The symptoms and signs of stroke vary according to the location of the lesions. Middle cerebral artery territory infarction produces symptoms such as contralateral hemiparesis (worse in the arm than in the leg), hemihypesthesia, dysarthria, aphasia (left lesion), and hemineglect (right lesion). Anterior cerebral artery infarction produces hemiparesis worse in the leg than in the arm, abulia, apathy, and urinary incontinence. Posterior cerebral artery infarction produces hemianopia. An occlusion of small penetrating branches such as lenticulostriate arteries or thalamogeniculate arteries is responsible for the so-called lacunar syndrome : pure hemiparesis, ataxic-hemparesis, dysarthria clumsy hand syndrome, or pure sensory stroke. The symptoms and signs of the brain stem infarction also vary greatly according to the area of involvement. Generally, they are characterized by virtigo, dizziness, diplopia, and ataxia. Major occlusion of the basilar artery may produce grave conditions characterized by altered consciousness, quadriparesis, and horizontal gaze paresis. Intracerebral hemorrhage occur in the basal ganglia, thalamus, lobar area, pons, and the cerebellum, in order of decreasing frequency. The symptoms and signs are dependent on the location and the amount of hemorrhages. The symptoms of subarachnoid hemorrhages are characterized by sudden headache and neck stiffness.
Apathy ; Aphasia ; Arm ; Arteries ; Ataxia ; Basal Ganglia ; Basilar Artery ; Brain Stem Infarctions ; Cerebellum ; Cerebral Hemorrhage ; Consciousness ; Diplopia ; Dizziness ; Dysarthria ; Hand ; Headache ; Hemianopsia ; Hemorrhage ; Infarction ; Infarction, Anterior Cerebral Artery ; Infarction, Posterior Cerebral Artery ; Leg ; Middle Cerebral Artery ; Neck ; Paresis ; Pons ; Quadriplegia ; Stroke* ; Stroke, Lacunar ; Subarachnoid Hemorrhage ; Thalamus ; Urinary Incontinence

OBJECTIVETo investigate the correlation between plasma fibrinogen level and cerebral infarction (CI) as well as the difference of fibrinogen among subtypes of CI.

METHODSA case-controlled study was conducted with 131 cases of CI and 148 controls. Plasma fibrinogen levels were detected by the Clauss method.

RESULTSHigh fibrinogen level (3.09 +/- 0.94 g/L) was correlated with CI (OR = 2.47, 95% CI: 1.51-4.04, P < 0.005) at the onset stage of the disease. Persistent high fibrinogen level (3.14 +/- 0.81 g/L) at 6-month after stroke onset was detected and correlated with CI (OR = 4.34, 95% CI: 1.80-10.51, P = 0.001). Higher fibrinogen level was correlated with total anterior circulation infarction (TACI), partial anterior circulation infarction (PACI), and posterior circulation infarction (POCI) (OR = 4.008, P < 0.001). Higher fibrinogen level was correlated with extracranial atherosclerosis (OR = 3.220, P < 0.05, but not with intracranial atherosclerosis.

CONCLUSIONFibrinogen level may be a risk factor of CI and probably correlates with subtypes of CI and distributions of atherosclerosis.

Aged ; Atherosclerosis ; blood ; Brain Infarction ; blood ; classification ; Case-Control Studies ; Cerebral Infarction ; blood ; classification ; Female ; Fibrinogen ; metabolism ; Humans ; Infarction, Anterior Cerebral Artery ; blood ; Infarction, Posterior Cerebral Artery ; blood ; Male ; Middle Aged

