Fluid Intake Related to Brain Edema in Acute Middle Cerebral Artery Infarction

Evidence of the appropriate amount of fluid intake during the first few days after acute stroke was scarce. Concerns were raised in patients with acute malignant middle cerebral infarction, who tended to have malignant brain edema later. The purpose of the study was to evaluate the effect of fluid intake on the occurrence of malignant brain edema in patients with acute middle cerebral artery infarction. Patients with acute middle cerebral artery infarction who had National Institute of Health Stroke Scale (NIHSS) score of at least 15 were included. Baseline characteristics and amount of fluid intake during the first few days were compared in patients with and without malignant brain edema. One hundred ninety-three patients were studied. Mean NIHSS score was 20. Malignant brain edema occurred in 69 patients (36 %). Higher amount of fluid intake (>1650 ml or >28 ml/kg/day or >93 % of daily maintenance fluid) showed a significant association with malignant brain edema (OR=13.86, 95 % CI 5.11-37.60, p value <0.001). Decompressive surgery was performed in 35 patients (18 %). With mean follow-up of 12 months, 49 patients (49/184, 27 %) had favorable outcomes (modified Rankin scale (mRS) 0-2) at final followup. Seventy-nine patients (79/184, 43 %) died. In the subgroup of patients with malignant brain edema, 39 patients (39/65, 60 %) died and only 11 % (7/65 patients) had favorable outcome. High amount of fluid intake in the first few days of acute middle cerebral infarction was related to the occurrence of malignant brain edema.