimberly WT, Elm JJ, et al. Exploratory analysis of glyburide as a novel therapy for preventing brain swelling. Neurocrit Care, 2014, 21(1): 43-51.
22. Bereczki D, Fekete I, Prado GF, et al. Mannitol for acute stroke. Cochrane Database Syst Rev, 2007, 2007(3): CD001153.
23. Wu S, Yuan R, Xiong Y, et al. Clinical features, management and outcomes of severe ischaemic stroke in tertiary hospitals in China: protocol for a prospective multicentre registry-based observational study. BMJ Open, 2018, 8(10): e024900.
24. Sandercock PA, Soane T. Corticosteroids for acute ischaemic stroke. Cochrane Database Syst Rev, 2011, 2011(9): CD000064.
25. 中华医学会神经病学分会神经重症协作组, 中国医师协会神经内科医师分会神经重症专委会. 大脑半球大面积梗死监护与治疗中国专家共识. 中华医学杂志, 2017, 97(9): 645-652.
26. Li J, Zhang P, Wu S, et al. Impaired consciousness at stroke onset in large hemisphere infarction: incidence, risk factors and outcome. Sci Rep, 2020, 10(1): 13170.
27. Li J, Zhang P, Wu S, et al. Stroke-related complications in large hemisphere infarction: incidence and influence on unfavorable outcome. Ther Adv Neurol Disord, 2019, 12: 1756286419873264.
28. Chumbler NR, Williams LS, Wells CK, et al. Derivation and validation of a clinical system for predicting pneumonia in acute stroke. Neuroepidemiology, 2010, 34(4): 193-199.
29. Masrur S, Smith EE, Saver JL, et al. Dysphagia screening and hospital-acquired pneumonia in patients with acute ischemic stroke: findings from get with the guidelines--stroke. J Stroke Cerebrovasc Dis, 2013, 22(8): e301-e309.
30. Titsworth WL, Abram J, Fullerton A, et al. Prospective quality initiative to maximize dysphagia screening reduces hospital-acquired pneumonia prevalence in patients with stroke. Stroke, 2013, 44(11): 3154-3160.
31. 张全超, 唐林军, 陈旭华. 肺部感染合并多器官功能衰竭患者的危险因素分析. 白求恩医学杂志, 2017, 15(4): 440-441.
32. Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults. Circulation, 2017, 135(8): 759-771.
33. Wang Y, Li Z, Zhao X, et al. Effect of a multifaceted quality improvement intervention on hospital personnel adherence to performance measures in patients with acute ischemic stroke in China: a randomized clinical trial. JAMA, 2018, 320(3): 245-254.
34. Chen Y, Wright N, Guo Y, et al. Mortality and recurrent vascular events after first incident stroke: a 9-year community-based study of 0.5 million Chinese adults. Lancet Glob Health, 2020, 8(4): e580-e590.
35. Cheng Y, Liu J, Zhang S, et al. Prior antithrombotic therapy is associated with cerebral microbleeds in ischemic stroke patients with atrial fibrillation and/or rheumatic heart disease. Front Neurol, 2019, 9: 1184.
36. 国家卫生健康委员会脑卒中防治专家委员会房颤卒中防治专业委员会, 中华医学会心电生理和起搏分会, 中国医师协会心律学专业委员会. 中国心源性卒中防治指南(2019). 中华心律失常学杂志, 2019, 23(6): 463-484.
37. 中华医学会外科学分会血管外科学组. 颈动脉狭窄诊治指南. 中国血管外科杂志(电子版), 2017, 9(3): 169-175.
38. Li J, Zhang P, Tao W, et al. Age-specific clinical characteristics and outcome in patients over 60 years old with large hemispheric infarction. Brain Behav, 2018, 8(12): e01158.
39. 王拥军. 缺血性卒中的二级预防. 中华神经科杂志, 2021, 54(2): 139-148.
40. Bai Y, Wang YL, Shantsila A, et al. The global burden of atrial fibrillation and stroke: a systematic review of the clinical epidemiology of atrial fibrillation in Asia. Chest, 2017, 152(4): 810-820.
41. 黄从新, 张澍, 黄德嘉, 等. 心房颤动: 目前的认识和治疗建议(2018). 中华心律失常学杂志, 2018, 22(4): 279-346.
42. 符伟国, 王利新, 王玉琦. 颅外段颈动脉狭窄治疗指南. 中国实用外科杂志, 2008(11): 913-915.
43. 吴淼, 杨宏, 鲁杨, 等. 颈动脉不稳定斑块转归的临床观察及随访. 中国老年学杂志, 2016, 36(6): 1349-1351.
44. 胡大一. 重视全民高血压预防. 中华高血压杂志, 2013(1): 1.

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