分水岭脑梗死的临床研究及磁共振特征分析

目的探讨分水岭脑梗死(CWSI)的临床特征、治疗、头部磁共振成像(MRI)及磁共振血管成像(MRA)特征和临床应用价值。方法对我院48例分水岭脑梗死患者回顾分析。结果治愈26例,显著进步12例,好转8例;恶化、死亡各1例;MRI显示皮质前型8例,皮质后型14例,皮质下型24例,混合性2例;MRA显示颈内动脉狭窄或闭塞17处,大脑前动脉或闭塞10处,中动脉狭窄或闭塞8处,大脑后动脉6处,椎基底动脉6处。结论全身血压下降、颈内动脉等脑主干动脉狭窄或闭塞引起分水岭区域血液动力学障碍、血流改变以及微栓塞、Willis环完整性是主要发病原因,磁共振成像对分水岭脑梗死能提供更多的影像学信息。     

脑白质区域非腔隙性梗死灶与颅内外血管狭窄关系的探讨

目的 探讨脑白质区域非腔隙性梗死灶与颅内外血管狭窄的关系.方法 对30例脑白质区域非腔隙性梗死患者的头颅MRI以及主动脉弓、全脑数字减影血管造影(DSA)检查资料进行分析.结果 本组MRI示12例单侧基底节区片状异常信号中,DSA表现为一侧颈内动脉(ICA)起始部闭塞或高度狭窄9例,一侧大脑中动脉(MCA)M1段高度狭窄2例,无明确血管病变1例.6例基底节以及侧脑室旁白质区域病灶中,一侧ICA起始部闭塞或高度狭窄3例,一侧ICA C5段闭塞1例,一侧MCA M1段闭塞2例.4例侧脑室旁或半卵圆中心白质区域病灶中,一侧ICA C6段闭塞1例,一侧MCA M1段高度狭窄2例,无明确血管病变1例.8例皮质下上型或皮质下侧型分水岭脑梗死患者中,一侧ICA起始部闭塞或高度狭窄6例,双侧ICA起始部闭塞1例,一侧MCA M1段高度狭窄1例.结论 脑白质区非腔隙性梗死灶的发生与ICA系统大血管的狭窄或闭塞有密切的关系.     

膦甲酸钠治疗脑动脉硬化症19例分析

目的:探讨抗病毒治疗脑动脉硬化症的疗效。方法:19例脑动脉硬化症患者,经检测外周血白细胞HC-MV-PP65抗原证实呈HCMV活动性感染状态,同时行颈动脉超声检查。所有患者应用膦甲酸钠(PFA)抗病毒治疗,每次3.0克,每日一次,静脉点滴。结果:疗效显著,有效率达89.5%(17/19),治疗10～18天后复查HCMV-PP65抗原转阴率78.9%(15/19),治疗结束后均转阴。6例复查颈动脉超声,4例软斑消失,1例软斑较前略变小。结论:抗病毒药物应用为脑动脉硬化症患者的治疗提供了一个新方法。     

急性分水岭区脑梗死-凸面蛛网膜下腔出血三例

目的探讨颈动脉颅内或颅外段狭窄或闭塞导致后分水岭区凸面蛛网膜下腔出血(cSAH)与前循环急性脑梗死(ACI)的发病机制、影像学特征及治疗,以提高对该类型卒中的认识。方法报道3例颈动脉颅内或颅外段狭窄或闭塞导致cSAH患者的临床表现、CT和MRI所见及治疗。结果 3例患者临床表现以局灶性神经功能损害为主,且均存在动脉粥样硬化的危险因素,头颅CT显示病变对侧大脑皮质沟高密度影,并出现新发梗死灶。MRA证实例1病变侧颈动脉颅内及颅外段狭窄,例2病变侧大脑中动脉闭塞,例3病变侧颈动脉颅内段狭窄。结论颈动脉颅内或颅外段狭窄或闭塞导致的急性分水岭区ACI可以cSAH为首发表现。     

