Demographics, Clinical Profile, and Outcome Correlations in Patients With Massive Cerebral Infarction: A Retrospective Study

Abstract

Background: Massive cerebral infarction (MCI), typically affecting over two-thirds of a major cerebral artery territory, most often the middle cerebral artery (MCA), is among the most devastating forms of ischemic stroke. It leads to extensive neuronal death, malignant cerebral edema, and elevated intracranial pressure, frequently resulting in rapid clinical deterioration, herniation, and death. Understanding how demographic, clinical, and radiological factors influence prognosis in MCI is essential for improving care strategies and public health interventions.

Study: A retrospective observational study was conducted at Madras Medical College, Chennai, from May 2024 to May 2025, including 110 adult patients with radiologically confirmed MCI. Inclusion criteria were infarctions involving at least two-thirds of MCA, anterior cerebral artery (ACA), posterior cerebral artery (PCA), or combined territories, confirmed by CT or MRI. Data were collected on demographics, comorbidities, neurological status at presentation, radiological features, treatment modalities, complications, and discharge outcomes. Functional outcome was assessed using the modified Rankin Scale (mRS), with scores of 0-4 defined as a good outcome. Statistical analysis was performed using IBM SPSS Statistics, with chi-square tests and correlation analyses to determine associations between variables and outcomes. The primary objective was to identify clinical and radiological predictors of mortality and poor functional outcome.

Results: The mean age was 61.8 years; 58.2% were male, and 70.9% had hypertension. Only 23.6% of patients arrived at the hospital within six hours of symptom onset. Early presentation correlated significantly with favorable outcomes (p = 0.0008). MCA territory infarction was most common (70.9%), and midline shift >5 mm was present in 36.4%. Dominant hemisphere involvement and hemorrhagic transformation were also frequent and associated with worse outcomes. Neurologically, 38.2% had a GCS ≤8, and 45.5% had NIHSS ≥16. Lower GCS strongly predicted higher mortality. Conservative management was used in 67.3%, and only a minority underwent thrombolysis (7.3%) or thrombectomy (3.6%) due to late presentation. Decompressive hemicraniectomy was performed in 18.2% of patients. In-hospital complications were common-aspiration pneumonia (20%), urinary tract infections (16.4%), and sepsis (12.7%). At discharge, only 55% had good mRS scores (0-4), while 27.3% died during hospital stay. Poor outcome correlated significantly with advanced age, delayed arrival, midline shift, and low GCS.

Conclusion: MCI remains a neurological emergency with high mortality and disability. Early hospital arrival, younger age, and absence of midline shift significantly improved prognosis. Delayed presentation, severe baseline deficits, and radiological features such as hemorrhagic transformation and midline shift were key predictors of poor outcome. Limited use of reperfusion therapies due to late referrals underscores the urgent need for public education, improved emergency triage, and expanded access to neurocritical care. Strengthening early intervention strategies and minimizing in-hospital complications could substantially improve functional recovery in patients with MCI.

Keywords: brain thrombectomy; india; massive infarct; middle cerebral artery infarction; stroke.