Clinical And Imaginal Features Of The Remote Lesions In Patients With Middle Cerebral Artery Occlusion

BackgroundThe formerly research of ischemic stroke mostly focus on the infarction area. In recent years, many researches indicate that the lesions not only confined in the infarction region but also occur in the nervous tissues remote from the infarction region which is not supplied by the infarction artery. A lot of clinical and animal experiment have proved the existence of the remote lesion after middle cerebral artery occlusion and discussed the pathology and imaginal features. But there is no large sample research on the relationship between the clinical and imaginal features so far.Purpose:We observe the remote lesion after middle cerebral artery occlusion using Magnatic Resonance Imaging and diffusion-weighted imaging and assess the clinical information of the patients to find the relationship between the clinical and imaginal features.Methods:We selected 24 patients admitted to the department of Neurology in Qianfoshan hospital between Sep 1,2010 and Feb 28,2011.Patients were involved in this study if clinical and imaginal examination show infarction in the area supplied by the middle cerebral artery. The patients accepted MRI and DWI at 24 hours after infarction and 2 weeks later. New low signal in the islateral thalamus or high signal in the islateral substantia nigra is considered as the positive event. All the patients are divided into two groups depends on whether has the positive event or not. Then the clinical and imaginal features, including risk,position,volume,and NIHSS are compared.Results:In all the 24 patients,12 patients were cortex infarction,4 patients were basal ganglia infarction,2 patients were cortex and basal ganglia infarction,3 patients were white matter infarction and 3 patients are watershed infarction.10 patients have imaginal positive event and considered as the positive group. The positive event is high signal in the islateral substantia nigra.14 without the imaginal positive event is considered as the negative group. There are not obvious difference in the ris,volume of the infarction between the two groups. The NIHSS of the positive group is larger than the negative group at both time(24h and 2 weeks after stroke); NIHSS has a remarkable reduction at 2 weeks after stroke compared to 24h after stroke in the negative group but there is no obvious difference of the N1HSS from 24h to 2 weeks after stroke in the positive group.Conclusions:1. High T2WI and DWI signal in the islateral substantia nigra can be observed in nearly half of the MCAO patients 2 weeks after stroke.2.No obvious connection between the risk,volume of the infarction and the degree of the remote lesions after MCAO is found in this study.3.The infarction at basal ganglia and frontal lobe has more possibility to lead to lesions in the islateral substantia nigra.4.The remote lesions are more serious in the patients whose symptom are more serious at 24h after MCAO, and the recovery of the neural function is delayed.