Moyamoya病的临床表现与影像学特点

目的 回顾分析12例Moyamoya病的临床和影像学特征，探讨Moyamoya病的影像学诊断价值。方法 分析12例Moyamoya病患的临床资料及数字减影血管造影(DSA)、磁共振血管造影(MRA)、磁共振成像(MRI)和CT结果。结果 所有病例均表现有颈内动脉或其分支不同程度的狭窄或闭塞和颅底异常血管网(MMD血管)；其中病变呈双侧8例．单侧4例。12例中头颅CT表现有梗塞灶4例，脑出血5例，其余3例表现正常。结论 除DsA外．MRI和MRA是两种可以很好评价Moyamoya病的影像学方法。若儿童或青壮年发生脑血管病，反复出现脑梗死或出现脑室出血、脑叶出血或蛛网膜下腔出血(SAH)则要考虑Moyamoya病的可能。     

多层螺旋CT诊断大面积脑梗死的应用价值

目的探讨螺旋CT对大面积脑梗死的诊断效果及应用价值。方法对在我院住院治疗的40例大面积脑梗死患者行多层螺旋CT平扫及CT血管造影(CTA),观察其诊断效果。结果 CT平扫初步诊断阳性率为55%,二次CT平扫复查阳性率为100%。CT表现为:22例为血管阻塞引起的大面积梗死,表现为片状低密度影,或表现浮云征、脑回征或假肿瘤征;12例为血栓脱落引起的大面积脑梗死,表现为大片状,低密度影,密度较均匀,边界较清楚,并且阴影沿血管走行;6例为外伤所致脑梗死,表现为在损伤基础上的大片状低密度影,且往往累及灰白质。CT血管造影示大脑前动脉严重狭窄或者闭塞患者7例,大脑中动脉严重狭窄或者闭塞患者18例,两动脉同时闭塞患者5例,颈内动脉末端闭塞2例,病变血管支配的脑实质范围比CT平扫所见梗死范围明显增大。结论多层螺旋CT平扫对大面积脑梗死诊断准确、省时,联合CT血管造影能够清楚显示病变血管狭窄程度及病变位置,为临床治疗提供有利依据,值得推广应用。     

大脑中动脉重度狭窄或闭塞患者脑梗死病灶类型与CT灌注成像分析

目的比较大脑中动脉(MCA)重度狭窄或闭塞患者不同脑梗死病灶类型的灌注状态。方法对89例MCA严重狭窄或闭塞患者进行头颅320排CTA+CT灌注成像检查,比较不同梗死病灶类型患者MCA闭塞率、侧支循环程度、MCA供血区灌注情况。结果 89例患者中,穿支动脉梗死(PAI)8例(9.0%)、皮质分支动脉梗死(PI)7例(7.9%)、大面积梗死(LTI)7例(7.9%)、分水岭梗死(BZI)43例(48.3%)、多发性脑梗死(MI)13例(14.6%)、无梗死灶11例(12.4%);不同类型梗死灶间MCA M1段病变、血管闭塞及不良侧支循环比率差异无统计学意义(均P0.05)。不同类型梗死灶局部脑血流量(rCBF)患健比、达峰时间(TTP)患健比差异有统计学意义(均P0.05)。BZI组rCBF患健比显著高于LTI组与无梗死灶组(均P0.05);LTI组及BZI组TTP患健比显著高于无梗死灶组及PAI组(均P0.05),MI组TTP患健比较无梗死灶组升高(P0.05)。LTI组MCA供血区低灌注发生率显著高于无梗死灶组(P0.05)。不同亚型BZI组间低灌注异常及不良侧支循环率差异有统计学意义(均P0.05),各灌注参数、MCA M1段病变及闭塞比率差异无统计学意义(均P0.05)。结论 LTI为失代偿期表现,低灌注发生率最高,其余类型为代偿期表现。皮质下型分水岭梗死较其他亚型侧支循环差,低灌注发生率更高,与血流动力学受损为主要病因的观点相符。MCA重度狭窄或闭塞患者脑梗死病灶类型以BZI为主。     

