Inferrence of poor prognosis in acute stage of cerebral infarction:A neuroradiological study of embolic and thrombotic cerebral artery occlusion
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Findings of brain CT and cerebral angiogram in acute stage were analized in patients with embolic and thrombotic cerebral artery occlusion in relation with their mortality.<BR>Thirty-three (17.8%) of 186 consecutive patients with embolic and 8 (5.6%) of 142 patients with thrombotic occlusion of the cerebral artery died during acute stage. Among them, 20 of embolic and 4 of thrombotic cases died due to tonsillar herniation within 10 days after onset. All of them presented with angiographic occlusions of more than two main cerebral arteries or the internal carotid artery with poor collateral circulation to regions normally supplied by the anterior and middle cerebral arteries.<BR>Thiry-nine percent of the embolic group and 6% of the thrombotic group showed a shift of midline structures on CT. A ratio of the shift of the midline structures to the maximum width of the hemisphere on CT was computed to represent a degree of mass effect (midline shift index, MLS-I). The majority of patients who died of tonsillar herniation showed MLS-I greater than 10% on the Day 2 and/or that greater than 20% on the Day 3. Only four survived among the patients who met the above criteria.<BR>The size of the infarct on CT (Infarct Indices) was significantly larger in embolic group than in thrombotic group. Infarct-Indices in patients who died due to herniation were greater than 66% and hypodense areas in these patients occupied more than entire region normally supplied by the middle cerebral artery.<BR>Hemorrhagic transformation evaluated by CT was found in 41% of non fatal patients with embolic infarction, while in only 16% of those who died due to tonsillar herniation.
- 一般社団法人 日本脳卒中学会の論文
一般社団法人 日本脳卒中学会 | 論文
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