2007 Volume 29 Issue 6 Pages 683-687
We studied consecutive patients with atheroscrerotic middle cerebral artery occlusive disease (ATBI-MCA) to delineate the characteristics of acute worsening. ATBI-MCA was defined as symptomatic MCA stenosis >50% or occlusion by angiography. Acute worsening (AW) was diagnosed when NIHSS scores increased 2 or more. Topographic patterns of infarcts were classified into 5 groups as follows: 1; cortical territorial infarcts (n=12), 2; striatocapsular infarcts (n=15), 3; confluent internal border zone infarcts (n=14), 4; rosarylike infarcts (n=6), 5; multiple small cortical or cortical border zone infarcts (n=12). AW occurred in 28 patinets (47.4%). Age and female sex were significantly associated with AW. Among infarcts patterns, all patients in group 4, 9 patients out of 14 (64.2%) in group 3 and 9 patients out of 15 (60%) in group 5 exhibited AW. Moreover, patients in group 4 showed fluctuation and progression during 7 days. Such three groups that exhibited AW tended to have occlusion or high grade stenosis of MCA. On the other hand, groups with cortical territorial infarcts and cortical border zone infarcts tended to have stable course in the acute phase. In conclusion, internal boderzone infarcts, especially rosarylike infarcts located in the centrum semiovale along the lateral ventricle, and striatocapsular infarcts showed higher prevalence of AW and are considered to be associated with severe hemodynamic impairment, whereas cortical boderzone infarcts tended to show stable course and appeared to be caused by microembolic mechanism.