BACKGROUND: To investigate the optimal values of transcranial doppler (TCD) index in the evaluation of leptomeningeal collateral circulation (CC) in patients with middle cerebral artery (MCA) stenosis. METHODS: Forty-one patients, with angiographically confirmed single stenosis or occlusion of the M1 segment of the MCA, were studied with TCD and brain MRI. Patients were divided into two groups according to the existence of CC though ipsilateral anterior cerebral artery on transfemoral cerebral angiography (TFCA). Mean flow velocities (mFV) of anterior and middle cerebral arteries (ACA, MCA) were analyzed. We then investigated the optimal values of TCD flow index: 1) ipsilateral mFV ACA/MCA (AMVR), 2) ACA velocity ratio (ACAVR), 3) mFVACA. We then correlated TCD flow index with TFCA results. RESULTS: TFCA revealed single moderate to severe M1 stenosis (n=35) and occlusion (n=6). Presence of CC was found in 11 (27%), absence of CC in 30 (73%). The mean of AMVR, ACAVR and mFVACA differed between the two groups: 1.76 +/- 0.69, 1.43 +/- 36, 86.27 +/- 31.73 cm/s in the presence of CC; 0.48 +/- 0.24, 1.21 +/- 0.39, 65.93 +/- 23.24 in the absence of CC. The optimal cutoff values for detection of CC were found at AMVR>or=0.9, ACAVR>or=1.30 and mFVACA>or=80 cm/s. The combination of individual TCD indexes had improved the specificity and positive predicted value in the detection of CC. CONCLUSIONS: TCD enables detecting the existence of CC in patients with MCA stenoocclusion. These optimal values may provide a noninvasive method for evaluate the pathomechanism of stroke and prospect the prognosis of these patients.
Anterior Cerebral Artery* ; Brain ; Cerebral Angiography ; Collateral Circulation* ; Constriction, Pathologic ; Humans ; Infarction, Middle Cerebral Artery* ; Magnetic Resonance Imaging ; Middle Cerebral Artery* ; Prognosis ; Sensitivity and Specificity ; Stroke

BACKGROUND & OBJECTIVE: Magnetic resonance angiography is helpful noninvasive evaluation of intracranial arteries and, in some patients, may spare invasive angiography which has potentially serious complication. However, it's diagnostic value in vertebrobasilar artery disease has not yet been evaluated. METHODS: MRA and axial brain MRI of 47 patients with acute cerebellar and/or brainstem ischemia, 26 patients with middle cerebral artery territory infarction, and 40 age matched normal controls were reviewed. Patients wit potential risks of cardiac embolization were excluded. MR Angiography was performed by three dimensional time-of-flight gradient-echo technique. Th diagnosis of vessel stenosis was made only when the lumen diameter was reduced by less than 50% on 3-D images to avoid overestimation of MR angiography. RESULTS: Forty-seven patients had cerebellar and/or brainstem infarction: with signal hyperintensities in T2-weighted MRI sequences. Pons was the most common infarcted site(28/47), followed by medulla (17/47), and cerebellum (11/47). The sensitivity of MR angiography in detecting vascular occlusive lesions of vertebrobasilar artery was 57.5% (28/47) in cerebellar and/or brainstem infarction patients, while 7 of 26 (26.9%) in middle cerebral artery territory infarction, and 2 of 40 (5%) in age matched control subjects showed occlusion or stenosis. MR angiography detected vascular occlusive lesions more frequently on vertebral arteries (25/47, 53.2%) than basilar artery (13/47, 27.7%). And occlusive or stenotic lesions of vertebral arteries were ipsilateral to ischemic lesion sites in 12 of 17 patients(70.6%), There was no difference between deep small lacunar stroke and perforator occlusion in pons. Absence of flow void on axial T2W imaging was seen only in 9 of 47 patients (19.1%). CONCLUSIONS: The results in this present study suggest that MR angiography is moderately sensitive diagnostic tool in vertebrobasilar occlusive disease although it has limitation in detection of smaller branches occlusion. Except vertebral arteries occlusion, absence of flow void in axial MR imaging is not a reliable findings.
Angiography ; Arteries ; Basilar Artery ; Brain ; Brain Stem Infarctions* ; Brain Stem* ; Cerebellum ; Constriction, Pathologic ; Diagnosis ; Humans ; Imaging, Three-Dimensional ; Infarction ; Ischemia ; Magnetic Resonance Angiography* ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Pons ; Stroke, Lacunar ; Vertebral Artery

