Updates in Management of Large Hemispheric Infarct

Abstract

This review delves into updates in management of large hemispheric infarction (LHI), a condition affecting up to 10% of patients with supratentorial strokes. While traditional management paradigms have endured, recent strides in research have revolutionized the approach to acute therapies, monitoring, and treatment. Notably, advancements in triage methodologies and the application of both pharmacological and mechanical abortive procedures have reshaped the acute care trajectory for patients with LHI. Moreover, ongoing endeavors have sought to refine strategies for the optimal surveillance and mitigation of complications, notably space-occupying mass effect, which can ensue in the aftermath of LHI. By amalgamating contemporary guidelines with cutting-edge clinical trial findings, this review offers a comprehensive exploration of the current landscape of acute and ongoing patient care for LHI, illuminating the evolving strategies that underpin effective management in this critical clinical domain.

Fig. 1

Midline shift at septum pellucidum and pineal gland shift on non-contrast CT scans. (A) Midline shift (red line) at the level of septum pellucidum (red dotted line). (B) Pineal gland shift (orange line) at the level of pineal gland (orange dotted line) have been associated with worsened outcome and arousal in large hemispheric infarction.