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Weighing the options after life-altering stroke
Date:3/12/2009

Choosing to have aggressive brain surgery after suffering a severe stroke generally improves the patients' lives and allows them to live longer, according to research by neurologists at the University of Rochester Medical Center.

The findings should help patients and families put into perspective a decision that is nearly always painful and difficult to make whether putting a patient through aggressive surgery after a catastrophic stroke is worth it.

"For families facing this difficult choice, the more information we can provide, the better for their decision-making," said neurologist Adam G. Kelly, M.D., who has helped hundreds of families chart a course after severe stroke. Kelly presented the findings last month at the International Stroke Conference in San Diego.

Kelly and colleague Robert Holloway, M.D., studied three separate analyses of patients who had had a serious type of stroke known as a malignant middle cerebral artery infarction, in which blood flow to a large part of the brain is cut off. Further damage occurs when the damaged brain swells in the days immediately following the initial stroke, as delicate brain tissue is pushed up against the hard inner skull. Increased swelling and pressure in the brain diminish blood flow even further.

Even under the best circumstances, patients who have suffered such strokes face at least moderate disability, and often their challenges are severe, no matter what type of treatment is chosen. A patient might be paralyzed on one side of the body. They may have lost their ability to speak or even to comprehend what is said to them. They may need a breathing or feeding tube. At the very least, they'll likely need help each day with tasks like bathing, cooking, and taking care of themselves.

Kelly and Holloway looked at patients who were treated with medical options alone and compared their outcomes to those of patients who had a surgical procedure known as a hemicraniect
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Contact: Tom Rickey
tom_rickey@urmc.rochester.edu
585-275-7954
University of Rochester Medical Center
Source:Eurekalert

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