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Background & Objectives : Severe hemispheric infarction(SHI) reportedly has various range of high mortality. Recently it has been reported that more aggressive therapeutic intervention, such as decompressive hemicraniectomy or mild hypothermia might has potential benefits in the management of SHI. However the mortality and the prognosis of SHI under the conservative treatment were rarely studied yet in Korea. Methods : Sixty-six patients with CT proven SHI were subjected among 1649 acute stroke patients registered at the Hallym Stroke Data Bank since Jan. 1993. We analyzed the computerized databases for the mortality and compared inclusively demographic features, clinical characteristics, etiology, therapy modalities and CT findings of fatal group with those of survivors. Results : Twenty-five patients were expired among 66 SHI patients (mean age: 64.9±11.5,male to female ratio; 37:29) The mean time to expire was 160.4 hours. The fatal group had a significantly higher incidence of cardioembolism, uncontrolled BP during the acute stage, and extensive infarction territory(MCA+ACA). Risk factors for ischemic stroke such as hypertension. hyperlipidemia, smoking, previous stroke history, diabetes mellitus, and old age were not related to mortality. The initial mental status, NIHSS scores, early low densities and hyperdense MCA signs on brain imaging were not different between two groups. Conclusions : The early mortality rate of SHI under the conservative care was 38% in a referral hospital of Korea. Intractable hypertension in the acute stage, cardioembolism and extent of infarct area may have predictable values of early mortality of SHI.
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