A 55-year-old woman presents with sudden dense right hemiparesis and global aphasia. CT shows hypodensity involving more than 50% of the left middle cerebral artery territory with midline shift. She is within 36 hours of symptom onset. According to pooled European trial data (DESTINY, DECIMAL, HAMLET), what intervention has been shown to reduce mortality and improve outcomes in malignant MCA infarction?

• A Intravenous thrombolysis with alteplase
• B Decompressive hemicraniectomy within 48 hours ✓
• C Hypothermia to 33°C for 24 hours
• D High-dose methylprednisolone pulse therapy

Explanation

Pooled analysis of DESTINY, DECIMAL, and HAMLET trials demonstrated that decompressive hemicraniectomy within 48 hours of malignant MCA infarction significantly reduces mortality (from approximately 70% to 20-30%) and improves functional outcomes in patients aged 60 years or younger. Thrombolysis is contraindicated with extensive early ischemic changes. Hypothermia and steroids have not shown benefit in this setting.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.