Computed Tomographic Findings and Prediction of Malignant Middle Cerebral Artery Infarction

To the Editor: In their recent Stroke article, Haring and colleagues1 presented recent data from 31 patients with malignant middle cerebral artery infarction (mMCAI) and 31 control patients with non-mMCAI and concluded that presence of attenuated corticomedullary contrast over the entire MCA territory is the crucial CT criterion for predicting mMCAI with high sensitivity and specificity. I have major concerns about their methods and wish to make the following comments. I fully agree that patients with mMCAI have a high mortality rate2 3 and that decompressive craniectomy may be a life-saving procedure.4 Randomized clinical trials are awaited to confirm the benefit of decompressive craniectomy in reducing mortality and, hopefully, in improving the functional outcome in patients with mMCAI. One major obstacle in the design of the aforementioned clinical …