BACKGROUND: Arteriovenous malformations (AVMs) with vascular abnormalities, including aneurysms, have been reported frequently. However, the coexistence of AVM and unilateral moyamoya disease is rare. We report herein an AVM patient who presented with acute ischemic stroke with unilateral moyamoya disease and occlusion of the feeding artery. CASE REPORT: A-41-year old man was admitted with sudden dysarthria and facial palsy. Brain computed tomography and magnetic resonance imaging revealed an acute infarction adjacent to a large AVM in the right frontal lobe. Cerebral angiography revealed occlusions of the proximal right middle cerebral and proximal anterior cerebral arteries, which were the main feeders of the AVM. Innumerable telangiectatic moyamoya-type vessels between branches of the anterior cerebral artery and dilated lenticulostriate arteries on the occluded middle cerebral artery were detected. However, a nidus of the AVM was still opacified through the distal right callosomarginal artery, which was supplied by the remaining anterior cerebral artery and leptomeningeal collaterals from the posterior cerebral artery. CONCLUSIONS: While AVM accompanied by unilateral moyamoya disease is rare, our case suggests an association between these two dissimilar vascular diseases.
Aneurysm ; Anterior Cerebral Artery ; Arteries ; Arteriovenous Malformations ; Brain ; Cerebral Angiography ; Dysarthria ; Facial Paralysis ; Frontal Lobe ; Humans ; Infarction ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Moyamoya Disease ; Stroke ; Vascular Diseases

An unanesthetized cat model of acute focal cerebral ischemia has been establishes by the technique of transorbital snare ligature for middle cerebral artery (MCA) occlusion, The model was used to investigate patterns of changes of regional cerebral blood flow (rCBF) for up to 16 hours following MCA occlusion by the hydrogen clearance technique and to explore the correlation among microregional blood flow changes, neurological deficit, and pathological changes including size of infarct and severity of brain edema. The animals were divided into 2 groups according to size of infarct that was identified by 2% triphenyl tetrazolium chloride solution stain. The results were as follows : 1) Infarct larger than 10% of coronal section surface of the ipsilateral cerebral hemisphere was found in 18 cats( Group A), and smaller infarct was found in the remaining 7 cats (Group B). Between these 2 groups, there was a statistically significant difference in the average rCBF value of ipsilateral MCA territory during 16 hours of ischemia (Group A:6.5ml/100g/min, Group B:32.6ml/100g/min) (P<0.01). 2) Increasing grade of contralateral paralysis correlated well with decreasing rCBF in MCA territory of occlusion side and all animals showing complete paralysis belonged to Group A with their average rCBF from ipsilateral MCA territory below 10.0ml/100g/min. 3) Increasing grade of cerebral hemispheric swelling was directly proportional to increasing grade of paralysis and there was also a significant difference in hemispheric swelling between Group A and B, Correlation between grades of infarct size and severity of paralysis was not evident. 4) There patterns of charges of rCBF were observed :In 15 cats of Pattern I, MCA occlusion caused persistent severe ischemia, measuring less than 16-17ml/100g/min(average rCBF:6.28ml/100g/min), to produce large infarct, pronounced paralysis, and severe histological damage(Group A). 5) In 7 cats of Pattern I, persistent mild to moderate ischemia, maintaining more than 23-24ml/100g/min(average rCBF:32.6ml/100g/min), was noted in association with much smaller infarct and milder hemiparesis(Group B). 6) In the remaining 3 cats of Pattern I, MCA occlusion caused immediate severe ischemia followed by early postischemic hyperemia and death during 8 to 14 hours after MCA occlusion owing to marked brain swelling and transtentorial herniation (Group A). 7) During the initial stage of ischemia, significant decrease in rCBF of the contralateral hemisphere was observed in both groups, however, in Group A, rCBF gradually increased to preocclusion level. Only Group B presented further decrease in rCBF suggesting the presence of interhemispheric diaschisis. Thus Group B appeared to take advantage of diaschisis during the late phase of infarct development as well as substantial collateral flow from the surrounding posterior cerebral and anterior cerebral artery territories.
Animals ; Anterior Cerebral Artery ; Brain Edema ; Brain Ischemia ; Cats ; Cerebral Infarction* ; Cerebrum ; Hydrogen ; Hyperemia ; Infarction, Middle Cerebral Artery* ; Ischemia ; Ligation ; Middle Cerebral Artery* ; Paralysis ; SNARE Proteins

