PROGNOSIS OF HEMIPARESIS AND APHASIA DUE TO CEREBROVASCULAR DISEASES IN RELATION TO THE FINDINGS ON COMPUTERIZED TOMOGRAPHY

Abstract

Computerized tomography (CT) of the brain allows the clinical diagnosis of intracerebral hemorrhage or cerebral infarction with a precision heretofore unattainable. The size, location and extension of lesion are acurately portrayed. At Mihara Memorial Hospital in the past two years, prognosis of 101 cases with cerebral infarction and 80 cases with cerebral hemorrhage has been studied in relation to the findings on computerized tomography.1) The hemiplegia (complete palsy) was not found in patients with localized thalamic hemorrhage by CT scan, but was found in most of the patients who had hemorrhagic extension into the ventricle. The prognosis of hemiplegia was determined by the size of hematoma. The larger the lesion, the poorer the prognosis of hemiplegia was.2) All of the patients with putaminal hemorrhage extended into the ventricular system had complete hemiplegia. The prognosis of hemiplegia in patients with the hemorrhage taking place in the anterior putamen, is more favorable than in those with the posterior putaminal hemorrhage.3) Aphasia was not found in the patients who had extension of the hematoma within less than 24mm. Most of the patients with the hematoma larger than 25mm showed total or motor aphasia. The prognosis of aphasia is unfavorable in patients with hematoma larger than 35mm.All of the patients with thalamic hemorrhage showed no aphasia.4) Only 3.3% of the patients with small basal ganglia infarction demonstrated complete hemiplegia as compared with 36.6% of the patients with major artery occlusion.Sixty-five per cent of the patients with small infarction of the basal ganglia made good recovery compared with 17% of the patients with major artery occlusion. Motor deficit were mild in patients with lesion in the anterior limb or genu of the internal capsule, whereas patients who sustained small infarction in the posterior two-third of the posterior limb generally had much more marked motor involvement, especially in the most posterior one-third of the posterior limb.Ninety-two per cent of the patients with lesion less than 10mm had a good recovery whereas there was little or no improvement in 40% of the patients with 10-15mm diameter lesions.The lesion due to major artery occlusion involved the watershed sparing internal capsule at the level including pineal body by CT scan. The hemiparesis and its improvement were unfavorable in the patients with major artery occlusion.Prognosis of aphasia of the patients without obvious low density area on cortex or subcortex was more excellent than those of the patients with above low density area by CT scan.