Overview
Large hemispheric infarction (LHI) involves significant damage to one cerebral hemisphere, often leading to severe neurological deficits and high mortality rates. The condition can be complicated by cerebral edema and increased intracranial pressure (ICP), impacting patient outcomes 12.Diagnosis
Clinical Presentation: Severe neurological deficits, altered consciousness levels.
Imaging: MRI or CT showing large area of infarction in one cerebral hemisphere.
EEG Monitoring: Non-α frequency on the non-infarct side and seizure activity at 6-14 days post-onset may predict poor prognosis 1.
Intracranial Pressure (ICP) Monitoring: Useful in assessing for elevated ICP, though not universally elevated in all cases 2.Management
Initial Supportive Care: Management of intracranial hypertension, including monitoring and supportive measures to maintain cerebral perfusion pressure (CPP).
ICP-Lowering Therapies: Consideration of therapies like osmotherapy (e.g., mannitol) if ICP is elevated, though caution is advised to avoid rebound ICP elevations 2.
Seizure Control: Anticonvulsants for seizure activity, particularly if identified as an independent risk factor 1.
Neurological Monitoring: Continuous monitoring for signs of deterioration and adjustment of management strategies accordingly.Special Populations
Elderly: Higher risk of complications and poorer outcomes; tailored supportive care and close monitoring essential 2.
Comorbidities: Presence of additional conditions like hypertension or diabetes may influence management strategies, emphasizing control of underlying risk factors 2.Key Recommendations
Monitor EEG for Non-α Frequency and Seizure Activity at 6-14 days post-onset to assess prognosis (Evidence: Moderate) 1.
Consider ICP Monitoring in patients showing signs of deterioration to guide management decisions, despite variability in ICP elevation (Evidence: Moderate) 2.
Implement Osmotherapy cautiously in cases where ICP elevation is confirmed, balancing the risk of rebound ICP increases (Evidence: Moderate) 2.References
1 Jing XJ, Zhou X, Zan ZY, Luo J, Li F, Zhang H. The value of electroencephalography features in the prognostic evaluation of large hemispheric infarction patients at different time intervals. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 2025. link
2 Frank JI. Large hemispheric infarction, deterioration, and intracranial pressure. Neurology 1995. link