PURPOSE: To investigate the relationship between changes in the posterior and anterior circulation, as seen at angiography, and the frequency and extent of cerebral infarction revealed by MR imaging in moyamoya disease. MATERIALS AND METHODS: This study involved 34 patients (22 females and 12 males, aged 2-52years) in whom cerebral angiography revealed the presence of moyamoya disease (bilateral: unilateral=24:10; total hemispheres=58) and who also underwent brain MR imaging. To evaluate the angiographic findings, we applied each angiographic staging system to the anterior and posterior circulation. Leptomeningeal collateral circulation from the cortical branches of the posterior cerebral artery (PCA) was also assigned one of four grades. At MR imaging, areas of cerebral cortical or subcortical infarction in the hemisphere were divided into six zones. White matter and basal ganglionic infarction, ventricular dilatation, cortical atrophy, and hemorrhagic lesions were also evaluated. To demonstrate the statistical significance of the relationship between the angiographic and the MR findings, both the Mantel-Haenszel chi-square test for trend and the chi-square test were used. RESULTS: The degree of steno-occlusive PCA change correlated significantly with the internal carotid artery (ICA) stage (p<0.0001). As PCA stages advanced, the degree of leptomeningeal collaterals from the PCA decreased significantly (p<0.0001), but ICA stages were not significant (p>0.05). The prevalence of infarction showed significant correlation with the degree of steno-occlusive change in both the ICA and PCA. The degree of cerebral ischemia in moyamoya patients increased proportionally with the severity of PCA stenosis rather than with that of steno-occlusive lesions of the anterior circulation. Infarctions tended to be distributed in the anterior part of the hemisphere at PCA stage I or II , while in more advanced PCA lesions, they were also found posteriorly, especially in the territories of the posterior middle cerebral artery (MCA), the posterior border zone, and the PCA (p<0.0001). The frequency of infarctions in the territories of the anterior cerebral artery (ACA) and the anterior MCA was unrelated to the degree of steno-occlusive ICA and PCA lesions (p>0.05). CONCLUSION: The degree of steno-occlusive lesions of the PCA correlated with the ICA stage. Progressive changes in steno-occlusive lesions of the ICA and PCA are associated with the extent and distribution of cerebral infarction. The degree of cerebral ischemia in moyamoya patients increased proportionally with the severity of PCA stenosis rather than with that of steno-occlusive lesions of the anterior circulation. In these patients, the presence of stenotic or occlusive PCA lesions appears to be significantly related to the occurrence of cerebral infarction.
Angiography ; Anterior Cerebral Artery ; Atrophy ; Brain ; Brain Ischemia ; Carotid Artery, Internal ; Cerebral Angiography ; Cerebral Infarction* ; Collateral Circulation ; Constriction, Pathologic ; Dilatation ; Female ; Ganglion Cysts ; Humans ; Infarction ; Magnetic Resonance Imaging ; Male ; Middle Cerebral Artery ; Moyamoya Disease* ; Passive Cutaneous Anaphylaxis ; Posterior Cerebral Artery ; Prevalence

We report a case of borderzone infarction which was developed after the coil embolization of unruptured internal carotid-posterior communicating artery aneurysm. Post-procedural angiography and brain computerized tomographic scan did not reveal any abnormality. However, brain magnetic resonance image (MRI) showed a wedge-shaped borderzone cerebral infarction between left middle cerebral artery and left anterior cerebral artery territory. It was suspected to be a manifestation of hypoperfusion in the internal carotid artery territory, caused by hemodynamic instability during the procedure. In order to prevent this unexpected serious complication, using the continuous hemodynamic monitoring during aneurysmal coil embolization, such as transcranial doppler ultrasonography, should be considered.
Aneurysm ; Angiography ; Anterior Cerebral Artery ; Arteries ; Brain ; Carotid Artery, Internal ; Cerebral Infarction ; Embolization, Therapeutic* ; Hemodynamics* ; Infarction* ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Ultrasonography, Doppler, Transcranial

