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A profound hemispheric hypoperfusion with relatively small infarcts indicates a progressing stroke.

S Takashima1, Y Taguchi, H Inoue

  • 1Second Department of Internal Medicine, Toyama Medical & Pharmaceutical University, Japan.

The Keio Journal of Medicine
|April 6, 2000
PubMed
Summary

Patients with profound hemispheric hypoperfusion and small acute cerebral infarcts often have internal carotid artery (ICA) stenosis. Collateral flow significantly impacts stroke prognosis, with good recovery possible if the circle of Willis compensates.

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Area of Science:

  • Neurology
  • Radiology
  • Vascular Medicine

Background:

  • Acute cerebral infarction presents diverse clinical and imaging features.
  • Profound hemispheric hypoperfusion with small infarcts suggests specific underlying pathologies.

Purpose of the Study:

  • To identify clinical features and outcomes of patients with acute cerebral infarction characterized by profound hemispheric hypoperfusion and small infarcts.
  • To investigate the role of internal carotid artery (ICA) stenosis and collateral circulation in these specific stroke cases.

Main Methods:

  • Retrospective analysis of 135 patients with acute cerebral infarction.
  • Utilized magnetic resonance imaging (MRI) and cerebral blood flow (CBF) measurements in the acute phase.
  • Performed angiography (magnetic resonance angiography or conventional) to assess ICA stenosis/occlusion.

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  • Repeated MRI and CBF measurements after one month.

    • Main Results:

    • Eleven patients (8.1%) exhibited profound hemispheric hypoperfusion with relatively small infarcts.
    • All 11 patients presented with mild consciousness disturbance and progressing neurological symptoms.
    • Internal carotid artery (ICA) stenosis or occlusion was identified in all 11 patients.
    • Patients with additional atherosclerotic lesions distal to the circle of Willis had poor prognosis and persistent hypoperfusion.
    • Patients with only ICA lesions showed good prognosis and recovered hypoperfusion.

    Conclusions:

    • Profound hemispheric hypoperfusion with small infarcts is associated with ipsilateral ICA stenosis.
    • The presence and adequacy of collateral flow through the circle of Willis are critical determinants of stroke outcome.
    • Adequate collateral compensation predicts a good prognosis in low-flow infarctions secondary to ICA lesions.