Abstract
Cerebral infarction is of two types, that is anemic and hemorrhagic. To investigate the clinical features of the hemorrhagic infaction (HI), we have studied 41 cases of HI in comparison with 163 cases of the anemic infaction (AI). The diagnosis was based on cerebrospinal fluid examinations, cerebral angiography and/or CT scan.
1) The majority of the cases with HI showed a completed type of stroke with sudden onset which was strongly suggestive of the cerebral embolism, while 70% of the cases with AI presented a progressive type of stroke.
2) The various types of cortical signs and homonymous hemianopsia were observed in high percentage in the HI group. These findings suggested that the occlusion of the main trunks of cerebral artery frequently occurred in HI group. The neck stiffness was observed in 59% of the cases in HI group. Therefore it is a useful symptom for making diagnosis of HI.
3) The disturbance of consciousness was observed in most of the cases in HI group. The consciousness was deteriorated during 2 to 3 days after the onset of stroke.
4) Less than 30% of the cases in HI group had the history of hypertension. The mean arterial pressure (MABP) in HI group was significantly higher (p<0.005) than that in AI group during 2 to 3 days after the onset of stroke, although, there was no significant difference between the two groups at the onset. This result suggested that the hypertension was not an apparent risk factor of HI, and elevated MABP might be consequence of acute cerebral edema caused by HI.
5) The prognosis for functional ability in cases with HI was poorer than that of AI. The mortality rate in HI group was much higher (24%) than that in AI group (6%).
6) The characteristic angiographical findings in HI group were occlusion of the main trunks of cerebral artery and its branches (recanalization was confirmed in 4 of 6 cases), residual stenosis, capillary blush with early venous filling and mass sign.
7) In HI group, scattered high and isodensity within the low density area were demonstrated on CT in 26% and 20%, respectively.
8) Sixty one percent of the cases in HI group was associated with the various types of cardiac diseases which could probably be source of embolism. This result indicated that HI occurred more frequently in cardiogenic cerebral embolism.
