Abstract
The neuropathological findings of acute severe cerebral infarction was analyzed in comparing with four autopsied cases and our experimental cerebral infarction in dogs. Four autopsied comm with acute severe cerebral infarction were 1 male and 3 females ranging in age from 57 to 68 years. All patients gave the history of hypertension and cardiac disease. Of all death, 3 of the 4 patients died within 7 days after clinical evidence of infarction. In 3 patients, angiography showed an occlusion of internal carotid or middle cerebral artery and a recanalization. A CT-scan was performed in 3 patients.
Experimental cerebral infarction was induced in 165 dogs by injecting one or two silicon rubber cylinder through the cervical internal carotid artery. The embolus was found to have obstructed the main trunk of the middle cerebral artery in 102 dogs. Horizontal sections of each brain were shown by carbon perfusion 24 hours after embolization. Large sized infarction of the cerebral hemisphere showing a large carbon perfusion defect in the cerebral cortex, the cortical and deep white matter, and in the basal ganglia were represented in 47 dogs.
The results obtained were as follows :
1. Pathologic changes of the autopsied and experimental case were resembled closely, and the gross specimens and histologic sections were reviewed that the massive hemorrhagic area was localized in the basal ganglia region and the petechial hemorrhagic area in the corticomedullary junction region of the infarct afecting the hemisphere in the middle cerebral artery distribution. It is suggested that the massive hemorrhagic infarction may be caused by the disruption of the arteriole in the perforating arterial terminal zone, and the petechial hemorrhagic infarction by the disruption of the venule in the cortical arterial terminal zone.
2. The CT of the patient with fatal cerebral infarction showed only large low-density area with a negative contrast enhancement which occupied the affected hemisphere almost entirely and which also showed large mass effects. Acute severe cerebral infarcts appear as low density area, with lower attenuation values due to the presence of large amounts of fluid, therefore the addition of blood in hemorrhagic infarcts of the basal ganglia and the corticomedullary junction may be negative on CT scan. Acute severe cerebral infarction appear in the CT image as low density areas due to marked edema, hewever, a histological correlation is not concomitant.
