O 240 cases with the cerebro-vascular diseases, 22 cases with the occlusion of the middle cerebral artery at its origin or at its big branches, were found by the carotid angiography. The patients could be divided into the 4 groups according to the onset, clinical feature, neurological findings and prognosis.
Group 1: 6 cases. In most of them severe unconsciousness and motor-disturbances were observed. It is difficult to make the differential diagnosis between this group and the patients with cerebral hemorrhage at the bedside.
Group 2: 8 cases. Their chief complaints were ataxia, agnosia, Gerstmann's syndrome and aphasia.
Hemiplegia and disturbance of consciousness were not found in most cases.
Group 3: 3 cases. Chief complaint of this group was the hemiplegia with facial palsy which was almost similar to the so-called hemiparesis of capsular type. Group 4: 5 cases. It was transient for the patients to have symptomes, for example, hemiparesis, dysarthria, and sensory disturbance. Some of them had the attack recurrently, and others did not so.
Cerebral circulation was measured according to the modified N
2O method. CBF of group 1, 2, 3, 4 was 34.6±6.8, 38.7±4.4, 37.5±0.9, 52.0±8.8, respectively (m
l/100g brain/min). Blood supply to the brain was kept sufficiently in group 4 and not so well in group 1.
Collateral circulation observed by the serial angiography developed very well in group 4, moderately in group 2, 3 and scarcely in group 1.
In a series of this study, it seems likely that those who had the well-developed collateral circulation showed mild clinical symptomes and good blood supply to the brain.
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