Later midline shift is associated with better post-hospitalization discharge status after large middle cerebral artery stroke
Abstract Space occupying cerebral edema is a feared complication after large ischemic stroke, occurring in up to 30% of patients with middle cerebral artery (MCA) occlusion and peaking 2–4 days after injury. Little is known about the factors and outcomes associated with peak edema timing, especially...
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Nature Portfolio
2025-04-01
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| author | Jonathan J. Song Rebecca A. Stafford Jack E. Pohlmann Ivy So Yeon Kim Maanyatha Cheekati Sydney Dennison Benjamin Brush Stefanos Chatzidakis Qiuxi Huang Stelios M. Smirnakis Emily J. Gilmore Shariq Mohammed Mohamad Abdalkader Emelia J. Benjamin Josée Dupuis David M. Greer Charlene J. Ong |
| author_facet | Jonathan J. Song Rebecca A. Stafford Jack E. Pohlmann Ivy So Yeon Kim Maanyatha Cheekati Sydney Dennison Benjamin Brush Stefanos Chatzidakis Qiuxi Huang Stelios M. Smirnakis Emily J. Gilmore Shariq Mohammed Mohamad Abdalkader Emelia J. Benjamin Josée Dupuis David M. Greer Charlene J. Ong |
| author_sort | Jonathan J. Song |
| collection | DOAJ |
| description | Abstract Space occupying cerebral edema is a feared complication after large ischemic stroke, occurring in up to 30% of patients with middle cerebral artery (MCA) occlusion and peaking 2–4 days after injury. Little is known about the factors and outcomes associated with peak edema timing, especially after 96 h. We aimed to characterize differences and compare discharge status between patients who experienced maximum midline shift (MLS) or decompressive hemicraniectomy (DHC) in the acute (< 48 h), average (48–96 h), and subacute (> 96 h) groups. We performed a two-center, retrospective study of patients with ≥ 1/2 MCA territory infarct and MLS. We constructed a multivariable model to test the association of subacute peak edema and favorable discharge status, adjusting for various confounders. Of 321 eligible patients, 32%, 36%, and 32% experienced acute, average, and subacute peak edema. Subacute peak edema was significantly associated with higher odds of favorable discharge than acute peak edema (aOR, 2.05; 95% CI, 1.03–4.11). Subacute peak edema after large MCA stroke is associated with better discharge status compared to acute peak edema courses. Understanding how the timing of cerebral edema affects risk of unfavorable discharge has important implications for treatment decisions and prognostication. |
| format | Article |
| id | doaj-art-1c4994e81bd343bf9936b1bbe5058790 |
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| issn | 2045-2322 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj-art-1c4994e81bd343bf9936b1bbe50587902025-08-20T02:08:08ZengNature PortfolioScientific Reports2045-23222025-04-0115111010.1038/s41598-025-95954-3Later midline shift is associated with better post-hospitalization discharge status after large middle cerebral artery strokeJonathan J. Song0Rebecca A. Stafford1Jack E. Pohlmann2Ivy So Yeon Kim3Maanyatha Cheekati4Sydney Dennison5Benjamin Brush6Stefanos Chatzidakis7Qiuxi Huang8Stelios M. Smirnakis9Emily J. Gilmore10Shariq Mohammed11Mohamad Abdalkader12Emelia J. Benjamin13Josée Dupuis14David M. Greer15Charlene J. Ong16Department of Neurology, Boston University Chobanian and Avedisian School of MedicineDepartment of Neurology, Boston Medical CenterDepartment of Neurology, Boston Medical CenterDepartment of Neurology, Boston Medical CenterDepartment of Biostatistics, School of Public Health, Boston UniversityDepartment of Biostatistics, School of Public Health, Boston UniversityDepartment of Neurology, NYU Langone Medical CenterDepartment of Neurology, Brigham and Women’s Hospital, Harvard Medical SchoolDepartment of Biostatistics, School of Public Health, Boston UniversityDepartment of Neurology, Brigham and Women’s Hospital, Harvard Medical SchoolDepartment of Neurology, Yale School of MedicineDepartment of Biostatistics, School of Public Health, Boston UniversityDepartment of Radiology, Boston Medical CenterDepartment of Epidemiology, Boston University School of Public HealthDepartment of Biostatistics, School of Public Health, Boston UniversityDepartment of Neurology, Boston University Chobanian and Avedisian School of MedicineDepartment of Neurology, Boston University Chobanian and Avedisian School of MedicineAbstract Space occupying cerebral edema is a feared complication after large ischemic stroke, occurring in up to 30% of patients with middle cerebral artery (MCA) occlusion and peaking 2–4 days after injury. Little is known about the factors and outcomes associated with peak edema timing, especially after 96 h. We aimed to characterize differences and compare discharge status between patients who experienced maximum midline shift (MLS) or decompressive hemicraniectomy (DHC) in the acute (< 48 h), average (48–96 h), and subacute (> 96 h) groups. We performed a two-center, retrospective study of patients with ≥ 1/2 MCA territory infarct and MLS. We constructed a multivariable model to test the association of subacute peak edema and favorable discharge status, adjusting for various confounders. Of 321 eligible patients, 32%, 36%, and 32% experienced acute, average, and subacute peak edema. Subacute peak edema was significantly associated with higher odds of favorable discharge than acute peak edema (aOR, 2.05; 95% CI, 1.03–4.11). Subacute peak edema after large MCA stroke is associated with better discharge status compared to acute peak edema courses. Understanding how the timing of cerebral edema affects risk of unfavorable discharge has important implications for treatment decisions and prognostication.https://doi.org/10.1038/s41598-025-95954-3Midline shiftMiddle cerebral arteryCerebral edemaTimingMass effectSwelling |
| spellingShingle | Jonathan J. Song Rebecca A. Stafford Jack E. Pohlmann Ivy So Yeon Kim Maanyatha Cheekati Sydney Dennison Benjamin Brush Stefanos Chatzidakis Qiuxi Huang Stelios M. Smirnakis Emily J. Gilmore Shariq Mohammed Mohamad Abdalkader Emelia J. Benjamin Josée Dupuis David M. Greer Charlene J. Ong Later midline shift is associated with better post-hospitalization discharge status after large middle cerebral artery stroke Scientific Reports Midline shift Middle cerebral artery Cerebral edema Timing Mass effect Swelling |
| title | Later midline shift is associated with better post-hospitalization discharge status after large middle cerebral artery stroke |
| title_full | Later midline shift is associated with better post-hospitalization discharge status after large middle cerebral artery stroke |
| title_fullStr | Later midline shift is associated with better post-hospitalization discharge status after large middle cerebral artery stroke |
| title_full_unstemmed | Later midline shift is associated with better post-hospitalization discharge status after large middle cerebral artery stroke |
| title_short | Later midline shift is associated with better post-hospitalization discharge status after large middle cerebral artery stroke |
| title_sort | later midline shift is associated with better post hospitalization discharge status after large middle cerebral artery stroke |
| topic | Midline shift Middle cerebral artery Cerebral edema Timing Mass effect Swelling |
| url | https://doi.org/10.1038/s41598-025-95954-3 |
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