Abstract
Background
Cerebral edema (CED) is a common complication of acute ischemic stroke, associated with increased mortality and poor functional outcomes. While infarct size is a known predictor, the role of sodium homeostasis remains unclear. This study evaluated risk factors for CED and its impact on outcomes.Methods
We prospectively enrolled 178 patients with acute non-lacunar ischemic stroke. Cerebral edema was assessed and graded using the SITS-MOST edema scale over the first seven days. Sodium concentration and variability were monitored daily. Risk factors for CED were identified through multivariate logistic regression, and the impact of CED on mortality, functional outcomes, hemorrhagic transformation, and seizures was analyzed.Results
CED occurred in 38.2% of patients and was associated with larger infarcts (> 3 cm), higher NIHSS, lower ASPECTS, lack of reperfusion, and multi-territory involvement. No differences were observed in demographics or cardiovascular risk factors. Sodium levels were higher on days 3 and 5 in CED patients, with greater variability, while baseline levels were not predictive. Infarct size and day 3 sodium were independent predictors. CED was linked to worse outcomes, including higher 1-month mortality (23.5% vs. 1.8%), increased hemorrhagic transformation, and reduced functional independence. No association with seizures was found.Conclusions
Infarct size remains the strongest risk factor for cerebral edema after ischemic stroke. Baseline sodium levels were not determining CED development. CED worsens outcomes but is not linked to seizure risk. These findings underscore the importance of early imaging and suggest a potential role for targeted anti-edema therapies in patients with larger strokes.