Abstract 255: Effect of Oral Glibenclamide on Delaying Peak Onset of Malignant Cerebral Edema in Large Hemispheric Infarctions

Title Delayed Peak of Malignant Cerebral Edema in Large Hemispheric Infarction with Oral Glyburide Treatment: A Case Study Introduction Malignant cerebral edema (MCE) is a severe complication of large hemispheric infarction, often leading to poor outcomes and high mortality rates. Invasive measures, such as decompressive craniotomy, are both reactive in nature and have limited applicability. Other medical therapies are also used, but are reactive and have mixed results with limited evidence of efficacy. A growing body of evidence has indicated that glyburide, a sulfonylurea receptor 1 (SUR1) inhibitor, may prevent or delay the onset of MCE. This case study explores the effects of oral glyburide on the timing and severity of MCE in a patient with a large hemispheric infarction. Methods A 53‐year‐old woman with a large left middle cerebral artery territory infarction was treated prophylactically with oral glyburide (2.5 mg daily) for five days. Standard care, including hyperosmolar therapy, was administered. The patient's neurological status and midline shift were monitored using serial CT imaging from post‐stroke day (PSD) 0 to PSD 18. Results Initial imaging showed large hemispheric infarction without midline shift. However, a gradual increase in midline shift was observed, peaking at 13 mm on PSD 14, which is later than the typical 3‐5‐day peak in similar cases. Despite this delayed peak swelling, the patient's clinical status remained stable, and no further escalation of care was needed. The patient tolerated glyburide without adverse effects, such as symptomatic hypoglycemia. Discussion The delay in the peak of MCE observed in this case suggests that glyburide may extend the window for effective management of edema. While the exact mechanism remains unclear, the early stabilization of neurological status with delayed significant edema warrants further investigation into glyburide as a potential prophylactic therapeutic option. This case aligns with earlier research indicating that glyburide can mitigate ischemia‐induced edema, potentially improving outcomes in stroke patients. Conclusion This case suggests that glyburide may delay the peak of malignant cerebral edema in large hemispheric infarctions, offering a new avenue for proactive management of this condition. Further studies are needed to confirm these findings and establish glyburide's role in acute stroke management.