DIAGNOSIS AND TREATMENT OF STROKES: RADIOLOGICAL ASPECTS

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Abstract
SUMMARY: A series of 150 consecutive patients admitted to hospital with the diagnosis of “stroke” was investigated radiologically by vascular and ventricular contrast studies. Comparison of clinical and radiological diagnoses showed that in many cases clinical impressions were incorrect. This particularly applies to the unsuspected presence of lesions such as aneurysms and subdural clots.In cases of suspected cerebral ischæmia, it has been shown that a complete survey of cervical and cerebral vessels is necessary to gain an overall idea of the position of the atheromatous lesions causing interference with cerebral blood flow. This is of great importance with regard to corrective surgical therapy.In many cases no actual occlusion of any vessels was found ; but the survey indicates the common occurrence of ectasia in both carotid and vertebral systems. The pathological lesion was found to be a defect in the elastica of the affected vessels. In view of the paucity of actual occlusions demonstrated compared with the frequency of a clinical diagnosis of “cerebral thrombosis”, it would seem that a reappraisal of nomenclature and pathological ætiology is in order.The position of radiological investigation with regard to practicability and safety is discussed, and it is concluded that it has a great deal to offer both diagnostically and therapeutically.