Cerebral thromboembolism

Abstract

A total of 100 patients with cerebral thromboembolism were studied to assess the accuracy of clinical diagnosis and to evaluate indicators of prognosis. Excluded were those patients with serious medical disorders, those with fulminant course, and those whose stroke had occurred more than a month before admission. Of the 100 patients, 76 presented with hemiparesis maximal in the upper limb (middle cerebral artery syndrome), 2 had maximal weakness in the lower limb (anterior cerebral artery syndrome), 21 had brainstem dysfunction (basilar-vertebral artery syndrome), and 1 had only homonymous hemianopsia (posterior cerebral artery syndrome). Angiogram in 67 of the patients with middle cerebral artery syndrome revealed significant abnormality of the middle cerebral artery in 13% and of the internal carotid artery in 37%. A total of 50% with middle cerebral artery syndrome had no significant angiographic abnormality. In the patients diagnosed clinically as having anterior cerebral artery occlusion and posterior cerebral artery occlusion, the diagnoses were confirmed by angiography. Angiograms were completed in 17 of the 21 subjects with basilar-vertebral artery syndrome, and the clinical diagnosis was confirmed in 41% of those studies. Serious complications, including 2 deaths, occurred in 21% of the patients who underwent angiography. In this series, 57% had improved or fully recovered by approximately 1 month after the stroke. Several factors were analyzed to determine their effect on early prognosis. It was found that late age at onset, precipitous attack, involvement of the anterior circulation, previous transient ischemic attacks, and a history of heavy alcoholic intake may have an adverse effect on early prognosis, but data were insufficient to demonstrate that these factors were significant on statistical analysis. Sex of the patient, smoking habits, type of activity, and a history of hypertension did not seem to influence prognosis appreciably.