With the advent of faster scan time and new computer program, a scanning technique called “dynamic computedtomography” has become possible. Dynamic CT consists of performing multiple rappid sequence scans after injectionof contrast material. The authors have evaluated the clinical usefulness of CT and dynamic CT of 93 patients withbrain infarction and/or ischemia during the period of 17 months from April 1983 to Aug. 1983 to Aug. 1984 inDepartment of Radiology, Chonbuk National University Hospital. The results were as follows; 1. The agedistribution ranged from 18 years to 78 years. Among them the most common age group was between 50 years and 59years(40.9%). 2. The sites of brain infarction were cerebral lobes(63 cases,68), basal ganglia(15 cases, 16.1%)and mlultiple sites(6 cases, 6.4%). The common affected site was middle cerebral artery territories. 3. Thecontrast enhancement of acute infarction was noted in 14 cases(17.5%) which occured commonly between 3 days and 2weeks from ictus. 4. The patterns of time-density curve in brain infarction and/or ischemia were as follow: a .Depression of slow wash-in phase was 20 cases(59%). b. Lower peak concentration was 17 cases(50%), c. Lower anddelayed peak concentration was 7 cases(21%), d. No definite peak concentration was 6 cases(18%). First threepatterns of time-density curve were thought as relatively characteristic curve of brain infarction and/orischemia. 5. Two cases that showed negative findings on precontrast CT scan appeared to be positive findings ashypodensity on postcontrast CT scan and were confirmed as brain infarction by dynamic CT. 6. The diagnostic entityof dynamic CT scan were as follows: a. large artery thrombotic infarction were 23 cases (58%). b. lacunarinfarction were 6 cases (15%). c. ischemia were 5 cases (13%), d. normal were 5 cases(13%), In six cases oflacunar infarction which was doubtful hypodensity on pre-and postcontrast CT scan had a marked difference in CT#(HU) on absolute scale graph of dynamic CT, so diagnosis of lacunar infarction could be made easily. 7. Theclinical values of dynamic CT consist in not only diagnosis of lacunar infarction but also evaluation ofeffectiveness of medical or surgical treatment.
Arteries ; Brain Infarction ; Brain ; Depression ; Diagnosis ; Humans ; Infarction ; Ischemia ; Jeollabuk-do ; Middle Cerebral Artery ; Stroke, Lacunar ; Tomography, X-Ray Computed

PURPOSE: The usefulness and radiographic findings of the angiography in cerebral infarction are well known. We attempted to evaluate the anglographic causes, findings, and the usefulness of DSA in cerebral infarction. MATERIALS AND METHODS: The authors reviewed retrospectively DSA images of 51 patients who were diagnosed as having cerebral infarction by brain CT and/or MRI and clinical settings. DSA was performed in all 51 patients, and in 3 patients, conventional anglogram was also done. Both carotid DSA images were obtained in AP, lateral, oblique projections, and one or both vertebral DSA images in AP and lateral. The authors reviewed the patient's charts for symptoms, operative findings and final diagnosis, and analysed DSA findings of cerebral atherosclerosis with focus on 6 major cerebral arteries. RESULTS: Among the 51 patients of cerebral infarction 43 patients(84.3%) had cerebral atherosclerosis, 1 dissecting aneurysm, 1 moyamoya disease and 6 negative in anglogram. DSA findings of cerebral atherosclerosis were multiple narrowings in 42 patients(97,7%), tortuosity in 22(51.2%), dilatation in 14, occlusion in 12, avascular region in 8, collaterals in 7, ulcer in 6, and delayed washout of contrast media in 3. In cerebral atherosclerosis, internal carotid artery was involved in 37 patients(86.0%), middle cerebral artery in 29(67.4%), posterior cerebral artery in 28, anterior cerebral artery in 26, vertebral artery in 22, and basilar artery in 15. Intracranial involvement of cerebral atherosclerosis (64.9%) was more common than extracranial involvement(16.2%). CONCLUSION: In cerebral infarction MRA may be the screening test, but for more precise evaluation of vascular abnormality and its extent, DSA should be considered.
Aneurysm, Dissecting ; Angiography ; Angiography, Digital Subtraction* ; Anterior Cerebral Artery ; Basilar Artery ; Brain ; Carotid Artery, Internal ; Cerebral Arteries ; Cerebral Infarction* ; Contrast Media ; Diagnosis ; Dilatation ; Humans ; Intracranial Arteriosclerosis ; Magnetic Resonance Imaging ; Mass Screening ; Middle Cerebral Artery ; Moyamoya Disease ; Posterior Cerebral Artery ; Retrospective Studies ; Ulcer ; Vertebral Artery