A study of cerebral infarction of the basal ganglia due to main trunk obstruction
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In general, infarctions of the basal ganglia are present in about 40% of all cerebral infarctions. Most basal ganglia infarctions are lacunar, typically caused by thrombosis of the small penetrating arteries, but some are due to embolism or thrombosis of the main trunks of the internal carotid and/or middle cerebral arteries. Differential diagnosis based on the pathogenesis of infarction is important clinically to assess the patient's prognosis and select the correct surgical treatment.<BR>In order to clarify the characteristics of each type of infarction, 5 of 105 patients with internal carotid artery occlusion and 52 of 246 patients with middle cerebral artery occlusion, who had deep cerebral infarctions in the basal ganglia and internal capsule, were examined based on CT, clinical manifestations, cerebral blood flow (CBF) and computed mapping of the EEG (CME).<BR>The results were as follows : <BR>1) Based on CT, the 57 patients were divided into three groups according to the size of the low density area (LDA) on a slice of 5 cm ±1 cm over the orbitomeatal line (OM line). The group with less than 1.5 cm as the longest diameter of LDA consisted of 17 patients, while 13 patients with LDA between 1.6 and 2.5 cm and 27 patients with LDA of more than 2.6 cm were present. Round or oval shaped LDA were mainly located in lenticular nucleus or internal capsule, partially in the head of the caudate nucleus. 88% of them were associated with LDA on the centrum semiovale, which was considered to be a border-zone infarction.<BR>2) As for clinical manifestations, severe motor disturbances were present in 60% of upper extremity (U/E) and 32% of lower extremity (L/E). Comparable motor disturbances in both the U/E and L/E were seen in 68%. In spite of no apparent cortical change on CT, patients with aphasia were present. Hemianopsia was seen in 16 patients and minimal disturbance of consciousness in 18. Pure motor hemiplegia was demonstrated in about 1/3 of all cases.<BR>3) Regional CBF, detected in 19 patients by <SUP>133</SUP>Xenon intra-arterial injection, revealed diffuse ischemia in 12 patients and focal ischemia in 3.<BR>4) Examining 35 times with CME in 18 patients, abnormal findings of high-voltage foci of slow components and/or an asymmetrical distribution of alpha activity were present 29 times in all patients.<BR>It is concluded that cerebral infarction of the basal ganglia due to main trunk obstruction has been more or less associated with diminution of blood flow in the cortical area.
- 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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