Clinical Pattern And Stroke Pattern Analysis And The Prognosis In Patients With Severe Stenosis Or Occlusion Of Middle Cerebral Artery Disease

To investigate the peculiarity of clinical pattern and stroke patterns in pations with severe stenosis or occlusion of MCA disease, further to understand the pathogenesis of stroke, and to reveal the relationship betweem clinical and stroke patterns and severe stenosis or occlusion of MCAs, we diagnosed 169 patients with severe stenosis or occlusion of MCA disease by TCD, and they were performed on CT and (or) MRI.A ccording to the lesions on CT and (or) MRI and the clinical symptoms, separate these pations ino clinical and stroke subtype; To investigate the prognosis in pations with severe stenosis or occlusion of MCA disease and further to understand the method to avoid the worse prognosis, we follow-up 28 patients with severe stenosis or occlusion of MCA disease diagnosed by TCD for 6 to 15 months (8.23 months on average), record the worse events and evaluated the prognosis acrording to the two results of TCD examination.From the above work, we got the results as followed:1. It showed that the occurance of clinical patterns is PACI with 47.80%, LACI with 18.68%, TACI with 3.85%, and the occurance og stroke patterns is LI with 38.46%, WI with 19.23%. TI, MSSI and SI are relativea with the existence of severe stenosis or occlusion of MCA.2. During the 28 pations of 30 stenosis or occlusion of MCAs, there are still 26 remaining stenosis or occlusion.24 of the pations got medical therapy, 3 of them got inter vascular therapy, and 1 of them got none therapy. There are 4 worse events occurred, 2 of them were diagnosed occlusive disease, and 2 were diagnosed severe stenosis with the velocity of more than 300cm/s. The 2 results of TCD showed that 10 MCAs became better (33.3%), 16 MCAs remained stable(53.3%), while 4 MCAs progressed.There are 4 MCAs becoming moderate stenosis and 2 MCAs becoming normal in the group of becoming better.There are 3 MCAs got internal vascular therapy, 2 of them become normal and one of them becomes occlusive.From the above results, we got the conclusion as followed:1. The main subpattern of clinical pattern of severe stenosis or occlusion of MCA is PACI 47.80%), and the main stroke subpattern of it is LI (38.46%).Various subtype could present. The stroke patterns on image of subtype of OCSP are WI mostly (19.23%), except LI. TI, MSSI and SI are relativea with the existence of severe stenosis or occlusion of MCA. So vascular examination should be the routine of ischemic vascular disease.2. Most of the prognisis of stenosis or occlusion of MCAs remains stable (53.3%) after treatment, part of the severe stenosis of MCAs could become moderate stenosis (13.3%), while part of them could become normal (13.3%), doctors should follow-up the stenosis by TCD, and then deside whether to give internal vascular therapy. Small amout of the severe MCAs progress to occlusion (13.3%), doctors should give enough regardence, and give accurate therapy in time to avoid the occlusion. Otherwise, the number of our sample is too small, the big number of sample is still needed to investigate the outcome.