A Retrospective Analysis Of Massive Cerebral Infarction In Clinic And Imageology

Objective: (1) To explore the etiopathogenisis,risk factors,clinical characteristics ,imaging ,treatments and prognosis of massive cerebral infarction (MCI)in order to raise the level of diagnosis and treatments about MCI.Methods: 47 patients suffering from MCI from November 1,2005 to November 1,2007 in our hospital were retrospectively analyzed.Their clinical characteristics,imaging and different strategies in treatment were analyzed.Results: (1)There were 21 men and 26 women among 47 patients, varying in age from 45 to 93,average age 74.09±12.49 years old(.2)In this group,39 cases(82.98%) were more than 60 years old,hypertension were found in 32 cases(68.09%),atrial fibrillation in 26 cases(55.32%),history of stroke or transient ischemia attack in 20 cases ( 42.55% ) ,hyperlipoidemia in 18 cases(38.30%),diabetes in 10 cases(21.28%),smoking in 8 cases(17.02%),drinking in 4 cases(8.51%).The cause of MCI was classified as cardioembolic,large-vessel atherosclerosis,iatrogenic or postoperative, arteritis,or others.In this group,there were 8 cases whose ages varied from 45 to 59 years old,a cardioembolic source of MCI was found in 2 patients suffering from rheumatic heart disease,iatrogenic MCI in 1 patient,arteritis from tuberculous encephalitis in 1 patient,no obvious cause was found in 4 patients;among 16 cases aging from 60 to 74 years old,a cardioembolic source of MCI in 8 patients suffering from nonrheumatic heart disease,large-vessel atherosclerosis was found in 3 patients,no obvious cause in 5 patients;among 19 cases aging from 75 to 89 years old,a cardioembolic source of MCI in 12 patients suffering from atrial fibrillation,large-vessel atherosclerosis was found in 1 patient,no obvious cause in 6 patients;among 4 cases more than 90 years old,a cardioembolic source of MCI in 3 patients suffering from nonrheumatic heart disease,no obvious cause in 1 patient.(3)In this group,28 patients manifested disturbance of consciousness,22 patients complete plegia ,20 patients headache or nausea and vomiting,13 patients disorder of urine and stool,12 patients gaze palsy,and 12 patients sensory disability,others handicap of speech,convulsion,ineqality pupils and so on.25 patients had pulmonary infection,13 patients herniation,5 patients alimentary tract hemorrhage,others hypopotassemia,urethra infection, bedsore , coronary artery disease and heart failure.(4)In this group, FIB was abnormal in 17 cases of 35 patients.Within 6 hours and during 6 to 12 hours after onset of MCI,hyperdense MCA, encephaledema and hypodense area were found on CT in some patients. Midline shift on CT was seen in 2 cases within 6 hours,9 cases during 24 hours to 1 week and 2 cases during 1 to 2 week.Hemorrhagic transformation (HT)on CT was found in 7 patients during 24 hours to 1 week,2 patients during 1 to 2 week and 2 patients during 3 to 4 week.HT was seen in primarily focus of infarction,site away from infarction and cerebral ventricle or subarachnoid cavity.MCI only involved the middle cerebral artery ( MCA) territory in 35 patients,left MCA and left posterior cerebral artery( PCA) territory in 2 patients,right MCA and right PCA territory in 6 patients, right MCA and right anterior cerebral artery (ACA) territory in 1 patient,left and right PCA territory in 1 patient,left PCA territory in 1 patient,left and right cerebellar hemisphere in 1 patient.Cerebral MRI almost showed the same results to CT in 8 patients.Cerebral MRA was abnormal in 2 of 3 patients. Ultrasonograph about carotid artery(CA) showed atherosclerotic plaque in 4 of 8 patients.(5)5 patients underwent decompressive hemicraniectomy,the 30-day mortality rate was 20%,survival rate 80%;42 patients received medical treatment,the 30-day mortality rate was 28.57%,survival rate 71.43%.Of all 13 patients who died,9 cases died of herniation,3 of multiple organ failure,1 of respiratory failure;among 13 patients,a cardioembolic source of MCI was found in 7 patients,large-vessel atherosclerosis in 1 patient , no cause obvious in 5 patients.Conclusions: ( 1 ) Hypertension,cardiac disease ( mainly atrial fibrilation)are crucial risk factors of MCI,which often occurs in adults more than 60 years old.Other risk factors include history of stroke or transient ischemia attack,hyperlipoidemia,diabetes,abnormal FIB,and so on.Etiopathogenisis includes cardioembolic source, arteriosclerostenosis, iatrogenic or postoperative,arteritis and others, rheumatic cardioembolic source and arteritis are usually found in the younger adults. ( 2 )Characteristic manifestation of MCI includes disturbance of consciousness,increased intracranial pressure, gaze palsy, complete plegia; some patients show convulsion, bilateral positive pathologic reflex,ineqality pupils,or complications,as follows:herniation,pulmonary infection,alimentary tract hemorrhage, myocardial infarction,hemorrhagic transformation,and so on.(3)Early computed tomography features such as hyperdense MCA, encephaledema and hypodense area, may suggest MCI.MRI,MRA or ultrasonograph about CA contribute to diagnosis of MCI(.4)Controlling intracranial pressure to prevent herniation is important to treat MCI, surgical interventions may raise survival rate of patients suffering from MCI. A cardioembolic source of MCI perhaps has high mortality rate, patients suffering from MCI die mainly of herniation.