Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R
Department of Neurology, University of Heidelberg, Germany.
Arch Neurol. 1996 Apr;53(4):309-15. doi: 10.1001/archneur.1996.00550040037012.
Although the clinical features of space-occupying ischemic stroke are well known, there are limited prospective data on the clinical course of complete middle cerebral artery territory infarction and on the predisposing factors leading to subsequent herniation and brain death.
The clinical course of patients with complete middle cerebral artery territory infarction, defined by computed tomography and vascular imaging, was evaluated. Initial clinical presentation was assessed by the Scandinavian Stroke Scale and the Glasgow Coma Scale. Serial computed tomography with measurement of midline and septum pellucidum shift and data on the presence and location of vascular occlusion by angiography or Doppler ultrasound were obtained directly after admission. Time course and outcome were analyzed with regard to the clinical findings on admission and at follow-up. The functional status of surviving patients was assessed using the Barthel Index.
Fifty-five patients with complete middle cerebral artery territory infarction caused by occlusion of either the distal intracranial carotid artery or the proximal middle cerebral artery trunk were studied. In all patients, embolic infarction was presumed. The mean Scandinavian Stroke Scale score on admission was 20, and the time course of deterioration varied between 2 and 5 days. Forty-nine patients required ventilator assistance during the acute stage of disease. Only 12 patients (22%) survived the infarct. The cause of death was transtentorial herniation with subsequent brain death in 43 patients. Survivors had a mean Barthel Index score of 60 (range, 45 to 70).
The prognosis of complete middle cerebral artery territory stroke is very poor and can be estimated by early clinical and neuroradiological data within the first few hours after the onset of symptoms. A space-occupying mass effect develops rapidly and predictably over the initial 5 days after presentation. Herniation occurred as an end point in 43 (78%) of these patients.
尽管占位性缺血性卒中的临床特征已为人熟知，但关于大脑中动脉完全梗死区域的临床病程以及导致随后脑疝和脑死亡的诱发因素的前瞻性数据有限。
对通过计算机断层扫描和血管成像定义的大脑中动脉完全梗死区域患者的临床病程进行评估。初始临床表现通过斯堪的纳维亚卒中量表和格拉斯哥昏迷量表进行评估。入院后直接获取连续计算机断层扫描图像，测量中线和透明隔移位，并通过血管造影或多普勒超声获取血管闭塞的存在和位置数据。根据入院时和随访时的临床发现分析病程和结局。使用巴氏指数评估存活患者的功能状态。
研究了55例由颅内颈内动脉远端或大脑中动脉主干近端闭塞导致大脑中动脉完全梗死区域的患者。所有患者均推测为栓塞性梗死。入院时斯堪的纳维亚卒中量表平均评分为20分，病情恶化的病程在2至5天之间有所不同。49例患者在疾病急性期需要呼吸机辅助。仅12例患者（22%）在梗死中存活。43例患者的死亡原因是经天幕疝并随后脑死亡。存活者的巴氏指数平均评分为60（范围为45至70）。
大脑中动脉完全梗死区域卒中的预后非常差，可在症状发作后的最初几小时内通过早期临床和神经放射学数据进行评估。占位性肿块效应在出现后的最初5天内迅速且可预测地发展。这些患者中有43例（78%）以脑疝为结局。
