tailieunhanh - Báo cáo y học: "Clinical review: Therapy for refractory intracranial hypertension in ischaemic stroke"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Clinical review: Therapy for refractory intracranial hypertension in ischaemic stroke. | Available online http content 11 5 231 Review Clinical review Therapy for refractory intracranial hypertension in ischaemic stroke Eric Juttler1 Peter D Schellinger2 Alfred Aschoff3 Klaus Zweckberger3 Andreas Unterberg3 and Werner Hacke1 1 Department of Neurology University of Heidelberg Im Neuenheimer Feld 400 D-69120 Heidelberg Germany 2Department of Neurology University of Erlangen Schwabachanlage 6 D-91054 Erlangen Germany 3Department of Neurosurgery University of Heidelberg Im Neuenheimer Feld 400 D-69120 Heidelberg Germany Corresponding author Eric Juttler Published 25 October 2007 This article is online at http content 11 5 231 2007 BioMed Central Ltd Critical Care 2007 11 231 doi cc6087 Abstract The treatment of patients with large hemispheric ischaemic stroke accompanied by massive space-occupying oedema represents one of the major unsolved problems in neurocritical care medicine. Despite maximum intensive care the prognosis of these patients is poor with case fatality rates as high as 80 . Therefore the term malignant brain infarction was coined. Because conservative treatment strategies to limit brain tissue shift almost consistently fail these massive infarctions often are regarded as an untreatable disease. The introduction of decompressive surgery hemicraniectomy has completely changed this point of view suggesting that mortality rates may be reduced to approximately 20 . However critics have always argued that the reduction in mortality may be outweighed by an accompanying increase in severe disability. Due to the lack of conclusive evidence of efficacy from randomised trials controversy over the benefit of these treatment strategies remained leading to large regional differences in the application of this procedure. Meanwhile data from randomised trials confirm the results of former observational studies demonstrating that hemicraniectomy not only significantly reduces mortality but