Case-Based Modules > Case 10 > Stage 3

Sorry! This patient is young (age < 60) and sustained a large MCA infarct that occupies ≥ 50% of that territory. This is a malignant MCA infarct. While the midline shift may not be very large, she is clearly affected by this mass effect. Her problem here is evolving cerebral herniation rather than intracranial hypertension. Hyperosmolar therapy in this setting is less helpful. It could still be used as a temporizing maneuver while getting the patient to the definitive therapy, but it isn't the best next treatment step itself-- just an adjunct. What else could you do to more definitively manage the cerebral herniation now?

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