抄録
Regional cerebral blood flow (rCBF) was measured 59 times in 54 completed stroke patients. The rCBF measurements were performed twice in 3 patients and three times in one patient. The rCBF measurements were performed by means of the 133Xe intracarotid injection method, using a scintillation camera and an on-line computer system. The rCBF data were analyzed and compared with the computed tomography (CT) and angiographic findings from each patient. Patients were classified into three groups which were defined from the CT findings as follows: Group 1, 13 patients with non-cortical low density area on CT scans; Group 2, 27 patients with enhanced cortical ischemic lesion; Group 3, 19 patients with non-enhanced cortical low density area. The Group 2 patients were studied between 7 and 33 days from the onset which did not overlap with the days for Group 3. The average of the mean hemispheric values of rCBF (mean CBFs) of completed strokes were significantly lower than those of the normal controls, transient ischemic attacks, and reversible ischemic neurological deficits. There was no significant difference in the averages of mean CBF between Group 2 and Group 3. Although there was a correlation between the elapsed time from the onset and the decrescent tendency of mean CBF of Group 2, there was no correlation with those of Group 3. Focal abnormalities were less frequent than diffuse ischemia in Group 1. Hemispheric patterns of flow distribution (HPFDs) were variously disturbed. Focal ischemia (6 cases, 22%), diffuse ischemia (14 cases, 52%), focal hyperemia (5 cases, 19%), and luxury perfusion (one case) were seen in Group 2. The patients with focal hyperemia and luxury perfusion showed a capillary blush which was characteristic of recanalization on the cerebral angiography (CAG). Focal ischemia (37%) and diffuse ischemia (63%) were shown, whereas hyperemia was not shown in Group 3. Focal ischemic areas with the rCBF below 32.8 ml/100 g/min were identical with the low density areas on CT scans.
It is suggested that completed stroke has various pathological conditions such as ischemia, hyperemia, and luxury perfusion of rCBF, contrast enhancement on CT scan, and capillary blush on CAG, accompanied by recanalization within 1 month after the onset, and that the ischemic lesion of completed stroke is destined to be completed without hyperemia by 1 month from the onset.