256层螺旋CT机头颈部CTA检查对脑梗死患者脑血管狭窄的诊断价值

目的探讨256层螺旋CT机头颈部CTA检查对脑梗死患者脑血管狭窄的诊断价值。方法采取256层螺旋CT机对300例急性脑梗死的患者进行CTA检查,观察脑血管狭窄、闭塞情况及责任血管。结果根据256层螺旋CT检查显示,有脑血管狭窄或闭塞的患者268例,正常32例,检出率为89.3%。有脑血管狭窄或闭塞的患者中,轻度狭窄64例(23.9%),中度狭窄83例(31.0%),重度狭窄45例(16.8%),闭塞76例(28.3%);单纯颅外动脉狭窄或闭塞15例(5.6%),单纯颅内动脉狭窄或闭塞72例(26.9%),颅内外动脉均有狭窄或闭塞181例(67.5%)。268例存在脑供血动脉狭窄或闭塞的脑梗死患者中,222例(82.8%)可以判断责任血管。单纯颅外动脉狭窄或闭塞12例(5.4%),单纯颅内动脉狭窄或闭塞41例(18.5%),颅内外动脉串联狭窄或闭塞169例(76.1%)。结论采用256层螺旋CT机进行头颈部CTA检查可明确脑梗死患者脑血管狭窄、狭窄程度及责任血管,可作为其诊断筛选方法。     

心源性脑梗死的影像表现

目的：评价CT和MRI-DWI在心源性脑梗死诊断中的临床应用价值。方法选择临床资料完整的89例心源性脑梗死患者的首次和治疗中复查影像表现进行回顾性分析。结果（1）首次影像学检查表现：单发47例,多发42例。C T检查57例,超急性期2例,急性期21例,亚急性期34例;M RI-DWI检查32例,超急性期15例,急性期10例,亚急性期7例。多呈片状、斑片状分布于皮质或（和）皮质下区,CT呈低密度灶,T2 WI呈高信号,DWI呈异常高信号,范围较 T2 WI大。大梗死灶（面积＞3 cm2）55个,小梗死灶（1.5～3.0 cm2）42个,腔隙性梗死灶（＜1.5 cm2）63个。（2）栓塞的血管分布：颈内动脉系统受累73例,其中大脑前动脉18例,大脑中动脉55例;椎基底动脉系受累11例,颈内动脉与椎基底动脉同时受累5例。（3）出血性脑梗死的影像表现：72例治疗中复查检出出血性脑梗死34例,1～3 d检出5例,3～7 d 9例,7～14 d 17例,14 d以上3例;影像表现为在片状梗死区内斑点、片状,血肿样出血灶或多处皮质区梗死灶内出血征象,斑点片状28例,血肿样6例,中心型10例,边缘型19例,混合型5例。结论 C T和M RI能够为心源性脑梗死的诊断、随访复查及判断预后提供更多直接可靠的影像学依据,DWI比CT与常规MRI在超急性期脑梗死治疗决策的确立中更具临床应用价值。     

