What is malignant MCA infarction?
1-MCA infarction involving>50-60% of MCA territory
2-edema with mass effect and midline shift
3-progressive neurological deterioration
Why the term malignant in MCA malignant infarction?
Because natural history is disastrous:
Mortality 70–80% with medical therapy alone
Death usually from transtentorial herniation within 2–5 days
What is midline shift?
Displacement of midline structures (usually septum pellucidum) from the ideal midline.
What is the interpretation of midline shift?
<3mm=mild
3-5mm=moderate
> 5mm=severe/surgical threshold
> 10mm=critical/herniation risk
What is Monroe Kellie doctrine?
The Monro–Kellie doctrine states that the cranial cavity is a fixed-volume space containing brain tissue, blood, and CSF, such that an increase in one component must be offset by a decrease in another or intracranial pressure will rise.
Brain parenchyma=80%
Blood=10%
CSF=10%
