Naito_subbed.qxp 12/2/09 9:50 am Page 62
Brain Trauma Stroke
Table 1: Fifteen Patients with Hyper-acute Cerebral Infarction
Case Age/Sex CTP Time Occlusion Decreased Prolonged CBV Change Catheter Final Infarction Cerebral Outcome Collateral
After Onset of Artery CBF Area MTT area Thrombolysis (territory) Haemorrhage (mRS) Supply
(min)
1 71/M 300 Rt ICA Rt basal Rt basal Decrease: Succeeded Rt hemisphere Rt cerebral V Poor
ganglia ganglia anterior
1
⁄3 hemorrhagic hemorrhage
a
and Rt and Rt of Rt MCA infarction
MCA MCA and Rt basal
ganglia
2 63/M 50 Rt ICA Bil ACA Bil ACA Decrease: Failed Anterior
1
⁄3 of _ IV Poor
and Rt basal and Rt basal anterior
1
⁄3 Rt MCA and
and Rt MCA ganglia and of Rt MCA Rt basal ganglia
ganglia Rt MCA and Rt basal
ganglia
3 65/M 60 Rt MCA: Rt MCA Rt MCA Decrease: Partially Anterior
2
⁄3 – I Poor
proximal anterior
2
⁄3 succeeded of Rt MCA
M1 of Rt MCA
4 38/M 60 Lt MCA: Lt basal Lt basal Decrease: Partially Lt basal ganglia Lt basal ganglia II Poor
proximal ganglia and ganglia and anterior
1
⁄3 of succeeded and
2
⁄3 of
M1 Lt MCA Lt MCA Lt MCA and Lt MCA
Lt basal ganglia
5 71/M 125 Lt MCA: Lt MCA Lt MCA No decreased Succeeded Lt caudate – 0 Poor
proximal area nucleus head
M1
6 59/F 55 Lt MCA: Lt basal Lt basal Decrease: middle Succeeded Middle
1
⁄3 of Lt basal ganglia IV Poor
proximal ganglia ganglia and
1
⁄3 of Lt MCA Lt MCA and Lt
M1 and Lt MCA Lt MCA and Lt basal basal ganglia
ganglia
7 82/F 320 Lt MCA: Lt basal Lt basal ganglia No decreased Failed Lt basal ganglia – V Intermediate
distal M1 ganglia and and Lt MCA area and Lt MCA
Lt MCA
8 73/F 60 Rt MCA: Rt MCA Rt MCA Decrease: anterior Failed Rt MCA – IV Intermediate
M2
2
⁄3 of Rt MCA
9 60/F 35 Lt MCA: Lt MCA Lt MCA Decrease: anterior Succeeded Anterior
1
⁄3 of Lt insular I Good
M2
1
⁄3 of Lt MCA and Lt MCA subcortical
Lt insular subcortical
10 67/M 50 Rt MCA: Rt MCA Rt MCA No decreased area Partially Posterior
1
⁄3 of – I Poor
M2 succeeded Rt MCA
11 57/M 60 Lt MCA: Posterior
2
⁄3 Posterior
2
⁄3 Decrease: posterior Partially Posterior
1
⁄3 of Lt basal ganglia
b
II Poor
M2 of Lt MCA of Lt MCA
1
⁄3 of Lt MCA succeeded Lt MCA
12 43/F 90 BA Bil PCA Bil PCA Increase: Rt PCA Partially Lt PCA, Lt SCA – II Poor
succeeded
13 20/M 90 BA Bil PCA Bil PCA No decreased Succeeded Lt thalamus – II Good
area and Lt PCA
14 70/M 150 BA Bil PCA, Bil Bil PCA, Bil Increase: Bil PCA Succeeded Small pontine – II Rt PCA: good;
cerebellar cerebellar and Bil cerebellar infarction Lt PCA Poor
hemisphere, hemisphere, hemisphere
pons pons
15 67/M 50 BA Bil PCA, Bil Bil. PCA, Bil Decrease: Pons; Succeeded Lt cerebellar – IV Poor
cerebellar cerebellar increase: Bil cerebellar hemisphere
hemisphere, hemisphere, hemisphere infarction
pons pons
CTP = computed tompgraphic perfusion; CTA = CT angiography; M = male; F = female; Rt = right; Lt = left; Bil = bilateral; ICA = internal carotid artery; MCA = middle cerebral artery (MCA
branch was divided into three portions: proximal M1, distal M1 and M2); BA = basilar artery; ACA = anterior cerebral artery; PCA = posterior cerebral artery; SCA = superior cerebellar artery;
CBV = cerebral blood volume; MTT = mean transit time. Thrombolysis: Succeeded = distant artery appeared and achieved recanalisation; Partially succeeded = distant artery was obscurely
appeared; Failed = distant artery did not appear. Outcome (modified Rankin Scale [mRS]): 0 = no symptoms at all; I = no significant disability despite symptoms; able to carry out all usual
duties and activities; II = slight disability; unable to carry out all previous activities but able to look after own affairs without assistance; III = moderate disability requiring some help, but able to
walk without assistance; IV = moderate severe disability; unable to walk without assistance and unable to attend to own bodily needs without assistance; V = severe disability; bedridden,
incontinent, and requiring constant nursing care and attention, VI = death. a. Haemorrhage at putamen, anterior peduncle of the internal capsle and external capsle.
b. Hemorrhage due to interventional radiological technique (IVR).
Discussion 2). Although magnetic resonance perfusion and CTP studies do not have
CTP can be performed soon after plain CT for emergent cases, which can the same results with hyper-acute stroke patients, several papers have
show abnormal perfusion sites in a short time.
4,7,9–13
In our investigation reported that prolonged MTT areas in perfusion studies were larger in size
with the box-MTF method, we found that the locations and areas of CBF than the final infarct areas, and sometimes than CBF reduction areas, with
reduction sites were nearly identical to the prolonged MTT areas (see Table or without thrombolysis therapy.
14–21
In addition, in some reports, MTT
62 EUROPEAN NEUROLOGICAL REVIEW
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122 |
Page 123 |
Page 124