彩色多普勒超声联合DSA在脑分水岭梗死颅外段动脉评价中的作用

目的探讨彩色多普勒超声(CDFI)联合全脑数字减影血管造影(DSA)对脑分水岭梗死患者颅外段动脉评价中的作用。方法分析本院2008年1月至2011年12月的92例脑分水岭梗死患者的临床及影像学资料,比较颈部CDFI及DSA两种检查手段对颅外段动脉评价中的优缺点;比较皮质分水岭梗死和内分水岭梗死的颅外段血管病变情况。结果对92例552条血管进行检查,DSA共发现52条血管狭窄,8条血管闭塞;CDFI共发现有64条血管狭窄,12条血管闭塞。两者总体对血管狭窄及闭塞的诊断比较差异无统计学意义(P>0.05)。对于动脉粥样硬化斑块性质的判断,两者之间比较差异有统计学意义(P<0.05)。皮质分水岭梗死与内分水岭在动脉狭窄或闭塞及不稳定斑块方面差异有统计学意义(P<0.05)。结论 CDFI及DSA对分水岭脑梗死颅外段供血动脉病变的判断具有重要意义且各具优缺点:DSA是诊断血管狭窄或闭塞的金标准,但对动脉硬化斑块性质的判断存在局限性;彩超能准确判断动脉粥样硬化斑块性质,但对血管狭窄或闭塞的判断存在一定的假阳性率。联合应用有助于对患者颅外段动脉的评价。     

动脉粥样硬化性缺血性脑血管疾病患者血清5种病原微生物IgM抗体的检测及意义

目的探讨脑梗死与HCMV、HSV1、HSV2、CP和HP活动性感染的相关性。方法用ELISA方法检测了209例(PS56例、CI88例和AS65例)患者血清HCMV、HSV1、HSV2、CPIgM抗体和122例(PS28例、CI55例和AS39例)患者HPIgM抗体。结果HCMV、HSV1、HSV2、CP和HPIgM抗体阳性率在PS、CI和AS组分别为58.93%、38.64%、29.23%;17.86%)、14.77%、10.77%;10.71%、9.09%、9.23%;16.07%(9/56)、9.09%、9.23%;60.71%、60%、48.72%。HCMV-IgM抗体阳性率PS与CI组比较有显著性差异(P<0.05);脑梗死(PS+CI)组与AS组比较有显著性差异(P<0.05);3组多重感染率(分别为44.64%、28.41%、23.08%)比较,PS与CI、AS组有显著性差异。其他病原微生物IgM抗体阳性率各组间无显著性差异。结论脑梗死的发生及病情进展与HCMV激活感染相关,与HCMV、HSV1、HSV2、CP和HP的多重感染有关。     

Risk factors for progressive ischemic stroke——A retrospective analysis

BACKGROUND: Progressive ischemic stroke has higher fatality rate and disability rate than common cerebral infarction, thus it is very significant to investigate the early predicting factors related to the occurrence of progressive ischemic stroke, the potential pathological mechanism and the risk factors of early intervention for preventing the occurrence of progressive ischemic stroke and ameliorating its outcome. OBJECTIVE: To analyze the possible related risk factors in patients with progressive ishcemic stroke, so as to provide reference for the prevention and treatment of progressive ishcemic stroke. DESIGN: A retrospective analysis. SETTING: Department of Neurology, General Hospital of Beijing Coal Mining Group. PARTICIPANTS: Totally 280 patients with progressive ischemic stroke were selected from the Department of Neurology, General Hospital of Beijing Coal Mining Group from March 2002 to June 2006, including 192 males and 88 females, with a mean age of (62±7) years old. They were all accorded with the diagnostic standards for cerebral infarction set by the Fourth National Academic Meeting for Cerebrovascular Disease in 1995, and confired by CT or MRI, admitted within 24 hours after attack, and the neurological defect progressed gradually or aggravated in gradients within 72 hours after attack, and the aggravation of neurological defect was defined as the neurological deficit score decreased by more than 2 points. Meanwhile, 200 inpatients with non-progressive ischemic stroke (135 males and 65 females) were selected as the control group. METHODS: After admission, a univariate analysis of variance was conducted using the factors of blood pressure, history of diabetes mellitus, fever, leukocytosis, levels of blood lipids, fibrinogen, blood glucose and plasma homocysteine, cerebral arterial stenosis, and CT symptoms of early infarction, and the significant factors were involved in the multivariate non-conditional Logistic regression analysis. MAIN OUTCOME MEASURES: Results of the univariate analysis of variance of the factors related to progressive ischemic stroke; Results of the multivariate regression analysis. RESULTS: All the 480 patients were involved in the analysis of results. ① Results of the univariate analysis variance: There were significantly more patients with fever, leukocytosis, history of diabetes mellitus, cerebral arterial stenosis and CT symptoms of early infarction in the progressive ischemic stroke group than in the control group (P < 0.01); The levels of blood glucose and fibrinogen in the progressive ischemic stroke group were significantly higher than those in the control group, while the level of blood pressure was significantly lower than that in the control group (P < 0.05–0.01). ② Results of the multivariate Logistic regression analysis: The independent predicting factors for progressive ischemic stroke were history of diabetes mellitus, fever, leukocytosis, cerebral arterial stenosis, CT symptoms of early infarction, blood glucose and blood pressure (OR =2.61, 2.96, 3.79, 1.03, 3.57, 2.68, 95% CI 0.92–3.59, P < 0.05–0.01). CONCLUSION: History of diabetes mellitus, fever, leukocytosis, levels of blood pressure, blood glucose, cerebral arterial stenosis and CT symptoms of early infarction are the risk factors for progress ischemic stroke     

