6533b7d3fe1ef96bd12608fc

RESEARCH PRODUCT

Clinical Syndromes, Pathogenesis, and Differential Diagnosis

subject

description

The temporal sequence of signs and symptoms in patients with cerebral ischemia provides important information for the analysis of underlying pathophysiologic mechanisms and in the search for a major hemodynamic or embolic cause. The signs reported and symptoms assessed are useful for localization of the ischemic region of the brain and identification of the affected vascular territories. Even in the case of a typical clinical picture the clinical findings alone are often insufficient for unequivocal anatomic and pathologic identification, however important they may be in the choice of diagnostic and therapeutic measures. In the first few hours after cerebral ischemia, determining the prognosis is extremely difficult, and it is usually impossible to decide whether complete remission may be expected, or whether progressive development of a severe deficit is taking place. There is currently a debate as to whether cerebral ischemia due to thromboembolism should be treated in the acute phase by thrombolysis, in the same way as recent myocardial infarcts (Zeumer 1985; del Zoppo et al. 1986; del Zoppo and Hacke 1987; Hacke et al. 1988); these prognostic aspects are therefore particularly important, as only those patients in whom no rapid spontaneous remission is to be expected should be exposed to the risk of treatment-associated hemorrhage.