• Alicia M Zha, Murat Sari, and Michel T Torbey.
• aDepartment of Neurology bDepartment of Neurosurgery, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
• Curr Opin Crit Care. 2015 Apr 1;21(2):91-8.

Purpose Of ReviewLarge hemispheric infarction is a devastating disease that continues to be associated with significant mortality and morbidity. Most often these patients are admitted to the ICU requiring significant physician and nursing resources. This review will address some of the ICU management issues and review the evidence supporting medical and surgical management of malignant cerebral edema.Recent FindingsThe most recent changes in management of large hemispheric infarct include the American Heart Association and Neurocritical Care Guidelines. These guidelines address airway management and mechanical ventilation, blood pressure control, fluid management, and glucose and temperature control. In addition, they addressed the indication for surgical management of cerebral edema. We review the recent guidelines updates and trials of surgical management of large hemispheric infarcts.SummaryLarge hemispheric infarcts continue to have significant morbidity and mortality. Recent guidelines have provided an excellent framework to help intensivists manage these complicated patients. Recent surgical data continue to support early hemicraniectomy even in elderly patients.

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