Weakness of the lower extremity in carotid occlusive disease

Nineteen patients experienced progressive or episodic weakness of one lower extremity caused by severe stenosis or occlusion of the internal carotid artery. The majority of patients (84.2%) had occlusion or severe stenosis at the origin. Based on clinical profiles, angiographic findings, and cerebral blood flow patterns, we concluded that the pathophysiologic mechanism was hypoperfusion in the border zone between the anterior cerebral artery and the middle cerebral artery and that patients with progressive weakness had more extensive compromise in cerebral circulation. Following surgical treatment in 17 patients, progressive and episodic weakness disappeared and the majority of them (76.4%) became asymptomatic. However, the patients with stenosis at the siphon and those with progressive weakness from occlusion at the origin appeared to be at increased risk for cardiac death.     

颈动脉粥样硬化斑块与脑梗死的临床相关分析

目的分析颈动脉粥样硬化斑块与脑梗死的关系。方法对临床诊断98例脑梗死(脑梗死组)和同时期的82例非脑梗死患者(对照组)行颈部血管行彩色多普勒超声检查,并对两组颈动脉粥样硬化斑块发生率、大小、性质、好发部位以及颈动脉狭窄程度进行对比分析。结果 1脑梗死组与对照组颈动脉粥样硬化斑块检出率均较高,差异无统计学意义(81.6%vs72.9%,P0.05),但面积大于20mm2斑块的检出率急性脑梗死组显著高于对照组(38.8%vs9.8%,P0.01);2两组颈动脉硬化斑块的分布部位均以颈总动脉分叉处为主,两组间比较,差异无统计学意义(66.6%vs62.7%,P0.05);3两组颈动脉狭窄发生率及程度比较,脑梗死组均高于对照组(χ2=6.98,P0.05)。结论颈动脉粥样硬化斑块形成与脑梗死的有密切相关性,彩色多普勒超声技术对高风险、老年人的脑卒中早期预防及诊治有重要意义。     

动脉粥样硬化所致单侧颈内动脉闭塞卒中类型分析

目的 研究动脉粥样硬化所致单侧颈内动脉闭塞卒中类型.方法 2006-10～2008-10收治的急性前循环脑梗死患者,行颈动脉超声、经颅多普勒超声(TCD)和磁共振血管成像(MRA),部分行数字减影全脑血管造影(DSA)检查,发现48例单侧颈内动脉闭塞患者为动脉粥样硬化所致, 颈内动脉颈段闭塞28例,脑段闭塞20例.根据MRI分析单侧颈内动脉闭塞卒中类型.结果 显著皮质下梗死20例(41.7%),边缘带梗死13例(27.1%),区域梗死8例(16.7%),弥散小梗死灶7例(14.5%).结论 动脉粥样硬化所致单侧颈内动脉闭塞卒中类型多为显著皮质下梗死和边缘带梗死.颈内动脉颈段闭塞组中边缘带梗死、区域梗死的发生率较颈内动脉脑段闭塞组高(42.8%vs 5.0%,28.6%vs 0),脑段闭塞组皮质下梗死的发生率较颈段闭塞组高(80.0%vs 14.3%).     

