Thirty-five patients under the age of 60 were admitted to the Neurosurgical Department of the Inselspital with acute supratentorial ischaemic strokes between February 1985 and June 1990. The mean delay from the onset of the symptoms until emergency room admission was 10 hours. CT scan, Doppler sonography, and angiography were done routinely at the time of admission and CT was repeated 24 hours later. Initial treatment consisted of mannitol, low-molecular dextran and prednisolone. Intravenous nimodipine was added to the protocol in 1987. Intensive care including hyperventilation and intracranial pressure monitoring was instituted in cases of deteriorating level of consciousness and considerable oedema as visualized on the primary or repeat CT scan. Eight patients developing severe intracranial hypertension and/or unilateral mydriasis despite hyperventilation and osmotherapy underwent decompressive craniectomy. A total of 9 patients died in the acute stage, all but one due to a cerebral cause. At 6 months, only 6 patients were without significant neurological or neuropsychological deficits. Fourteen patients were moderately disabled and 6 were severely disabled. There were no vegetative survivors.
A number of demographic, clinical and radiological variables were investigated for a possible prognostic significance. A grading scale was developed for each variable. Of the initial neurological deficits, degree of motor paralysis, gaze deviation, and decreased level of consciousness correlated with an unfavourable result. While the prognostic significance of each of these individual variables was only moderate, the combined score of these 3 variables correlated better with outcome (r=0.62). More advanced age was found to correlate with a less favourable prognosis. The extension of the low-density area as visible on CT 24 hours after the event, was the single most significant prognostic factor (r=0.63). The site of vascular pathology, as visualized on angiography, was less predictive. Arterial recanalisation, as demonstrated by Doppler sonography, was weakly associated with a more favourable prognosis.
In conclusion, if the present preliminary data can be confirmed on a larger number of patients, the analysed variables allow assessment of the severity of hemispheric infarction for the purpose of therapeutic studies, however, the predictive value is not high enough to allow early therapeutic decisions for an individual patient.
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Bauer RB, Tellez H (1973) Dexamethasone as treatment in cerebrovascular disease 2. A controlled study in acute cerebral infarction. Stroke 4: 547–555
Bogousslavsky J, Regli F, Uske A (1988) Thalamic infarcts: clinical syndromes, etiology, and prognosis. Neurology 38: 837–848
Bounds JV, Wiebers DO, Whisnant JP, Okazaki H (1981) Mechanism and timing of deaths from cerebral infarction. Stroke 12: 474–477
Brott T, Adams HP, Olinger CP, Marler JR, Barsan WG, Biller J, Spilker J, Holleran R, Eberle R, Hertzberg V, Rorick M, Moomaw CJ, Walker M (1989) Measurement of acute cerebral infarction: a clincial examination scale. Stroke 20: 864–870
Brott T, Marler JR, Olinger CP, Adams HP, Tomsick T, Barsan WG, Biller J, Eberle R, Herztberg V, Walker M (1989) Measurement of acute cerebral infarction: lesion size by computed tomography. Stroke 20: 871–875
Brown M, Glassenberg M (1973) Mortality factors in patients with acute stroke. JAMA 224: 1493–1495
Cote R, Hachinski VC, Shurvell BL, Norris JW, Wolfson C (1986) The Canadian neurological scale: a preliminary study in acute stroke. Stroke 17: 731–737
Damasio H (1987) Vascular territories defined by computed tomography. In: Wood JH (ed) Cerebral blood flow: physiological and clinical aspects. McGraw-Hill, New York, pp 324–332
Duncan PW, Probst M, Nelson SG (1983) Reliability of the Fugl-Myer assessment of sensorimotor recovery following cerebrovascular accident. Phys Ther 63: 1606–1610
