Clinical Significance of Mixed Stroke; in non-Embolic Ischemic Stroke

J Korean Neurol Assoc > Volume 14(1); 1996 > Article

Journal of the Korean Neurological Association 1996;14(1): 26-33.

혼합형 뇌졸중의 임상적 의의(비색전성 뇌경색 환자를 대상으로)

이병철, 유경호, 도화범, 권기한, 황성희, 김형철, 강익원*

한림대학교 의과대학 신경과학교실, 방사선과학교실*

Clinical Significance of Mixed Stroke; in non-Embolic Ischemic Stroke

Byung-Chul Lee, M.D., Kyung-Ho Yu, M.D., Wha-Beum Doh, M.D., Ik Won Kang, M.D.*

Departments of Neurology & Radiology*, Hallym University College of Medicine

Abstract

Background & Objectives; After introduction of MRI with excellent capability of diagnosis In intracerebral hemorrhage (ICH) , old ICH is more readily detected in patients with ischemic stroke. However, very few studies have addressed the identification of clinical significance of mixed stroke. The aims of the study are to elucidate the incidence and the location of the coexisting ICH in non-embolic ischemic stroke. Also we tried to seek the difference of the vascular risk factors between ischemic strokes combined with and without ICH. Methods; Having 222 patients with non-embolic ischemic stroke as subjects, we reviewed the clinical data and MRIs of them retrospectively. We have defined mixed stroke as ischemic stroke combined with MR evidence of coexisting old ICH. The diagnosis of old ICH was made on the basis of the following findings; T2 weighted image showing a low signal intensity lesion with or without a hyperintesity area within it, and Tl weighted image revealing a low intensity lesion in the corresponding area. The frequency of vascular risk factors in the patients with mixed stroke was compared to that of those with pure ischemic stroke. Results; MRI examinations showed old coexisting ICH in 10.4% (23) of 222 non-embolic ischemic stroke patients. Of 23 patients, nineteen patients had old ICH associated with multiple lacunar infarction and others were cortical infarction. The anatomic distribution of the hemorrhage was as follows; basal ganglia and internal capsule 19(78.3%), thalamus 3(13.1%), corona radiata 1 (4.3%) , cerebellum 1 (4.3%) . Analyzing the vascular risk factors, no significant difference was noted between lacunar infarctions and mixed stroke.
Conclusion: The results of the study support that lacunar infarction and hypertensive ICH are bases on similar vascular pathophysiology. Therefore, old intracerebral hemorrhage may have a similar significance as a risk factor like previous ischemic stroke and inadvertent anti-thrombotic therapy might be avoided in certain stroke subtypes, which must be defined in future study.