A dynamic concept of middle cerebral artery occlusion and cerebral infarction in the acute state based on interpreting severe hyperemia as a sign of embolic migration

The present study investigates the pathogenesis of focal cerebral hyperemia, its effect on brain tissue and discusses its pathophysiological and therapeutic importance in the light of interpreting severe hyperemia as a sign of arterial reopening probably due to embolic migration. Cerebral angiography, serial CT-scans and serial TC99 -scans were performed in a consecutive group of 73 patients with completed stroke all admitted to hospital within 3 days after stroke onset. When possible the regional cerebral blood flow (rCBF) was studied with the intracarotid Xe 133 injection method. Twenty-nine patients had evidence of middle cerebral artery (MCA) occlusion; rCBF was investigated in 24. Fourteen patients had either occlusion or severe internal carotid artery (ICA) stenosis; rCBF was not measured in these patients. Thirty patients had no angiographical evidence of MCA occlusion, ICA occlusion or severe ICA stenosis; rCBF was investigated in 24. Focal hyperemia was observed in 21 patients but exclusively in the group with evidence of MCA occlusion. Hence, these 21 patients are typical and representative for the group of patients with evidence of MCA occlusion. Hyperemia was found in infarcted as well as in non-infarcted tissue. Apparently, it is the severity of the initial ischemic episode and not the hyperemia that determines whether or not tissue necrosis develops. Interpreting severe hyperemia as a sign of arterial reopening and embolic migration (evidenced by partial reopening affecting only some MCA branches) reopening had occurred in about 1/3 of the patients with MCA occlusion before they were examined 1 to 4 days after stroke onset. Autopsy studies performed in 8 of the patients with MCA occlusion indicate that arterial reopening also takes place in many patients later on (7 of 8). According to this interpretation, hypothetical as it is, the changing position of the embolus is associated with partial or complete reperfusion leading to hyperemia in the initially ischemic brain tissue. The hemodynamic basis for appropriate therapy therefore may change from one day to the next in the acute state of stroke due to MCA occlusion.     

中青年脑卒中危险因素回顾性分析

目的：探讨现代中青年人群脑卒中危险因素,为中青年脑卒中的一级预防提供依据。方法：回顾性分析2007年7月至2009年7月收治的162例中青年脑卒中患者的临床资料。结果：①本研究中男女性别比例为2.31：1,男性中年脑卒中比例〉青年脑卒中;②脑梗死病例占较大比例[116/162例（71.6%）];③中青年脑卒中危险因素构成比由高至低为：缺乏运动、血脂异常、高血压病、吸烟史及重度饮酒史等。结论：①青年脑卒中患者男女性别比例相仿,中年脑卒中患者男性〉女性;②中青年脑卒中类型以脑梗死为主;③中青年脑卒中的主要危险因素为缺乏运动、血脂异常、高血压病、吸烟史和重度饮酒史等。     

