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Malignant MCA Infarction — SCE Neurology MCQ

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HardCerebrovascular DiseaseMalignant MCA InfarctionSCE Neurology

A 72-year-old man presents with acute onset of left-sided weakness. CT head shows a right MCA territory ischaemic infarct with early signs of oedema at 48 hours. He is now drowsy with a GCS of 10. CT shows midline shift of 8 mm. His NIHSS is 22. What surgical intervention may improve survival?

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Correct answer: B — Decompressive hemicraniectomy

Decompressive hemicraniectomy reduces mortality in malignant MCA infarction, though it increases the proportion of survivors with moderate-to-severe disability. The DECIMAL, DESTINY, and HAMLET trials demonstrated benefit when performed within 48 hours. However, in patients over 60, the benefit is less clear (DESTINY II showed survival benefit but with higher disability). The decision requires careful discussion of likely outcomes. A: VP shunt is for hydrocephalus. C: CEA is not indicated acutely. D: Stereotactic aspiration is for ICH. E: ICP monitoring alone without intervention is insufficient.

Reference: RCP National Clinical Guideline for Stroke (2023); DESTINY/DECIMAL/HAMLET Trials