Abstract
Pathogenesis of gastrointestinal bleeding (GI bleeding) following cerebrovascular accidents (CVA) was studied by gastroendoscopy.
Gastroendoscopic examinations were performed in patients with acute cerebrovascular accidents. These patients were operated on except for 2 cases. The gastroendoscopic examination was performed under general anesthesia just before or after the operation. Forty seven patients were examined (35 cerebral hemorrhages, nine subarachnoid hemorrhages, two infarctions, one moyamoya). The gastroscopy was performed in 25 cases within 24 hours from the onset of the CVA.
Acute gastric changes within 24 hours were mainly gastric petechiae (GP). These findings were classified as follows: GP(1), petechiae localized in the fundal region; GP(2), petechiae observed diffusely and mainly in the fundal region; and GP(3), petechiae observed on the whole gastric wall with bleeding. GI bleeding and the degree of petechiae were closely related. GI bleeding was noticed in 25% of GP(1), 89% of GP(2) and 100% of GP(3). No fresh ulcerative findings were noted within 24 hours in our cases. Acute gastric changes were related to the level of consciousness. CT scans showed that cerebral hemorrhage frequently involved the hypothalamic region in cases of GP (2) or GP(3).
It is concluded that characteristic acute gastroendoscopic findings within 24 hours from the onest of CVA are petechiae and the main cause of GI bleeding are these petechiae. Mucosal ulceration of the stomache and duodenum are secondary changes following petechiae.
