ArticleNeurocritical care2022
Midline Shift Greater than 3 mm Independently Predicts Outcome After Ischemic Stroke.
Article in Neurocritical care, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers.
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Who cites it
26 citing papers in PubMed, 43 citations in OpenAlex.
- Safety and Feasibility of YC-6 in Patients With Large Hemispheric Infarction: A Randomized Clinical Trial.Journal of the American Heart Association · 2025Trial
- Mechanical compression induces neuronal apoptosis, reduces synaptic activity, and promotes glial neuroinflammation in mice and humans.Proceedings of the National Academy of Sciences of the United States of America · 2026Article
- Brain Midline Approximation to Improve Symmetry Analysis of Brain CT Scans.Journal of imaging informatics in medicine · 2025Article
- FLAIR extending beyond a quadrant (FEQ) of the cerebrum as a qualitative imaging biomarker: a conceptual proposition and proof-of-principle.Clinical & experimental metastasis · 2025Article
- Hybrid machine learning for real-time prediction of edema trajectory in large middle cerebral artery stroke.NPJ digital medicine · 2025Article
- Association of Dynamic Trajectories of Time-Series Data and Life-Threatening Mass Effect in Large Middle Cerebral Artery Stroke.Neurocritical care · 2025Article
- Channels and Transporters in Ischemic Brain Edema.Journal of inflammation research · 2025Review
- IL-33/ST2 signaling in monocyte-derived macrophages maintains blood-brain barrier integrity and restricts infarctions early after ischemic stroke.Journal of neuroinflammation · 2024Article
- Chronic consequences of ischemic stroke: Profiling brain injury and inflammation in a mouse model with reperfusion.Physiological reports · 2024Article
- Updates in Management of Large Hemispheric Infarct.Seminars in neurology · 2024Review
- Brain Swelling versus Infarct Size: A Problematizing Review.Brain sciences · 2024Review
- Heart Rate Variability in Patients with Spontaneous Intracerebral Hemorrhage and its Relationship with Clinical Outcomes.Neurocritical care · 2024Article
- Factors associated with an increased risk of developing pneumonia during acute ischemic stroke hospitalization.PloS one · 2024Observational
- Acute ischemic STROKE - from laboratory to the Patient's BED (STROKELABED): A translational approach to reperfusion injury. Study Protocol.Translational neuroscience · 2024Article
- Analysis of brain edema in RHAPSODY.International journal of stroke : official journal of the International Stroke Society · 2024Article
- Dynamic trajectories of life-threatening mass effect in patients with large middle cerebral artery stroke.Research square · 2023Article
- Relationship between edema and intracranial pressure following intracerebral hemorrhage in rat.Frontiers in stroke · 2023Review
- Astrocytes in stroke-induced neurodegeneration: a timeline.Frontiers in molecular medicine · 2023Review
- Net water uptake within the ischemic penumbra predicts the presence of the midline shift in patients with acute ischemic stroke.Frontiers in neurology · 2023Article
- Tanshinone IIA-Loaded Nanoparticle and Neural Stem Cell Therapy Enhances Recovery in a Pig Ischemic Stroke Model.Stem cells translational medicine · 2022Article
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Authors and funding
14 authors at 6 institutions in 2 countries.
Funding
Abstract
backgroundCerebral edema is associated with worse outcome after acute stroke; however, the minimum clinically relevant threshold remains unknown. This study aimed to identify the minimal degree of midline shift (MLS) that predicts outcome in a cohort encompassing a broad range of patients with acute stroke.
methodsPatient-level data from six acute stroke clinical trials were combined with endovascular thrombectomy registries from two academic referral centers, generating a combined cohort of 1977 patients. MLS was extracted from the original trial data or measured on computed tomography or magnetic resonance imaging that was obtained a median of 47.0 h (interquartile range 27.0-75.1 h) after stroke onset. Logistic regression was performed to identify predictors of poor outcome and the minimal clinically relevant MLS threshold.
resultsThe presence of MLS was a predictor of poor outcome, independent of baseline clinical and demographic factors (adjusted odds ratio 4.46, 95% confidence interval 3.56-5.59, p < 0.001). Examining the full range of MLS values identified, a value of greater than 3 mm was the critical threshold that significantly predicted poor outcome (adjusted odds ratio 3.20 [1.31-7.82], p = 0.011).
conclusionsThese results show that the presence of MLS predicts poor outcome and, specifically, MLS value greater than 3 mm is an important threshold across a variety of clinical settings. These findings may have relevance for the design and interpretation of future trials for antiedema therapies.
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