DRAMATIC REVERSAL OF THE UNCAL SYNDROME AND BRAIN EDEMA FROM INFARCTION IN THE MIDDLE CEREBRAL-ARTERY TERRITORY

Brain edema following ischemic stroke often results in significant mor bidity and death. Decompressive craniotomy has been advocated and may result in a surprisingly satisfactory outcome. We present a 17-year-ol d patient who developed a right middle cerebral artery territory infar ction associated with a cardiac myxoma, Five days after the ictus and two days after a thoracotomy to remove the obstructing tumor, he devel oped clinical signs of uncal herniation, CT scans showed massive cereb ral edema and development of obstructive hydrocephalus. An intracrania l pressure monitor measured 30 mmHg on insertion. Management with mann itol reversed the clinical and radiologic signs of uncal herniation. T here is a renewed interest in decompressive craniotomy. Our patient in dicates that conventional management of increased intracranial pressur e may reverse brain edema when associated with hemispheric infarction, Decompressive craniotomy needs validation in a randomized trial.