[Progressive stroke during the acute state of cerebral infarction in the territory of the internal carotid artery]

Abstract

Diagnosis of deterioration of neurological deficits in the early stage after hospital admission immediately after the onset of cerebral infarction is important in establishing a treatment plan. This study investigated the clinical characteristics of progressive stroke on admission. The subjects were 309 patients admitted on the day of the onset of symptoms and showed a low density area on CT images within 5 days. There were 202 with cerebral infarction in the territory of the deep perforate arteries, 77 with cerebral infarction in the territory of the cortical branch of the middle cerebral artery (MCA), and the remaining 36 had cerebral infarction in the territory of MCA. The results were as follows: 1) Progressive stroke was observed in 71 patients (23.0%): 60 with completed stroke and 11 with reversible ischemic neurological deficits (RIND). 2) The patients with progressive stroke were clearly older than those with non progressive stroke (p < 0.05: Cochran Cox's test). 3) Progressive stroke was seen more frequently in patients with cerebral infarction of the cortical branch of the MCA and patients with occlusion of the internal carotid artery and MCA trunk than patients with cerebral infarction of the deep perforate arteries (p < 0.001: chi 2 test). 4) All patients with progressive stroke had initial evidence of deterioration of neurological deficits within 5 days after the onset, with 39 patients showing deterioration on day 2 and 13 patients showing deterioration on day 3. 5) Deterioration of neurological deficits usually stopped the day after the start of progression. The maximum period from the beginning to the end of the deterioration of neurological deficits was 7 days. 6) Progressive stroke was not seen in 11 patients who were admitted with higher cortical dysfunction and without sensory or motor disturbances, and was seen in only 8 (4%) of the 187 patients with sensory or motor disturbances without higher cortical dysfunction. 7) Progressive stroke was seen in 63 (57%) patients with sensory or motor disturbances and higher cortical dysfunction. 8) Progressive stroke was seen frequently in patients with atrial fibrillation (Af) on the ECG [P < 0.001). 9) Fifty-six of 71 patients with progressive stroke showed persistent severe motor impairment in the upper limbs. Therefore, to diagnose progressive stroke, it is useful to assess the higher cortical dysfunction and examine for Af on admission.