Clinical manifestation in patients with ischemic stroke in the border zone of the middle cerebral artery

Vekoslav Mitrović ,
Vekoslav Mitrović
Snežana Filipović-Danić
Snežana Filipović-Danić

Published: 01.12.2017.

Volume 47, Issue 3 (2018)

pp. 1-5;

https://doi.org/10.5937/pramed1804001m

Abstract

Introduction: Clinical features of the ischemic neurovascular syndromes is constant and dependable from vascular territory of the affected blood vessel. Best examples are sensory and motor hemisyndromes and vision disturbances. Aim: To define motor, sensory and visual disturbances’ in patients with ischemic stroke in the border zone of the middle cerebral artery. Material and methods: Border zone ischemic stroke diagnosis was based on clinical and neurological examination and confirmed with brain computerized tomography. Estimation of the symptoms was obtained by history, and degree of functional (neurological) deficit was estimated based on NIH-NINDS scale. Results: In total 30 patients were included in the study, 12 (40%) were females 47-79 years of age (±62.3 years) and 18 (60%) males 43-79 years of age (± 58.7 years). Neurological features were clearly different based on the side of the infarct. In the group with (ACA+ACM) + (ACM+ACM) infarct localization hemiparesis is significantly more frequent. In the group with ACM+ACP infarct localization homonymous hemianopia is significantly more frequent. Initial symptom of the reversible loss of consciousness in duration of several minutes was observed in 14 (46.6%) patients. Focal seizures (clonic seizures of the face, arm and leg) were detected in 4 (13.3%) patients (all with infarcts in the anterior border zone ACA-ACM). Headache was rare manifestation seen in 5 (16.6%) patients with 4 having posterior border zone infarcts. Conclusion: Supratentorial border zone infarcts have high specificity in clinical manifestations. The implicates therapeutical approaches which are prone to specific procedures.

Keywords

References

1.
Republička stručna komisija za izradu i implementaciju vodiča dobre kliničke prakse. Ishemijski moždani udar. Nacionalni vodič dobre kliničke prakse. 2011.
2.
Gavrilescu T, Carlos C. Clinical stroke syndromes: clinical-anatomical corelations. 1995;7:218.
3.
Victor M. Nerurovascular syndromes, in:Adams and Victor’s Principles of Neurology 10th Edition Hardcover. 2014;
4.
Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG. New Approach to Stroke Subtyping: The A-S-C-O (Phenotypic) Classification of Stroke. Cerebrovascular Diseases. 2009;27(5):502–8.
5.
The European Stroke Organization (ESO) Executive Committee and the ESO Writing Committee. In 2009.
6.
Momjian-Mayor I, Baron JC. The Pathophysiology of Watershed Infarction in Internal Carotid Artery Disease. Stroke. 2005;36(3):567–77.
7.
Mangla R, Kolar B, Almast J, Ekholm SE. Border Zone Infarcts: Pathophysiologic and Imaging Characteristics. RadioGraphics. 2011;31(5):1201–14.
8.
Albers GW, Caplan LR, Easton JD, Fayad PB, Mohr JP, Saver JL, et al. Transient Ischemic Attack — Proposal for a New Definition. New England Journal of Medicine. 2002;347(21):1713–6.
9.
Lovett JK, Dennis MS, Sandercock PAG, Bamford J, Warlow CP, Rothwell PM. Very Early Risk of Stroke After a First Transient Ischemic Attack. Stroke. 2003;34(8).
10.
Masuda J, Yutani C, Ogata J, Kuriyama Y, Yamaguchi T. Atheromatous embolism in the brain. Neurology. 1994;44(7):1231–1231.
11.
Klijn CJ, Kappelle LJ. Haemodynamic stroke: clinical features, prognosis, and management. The Lancet Neurology. 2010;9(10):1008–17.
12.
Verdelho A, Ferro J, Melo T, Canhão P, Falcão F. Headache in Acute Stroke. A Prospective Study in the First 8 Days. Cephalalgia. 2008;28(4):346–54.
13.
Denier C, Masnou P, Mapoure Y, Souillard-Scemama R, Guedj T, Théaudin M, et al. Watershed Infarctions Are More Prone Than Other Cortical Infarcts to Cause Early-Onset Seizures. Archives of Neurology. 2010;67(10).
14.
Bisschops RHC, Klijn CJM, Kappelle LJ, van Huffelen AC, van der Grond J. Association Between Impaired Carbon Dioxide Reactivity and Ischemic Lesions in Arterial Border Zone Territories in Patients With Unilateral Internal Carotid Artery Occlusion. Archives of Neurology. 2003;60(2):229.
15.
Derdeyn CP, Videen TO, Yundt KD, Fritsch SM, Carpenter DA, Grubb RL, et al. Variability of cerebral blood volume and oxygen extraction: stages of cerebral haemodynamic impairment revisited. Brain. 2002;125(3):595–607.
16.
Seiler A, Jurcoane A, Magerkurth J, Wagner M, Hattingen E, Deichmann R, et al. T2′ Imaging Within Perfusion-Restricted Tissue in High-Grade Occlusive Carotid Disease. Stroke. 2012;43(7):1831–6.

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