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6.1. Brain Swelling (General Recommendations)
COR LOE
Recommendations
1 C-EO
1. In patients with large cerebral or cerebellar infarctions at high
risk for developing brain swelling and herniation, an early
discussion of care options and possible outcomes should take
place with patients (if feasible) and family or next of kin to
ascertain patient-centered preferences in shared decision-
making, especially during prognosis formation and when
considering interventions or limitations in care.
1 C-EO
2. In patients with large cerebral or cerebellar infarctions, close
monitoring of the patient for signs of neurological worsening
during the first days after stroke is recommended to rapidly
evaluate the need for potential interventions.
1 C-LD
3. In patients with large cerebral or cerebellar infarctions who are
at increased risk for malignant brain swelling, early transfer to
an institution with appropriate neurosurgical and critical care
expertise is recommended to ensure timely treatment.
6.2. Brain Swelling (Medical Management)
COR LOE
Recommendations
2a C-LD
1. In patients with large cerebral or cerebellar infarctions and
neurological decline from brain swelling, the use of osmotic
therapy as a bridge to a surgical intervention is reasonable to
improve functional outcome and reduce mortality.
3: No
benefit
B-R
2. (New and of High Impact) In patients with large hemispheric
infarction aged 18 to 70 years, the use of IV glibenclamide
does not result in improved functional outcome and is not
recommended.
3: Harm C-LD
3. In patients with large cerebral or cerebellar infarctions and brain
swelling, hypothermia, barbiturates, or corticosteroids should
not be administered to treat brain swelling due to the lack of
evidence of efficacy and potential of increased adverse effects.
In-Hospital Management of AIS:
Treatment of Acute Complications
