Semin Neurol 2024; 44(03): 281-297
DOI: 10.1055/s-0044-1787046
Review Article

Updates in Management of Large Hemispheric Infarct

Charlene J. Ong
1   Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University School of Medicine, Boston, Massachusetts
2   Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, Massachusetts
Stefanos Chatzidakis
3   Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
Jimmy J. Ong
4   Department of Neurology, Sidney Kimmel Medical College, Philadelphia, Pennsylvania
5   Department of Neurology, Jefferson Einstein Hospital, Philadelphia, Pennsylvania
Steven Feske
1   Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University School of Medicine, Boston, Massachusetts
2   Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, Massachusetts
› Author Affiliations


This review delves into updates in management of large hemispheric infarction (LHI), a condition affecting up to 10% of patients with supratentorial strokes. While traditional management paradigms have endured, recent strides in research have revolutionized the approach to acute therapies, monitoring, and treatment. Notably, advancements in triage methodologies and the application of both pharmacological and mechanical abortive procedures have reshaped the acute care trajectory for patients with LHI. Moreover, ongoing endeavors have sought to refine strategies for the optimal surveillance and mitigation of complications, notably space-occupying mass effect, which can ensue in the aftermath of LHI. By amalgamating contemporary guidelines with cutting-edge clinical trial findings, this review offers a comprehensive exploration of the current landscape of acute and ongoing patient care for LHI, illuminating the evolving strategies that underpin effective management in this critical clinical domain.

Publication History

Article published online:
17 May 2024

© 2024. Thieme. All rights reserved.

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