The effect of brain atrophy on outcome after a large cerebral infarction

Purpose We retrospectively evaluated the effect of brain atrophy on the outcome of patients after a large cerebral infarct. Methods Between June 2003 and Oct 2008, 134 of 2975 patients with stroke were diagnosed as having a large cerebral infarct. The mean age of the patients was 70 (21-95) y. The mean infarct volume was 223.6 +/- 95.2 cm(3) (46.0-491.0). The inter-caudate distance (ICD) was calculated as an indicator of brain atrophy by measuring the hemi-ICD of the intact side and then multiplying by two to account for brain swelling at the infarct site. The mean ICD was 18.0 +/- 4.8 mm (9.6-37.6). Results Forty-nine (36.6%) patients experienced a malignant clinical outcome (MCO) during management in the hospital. Thirty-one (23.1%) patients had a favourable functional outcome (FO) (modified Rankin scale (mRS) <= 3) and 49 (36.6%) had an acceptable functional outcome (AO) (mRS <= 4) at 6 months after stroke onset. In the multivariate analysis, brain atrophy (ICD >= 20 mm) had a significant and independent protective effect on MCO (p-0.003; OR-0.137; 95% CI 0.037 to 0.503). With respect to FO, the age and infarct volume reached statistical significance (p<0.001, OR=0.844, 95% CI 0.781 to 0.913; p=0.006, OR=0.987, 95% CI 0.977 to 0.996, respectively). Brain atrophy (ICD >= 20 mm) was negatively associated only with AO (p=0.022; OR=0.164; 95% CI 0.035 to 0.767). Conclusions Brain atrophy may have an association with clinical outcome after a large stroke by a trend of saving patients from an MCO but also by interfering with their functional recovery.