Catharina Keller and Henning Stetefeld
Although the latest trials (DESTINY, DESTINY II, HAMLET, DECIMAL) have provided evidence that
decompressive hemicraniectomy in malignant MCA infarction (MMI) can improve survival rates and neurological
outcomes, the decision for or against the procedure remains challenging in respect of the inclusion and exclusion
criteria, such as the definition of MMI, severity of symptoms at stroke onset and neuroimaging findings.
This report focuses on a young patient who suffered an MMI of the right hemisphere. Because of a rapid
deterioration in the clinical symptoms, we decided to perform an early decompressive hemicraniectomy after 24h.
The patient survived without any complications, and with a favourable outcome (mRS 1).
The case shows that young patients in particular can have a remarkable potential for full recovery after an MMI,
and that the benefits of surgery outweigh the risks, provided that 1) the hemicraniectomy is performed promptly
(after careful consideration of whether brain swelling might occur soon after MMI), and 2) the elective brain territories
have not yet been affected.