Stroke is the most common life threatening neurological disease and the third leading cause of death after heart disease
and cancer, accounting for 1 of every 15 deaths. In the elderly, the segment of the population in which stroke occurs most
frequently, it is the leading cause of disability requiring long term institutionalization.
Faced with an acute stroke, the physician must determine the cause, estimate the severity, consider the possibility of
progression or recurrence and seek ways of stabilizing or reversing it. Investigations should be designed to assist
clinicians in subcategorizing patients at three specific levels (1) separating strokes from non strokes such as cerebral tumours and
subdrual hematoma (2) distinguishing hemorrhage from infarction and (3) identifying specific pathophysiological sub
types of cerebral infarction. Because the possibility of worsening or recurrence is paramount, speedy efforts should be made to
arrive at a diagnosis of stroke mechanism using this approach.
The ideal test should be inexpensive, noninvasive, accessible, accurate and informative.
82 patients, both male and female were included in the study satisfying the defined inclusion and exclusion criteria.
Analysis of their CT brains resulted in the following conclusions. 1. Infarcts in the anterior circulation fit into 6 different patterns namely
a. Large territorial or cortical infarcts, b. Large / discrete subcortical infarcts involving he striatocapsular and corona radiata region.
c. Large fragmentary infarcts in the MCA/ACA territory, d. Small fragmentary infarcts in the MCA/ACA territory,e. Cortical borderzone infarcts and subcortical borderzone i.e linear corona radiata and linear centrum semiovale infarcts, f. Discrete corona-radiata and discrete centrum semiovale infarcts, Among the 6, pattern 5 or border zone infarcts are most common.
2. Two or more of these patterns can co-exist, though there are no definite combinations. Combinations vary depending on the proposed pathophysiology of stroke.
3. Cortical borderzone infarcts usually thought to be due to haemodynamic failure can be embolic in origin too.
4. Heart disease can result in infarcts in any pattern or their combinations thereof. 5. Pattern1 cortical infarcts and pattern 2 large striatocapsular infarcts show sudden peak clinically with a subsequent
static or regressive course. 6. Progressive strokes are usually associated with combinations of different patterns in CT Brain
7. Sensorium at onset is associated more with the size of the infarct than with a pattern of infarct.
It is difficult to correctly guess the artery involved in
anterior circulation strokes from the pattern of CT Brain involvement and the clinical course, though certain patterns
do indicate possible aetiologies
