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

Abstract

We determined clinical features of patients who had a profound hemispheric hypoperfusion with relatively small, acute cerebral infarcts. One hundred and thirty-five patients with acute cerebral infarction underwent both magnetic resonance imaging (MRI) and cerebral blood flow (CBF) measurement in the acute phase of stroke. Eleven (8.1%) had a profound hemispheric hypoperfusion with relatively small infarcts. In these patients, magnetic resonance angiography or conventional angiography was performed, demonstrating the internal carotid artery (ICA) stenosis or occlusion on the ipsilateral side of the infarcts. MRI and CBF measurement were repeated one month later. All of 11 patients suffered from a mild consciousness disturbance, and showed a progress of neurological symptoms during a few days, indicative of a progressing stroke. Five patients of 11 concomitantly had atherosclerotic lesions in the arteries distal to the circle of Willis. The remaining six patients had only the ICA lesions. The prognosis of the former was poor and the hemispheric hypoperfusion pattern did not improved. On the other hand, the prognosis of the latter was good and the hemispheric hypoperfusion was recovered soon. In conclusion, if the collateral flow through the circle of Willis could compensate the misery perfusion, the prognosis of low-flow infarctions with ipsilateral ICA lesions might be good.