malignant MCA syndrome
Severe middle cerebral artery stroke with significant brain swelling leading to elevated intracranial pressure and herniation risk.
Full Definition
Malignant MCA syndrome refers to massive middle cerebral artery territory infarction involving more than 50% of the MCA distribution, typically occurring in young patients with occlusion of the proximal MCA or internal carotid artery. The syndrome is characterized by rapid development of cytotoxic edema, elevated intracranial pressure, and high risk of transtentorial herniation, usually within 24-48 hours of stroke onset. Clinical features include progressive obtundation, contralateral hemiplegia, gaze deviation, and often early neurological deterioration despite initial alertness. Without intervention, mortality approaches 80%. Treatment options include osmotic therapy, positioning, and most importantly, decompressive hemicraniectomy, which can significantly reduce mortality when performed within 48 hours of symptom onset, particularly in patients under 60 years of age.
Usage
Usage note: Specific syndrome requiring rapid recognition and intervention; often abbreviated as malignant MCA.
In Context
- "The patient developed malignant MCA syndrome requiring emergent hemicraniectomy." — Stroke team consultation
- "CT showed early signs of malignant MCA syndrome with midline shift and effacement of cisterns." — Radiology interpretation