Clinical course and prognosis of middle cerebral artery occlusion in the acute stage

In order to evaluate the effects of therapeutic methods which have recently been performed for patients with cerebral infarction in acute stage, it seems essential to clarify the clinical course of cerebral infarction from acute stage after onset. In the present study, clinical course in 188 cases of middle cerebral artery occlusion admitted within 24 hours after onset was investigated. The prognosis in 183 cases at 2 months after the onset was as follows : excellent in 16 cases (8.5%), good in 23 cases (12.2%), fair in 49 cases (26.1%), poor in 74 cases (39.4%), dead in 26 cases (13.8%). In died 26 cases, 14 cases were dut to the complications, and 12 cases died from cerebral infarction directly without any complications, in which 7 of 12 died of hemorrhagic infarction. The relationship between the prognosis and the occlusive lesions revealed that the prognosis of the occlusion at the origin of middle cerebral artery was poorest, and it is better at the more distal site of occlusion. By classification into embolism and thrombosis, 90 were classified as embolism, 44 thrombosis and 54 unknown. The prognosis of patients with embolism was significantly worse than that with thrombosis. In addition, all patients with thrombosis died of complications. Hemorrhagic infarction was observed in 49 cases. The prognosis of hemorrhagic infarction was significantly poorer than that of non-hemorrhagic infarction. In 99 cases of embolism, hemorrhagic infarction was observed in 33 in tis rate as high as 37%, but it was also observed in 6 (14%) out of 44 cases with thrombosis. Neurological symptoms at the admission were closely related with the prognosis. 40% of patients with the consciousness level “O” (alert) at admission showed excellent or good prognosis, and were possible to return to the social life 2 months after onset. While the severer disturbance of consiousness resulted in poorer prognosis, and in cases of Grade III, nearly 90% of cases died, for which, there was significant difference. In 162 survived cases after 2 months, about 80% cases of slight motor disturbance over grade 4 at admission showed the recovery up to the favorable motor function with grade 4-grade 5, while its degree became 40% in the moderate disturbance grade 3-grade 2 at admission. Only 10% casse with severe disturbance of grade 1-grade 0 at admission showed favorable recovery. Dead cases were distributed widely from slight to severe motor distubances at admission and no distinct difference wa