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P233 Background Large MCA ischemic stroke when  associated with extensive mass effect can result in brain herniation  and death. As yet there are no guidelines to aid the selection of  patients for decompressive therapies, such as hemicraniectomy.Methods This was a multicentre retrospective study of large  MCA infarction requiring neurocritical care. The repeat CT scans  performed within 120 hours of stroke onset were assessed for horizontal  displacement of septum pellucidum and pineal gland, the size of MCA  infarction, involvement of other vascular territories and  hydrocephalus. The primary outcome measure was death within 30 days.Results A total of 251 patients fulfilled entry criteria  into the study of which 201 received conventional medical therapy  alone. Univariate analysis identified the following predictors of early  death: NIHSS &gt;16 (P 7 mm (P 3 mm  (P  7 mm had sensitivity 53%,  specificity 93%, positive predictive value (PPV) 88%, negative  predictive value (NPV) 69% for neurological death. Pineal shift  dichotomised &lt;3 and = 3 mm had sensitivity 45%, specificity  94%, PPV 87% and NPV 66%.Conclusions We identified the  role of follow-up CT in predicting early death following massive MCA  infarction. Anteroseptal shift &gt;7 mm and pineal shift &gt;3 mm if  present were strongly predictive of fatal outcome. These follow-up CT  parameters require validation before they impact the decision to  perform surgical intervention.

The Role of Repeat CT for Predicting Fatal Outcome Following Massive Middle Cerebral Artery Territory Infarction