Large subcortical hemispheric infarctions. Presentation and prognosis
R. L. Levine, H. L. Lagreze, J. A. Dobkin and P. A. Turski
Department of Neurology, William S. Middleton Veterans Administration Hospital, Madison, WI 53705.
A specific form of large subcortical hemispheric infarction on computed
tomography was identified in 24 of 2198 (1%) stroke registry patients.
Combined with 13 cases from earlier literature reports, a characteristic
neurologic picture developed. Severe face plus arm plus leg weakness at
onset (76%), corticallike features of aphasia and/or contralateral neglect
(68%), and premonitory transient ischemic attacks (24%) were frequent.
Twenty-two patients (59%) had large vessel arterial occlusive disease.
Eight patients (22%) had primary embolic occlusion in the middle cerebral
artery territory. During an average follow-up of 16 months, five patients
(14%) suffered recurrent stroke or death. The clinical presentation and
prognostic features of this distinct stroke subtype are described.
