Abstract
Among patients who were admitted to our hospital with a suspicion of cerebrovascular disease, we selected patients with cerebral thrombosis and cerebral embolism. All patients were serial cases and the diagnosis was made as follows. Cerebral embolism was finally confirmed by neuroradiological examinations; namely patients showed massive hemorrhagic infarction sign on CT or massive low density area with no occlusive findings of corresponding arteries on crebral angiogram or abrupt occlusion of main arteries due to the plugging of embolus with no sclerotic change in the surrounding arteries seen on angiogram. Heart diseases such as atrial fibrillation and myocardial infarction are generally thought to be important factors for the diagnosis of cerebral embolism, but their existence was not taken into consideration for the diagnosis of embolism in this study. Cerebral thrombosis was also confirmed by neuroradiological evaluation; low density area including lacunes on CT with sclerotic change on corresponding cerebral angiogram. There are 79 cases of thrombosis and 21 cases of embolism. Mean age at onset is 65.9 on thrombosis and 68.3 on embolism and there was no statistic significance between these two groups.
Alcohol drinking was more frequently observed in cases of embolism than in cases of thrombosis. On EKG, atrial fibrillation was more frequently observed in embolic patients than in thrombotic patients, although high R in V5is predisposed to thrombosis. Neurologically, conjugate deviation of the eyes and aphasia as well as agnosia were more frequently seen in patients with embolism. Statistically significant laboratory data examined on admission between these two groups were serum total protein (thrombosis group 6.96±0.73, embolim group 6.38 ± 0.68, p<0.01), serum albumin (4.05 ± 0.48, 3.63 ± 0.45, p<0.01) and serum total cholesterol (193 ± 41.5, 158 ± 42.5, p<0.01). We conclude from these laboratory data that patients with cerebral embolism in Akita (northern part of Japan) are more likely exposed to insufficient nutrition than patients with cerebral thrombosis and that was acceleratd by the habit of alcohol drinking.
Epidemiological study among Japanese done before the introduction of CT had revealed that lower total cholesterol levels reflecting the low fat intake might be one of the factors for developing of cerebral hemorrhage.
But type specific diagnosis was very difficult at that time.
We also conclude that among patients who were rated as cerebral hemorrhage, there might be some patients who should be diagnosed as cerebral embolism.