中青年急性脑梗死患者的生活方式及颈动脉病变的特征分析

目的探讨中青年急性脑梗死(ACI)患者的生活方式及其颈动脉病变的特征。方法①小于45岁ACI患者87例为中青年组,与81例健康对照组比较,分析他们的生活方式(饮食结构,生活规律,睡眠状况,饮酒,吸烟,社会劳动性质,手机使用时间,运动时间等);②大于55岁的ACI患者95例为老年对照组,比较中青年ACI组与老年ACI对照组的颈动脉病变的特征。结果①中青年ACI患者多体型肥胖,大量吸烟,酗酒,生活无规律,以高盐,高脂注重口味饮食为主及运动量减少等;②颈动脉彩超示,中青年组患者颈动脉不稳定斑块检出率为32.18%(28/87),稳定斑块检出率21.84%(19/87),颈动脉狭窄主要为轻-中度狭窄;③老年组不稳定斑块检出率为47.37%(45/95),稳定型斑块检出率为23.16%(22/95),颈动脉狭窄主要为中-重度狭窄。结论不良生活方式是中青年脑梗死发病的重要危险因素,颈动脉病变以不稳定型斑块为主,颈动脉内径主要表现为轻-中度狭窄。     

Antithrombotic treatment of ischemic stroke among patients with occlusion or severe stenosis of the internal carotid artery: A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST).

OBJECTIVE: To examine the responses to early IV administration of an anticoagulant or placebo started within 24 hours of stroke among persons with an ipsilateral occlusion or severe stenosis of the internal carotid artery (ICA) identified by carotid duplex imaging. BACKGROUND: Patients with ischemic stroke of the cerebral hemisphere secondary to an ipsilateral occlusion or severe stenosis of the ICA generally have a poor prognosis. Early, accurate identification of these patients might permit improved treatment. METHODS: Exploratory analysis of outcomes at 7 days and 3 months was performed among patients enrolled in the Trial of Org 10172 in Acute Stroke Treatment (TOAST) who had an ischemic stroke in the cerebral hemisphere ipsilateral to an occlusion or a stenosis >50% of the ICA identified by carotid duplex imaging. RESULTS: Regardless of treatment, patients with duplex evidence of an occlusion of the ICA had more severe strokes and poorer outcomes at 7 days and 3 months than patients who had a stenosis. Favorable outcomes at 7 days were noted in 64 of 119 patients given danaparoid (53.8%) and 41 of 108 patients treated with placebo (38.0%; p = 0.023). By 3 months, favorable outcomes were noted in 82 patients given danaparoid (68.3%) and 58 patients administered placebo (53.2%; p = 0.021). CONCLUSIONS: Early identification by duplex imaging of an occlusion or severe stenosis of the ICA ipsilateral to a hemispheric ischemic stroke might improve selection of patients who could be treated with emergent anticoagulation. Further testing of this approach is needed.     

Cause of cerebral infarction in the carotid territory. Its relation to the size and the location of the infarct and to the underlying vascular lesion

Seventy-three patients with acute nonhemorrhagic stroke in the carotid territory were investigated for the cause of the stroke: middle cerebral artery (MCA) occlusion/stenosis or internal carotid artery (ICA) occlusion/stenosis; embolus from the heart and extra-cranial arteries or thrombosis. The study is prospective and consecutive comprising stroke patients below the age of 75 years, admitted in the acute state i.e. within 3 days after stroke onset. Excluded were patients with intracerebral hematoma, subarachnoid hemorrhage, vertebrobasilar stroke and patients in whom another severe disease was present. Cerebral angiography and CT-scan were performed in all patients within one and two days after admission. CT-scan was repeated 2 weeks and 6 months later. Forty percent had MCA occlusion, none had MCA stenosis, 12% had ICA occlusion, 14% had severe ICA stenosis (half of these were associated with MCA occlusion) and 41% were without significant MCA/ICA lesions. Twenty-seven percent had large infarcts with a diameter greater than 3 cm; 34% had medium-sized infarcts with a diameter between 3 and 1.5 cm; 21% had small infarcts with a diameter less than 1.5 cm; 18% had no identifiable infarct on CT-scan. MCA occlusion was responsible for 62% of the large or medium-sized infarcts. ICA occlusion or severe ICA stenosis were responsible for only 27% of the large or medium-sized infarcts. Only 11% of the patients with small or no infarct on CT-scan had significant MCA/ICA lesion.(ABSTRACT TRUNCATED AT 250 WORDS)