This case demonstrates features of a "malignant MCA infarction", a term which is used to describe the rapid aggravation of neurological symptoms following an MCA infarction that are attributed to space-occupying vasogenic edema and/or hemorrhagic transformation with consecutive raised intracranial pressure. Malignant infarction has, if left untreated, a very high mortality due to compression of vital brain structures 1.
Prognostic factors for developing a malignant infarction are affection of 50 % or more of the MCA territory, a small penumbra and a large infarcted core as well as early signs of midline shift.
Therapeutic options are limited, with decompressive hemicraniectomy being the best option and hence, is the mainstay of treatment 2.