Foulkes MA, Wolf PA, Price TR, Mohr JP, Hier D (1988) The stroke data bank: design, methods, and baseline characteristics. Stroke 19: 547–554
Jencks SF, Daley J, Draper D, Thomas N, Lenhart G, Walker J (1988) Interpreting hospital mortality data. The role of clinical risk adjustment. JAMA 260: 3611–3616
Jennet B, Teasdale G, Braakman R (1976) Predicting outcome in individual patients after severe brain injury. Lancet 1: 1031–1034
Jones HR, Millikan CH (1976) Temporal profile (clinical course) of acute carotid system cerebral infarction. Stroke 7: 64–71
Jongbloed L (1986) Prediction of function after stroke: a critical review. Stroke 17: 765–775
Kondziolka D, Fazl M (1988) Functional recovery after decompressive craniectomy for cerebral infarction. Neurosurgery 23: 143–147
Knaus WA, Draper EA, Wagner DP, Zimmermann JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13: 818–829
Martinez-Vila E, Guillen F, Villanueva JA, Matias-Guiu J, Bigorra J, Gil P, Carbonell A, Martinez-Lage JM (1990) Placebocontrolled trial of nomodipine in the treatment of acute ischaemic cerebral infarction. Stroke 21: 1023–1928
Mathew NT, Rivera VM, Meyer JS, Charney JZ (1972) Doubleblind evaluation of glycerol therapy in acute cerebral infarction. Lancet 2: 1327–1329
Millikan CH (1985) Treatment of occlusive cerebrovascular disease. In: McDowell FH, Caplan LR (eds) Cerebrovascular survey report. The National Institute of Neurological and Communicative Disorders and Stroke, Bethesda
Mulley G, Wilcox RG, Mitchell JRA (1978) Dexamethasone in acute stroke. Br Med J 2: 994–996
Mullie A, Buylaert W, Michem Net al (1988) Predictive value of Glasgow Coma Score for awakening after out-of-hospital cardiac arrest. Lancet i: 137–140
Norris JW (1976) Steroid therapy in acute cerebral infarction. Arch Neurol 33: 69–71
Norris JW (1982) Comment on “Study design of stroke treatments” (letter). Stroke 13: 527–528
Oxbury JM, Greenhall RCD, Grainiger KMR (1975) Predicting the outcome of stroke: acute cerebral infarction. Br Med J 3: 125–127
Oye RK, Bellamy PE (1986) Assessing illness severity and outcome in critically ill patients. Emerg Med Clin North Am 4: 623–633
Portenoy RK, Lipton RB, Berger AR, Lesser ML, Lantos G (1987) Intracerebral hemorrhage: a model for the prediction of outcome. J Neurol Neurosurg Psychiatry 50: 976–979
Radu EW, Moseley IF (1978) Carotid artery occlusion and computed tomography, a clinicoradiological study. Neuroradiology 17: 7–12
Shenkin HA, Haft H, Somach FM (1965) Prognostic significance of arteriography in nonhemorrhagic strokes. JAMA 194: 142–146
Shinar D, Gross CR, Mohr JP, Caplan LR, Price TR, Wolf PA, Hier DB, Kase CS, Fishman IG, Wolf CL, Kunitz SC (1985) Interobserver variability in the assessment of neurologic history and examination in the stroke data bank. Arch Neurol 42: 557–565
Sisk Ch, Ziegler DK, Zileli T (1970) Discrepancies in recorded results from duplicate neurological history and examination in patients studied for prognosis in cerebrovascular disease. Stroke 1: 14–18
Spence JD, Donner A (1982) Problems in design of stroke treatment trials. Stroke 13: 94–99
Spiegel MR (1961) Theory and problems of statistics. McGraw-Hill, New York
Steiger HJ (1988) Zur Behandlung der traumatischen Karotisdissektion. Neurochirurgia 31: 128–133
Sugiura K, Muranka K, Chishiki T, Baba M (1983) The Edinburgh 2 coma scale: a new scale for assessing impaired consciousness. Neurosurgery 12: 411–415
Suzuki J (1987) Treatment of cerebral infarction. Springer, Wien New York
Trust tudy Group (1990) Randomized, double-blind, placebo-controlled trial of nimodipine in acute stroke. Lancet 336: 1205–1209
Weingarten S, Bolus R, Riedinger MS, Maldonado M, Stein S, Ellrodt AG (1990) The principle of parsimony: Glasgow Coma Scale Score predicts mortality as well as the APACHE II score for stroke patients. Stroke 21: 1280–1282
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Steiger, H.J. Outcome of acute supratentorial cerebral infarction in patients under 60. Acta neurochir 111, 73–79 (1991). https://doi.org/10.1007/BF01400491