INFARCTS IN THE MIDDLE CEREBRAL-ARTERY TERRITORY - PATHOLOGICAL-STUDYOF THE MECHANISMS OF DEATH

Correlates of the size of infarcts, the time from stroke to death, and the mechanisms of death were studied in 77 consecutive patients who d ied from infarction in the middle cerebral artery territory. The area of infarcts was assessed by planimetry on schemas of representative br ain levels and the results were expressed as a ratio of infarcted area on the whole MCA territory. No clear relationship was found between t he size of infarcts in the MCA territory, and any of the characteristi cs of the patients, but extensive infarcts were more frequent when the internal carotid artery was occluded. No evidence was found of an adv erse effect of age, diabetes or initial hyperglycemia on the size of i nfarcts. The mechanisms of death were not linked to sex, age, high blo od pressure, diabetes, blood glucose level at admission, presence and location of an arterial occlusion, or etiology of the infarct. On the contrary, they varied as a function of interval from stroke to death. Transtentorial herniation, the main cerebral cause of death, occured m ainly in the first week and was related to the large size of infarcts. Rare recurrences of stroke and frequent extracerebral mechanisms of d eath (mainly pneumonia, pulmonary embolism and cardiopathy) occurred l ater on.