Clinical Features of the Hemorrhagic Cerebral Infarction

Among 199 cases with cerebral infarction 23 cases ( 11.6%) developed hemorrhagic infarction on repeated computerized tomography (CT) scans. The hemorrhagic pattern was classified into 3 groups according to the CT findings; massive type (12 cases), partial type (6 cases), and scattered type (6 cases). Massive type hemorrhagic infarction was accompanied by cerebral swelling and mass effect and was observed, as a rule, within 4 days from clinical onset of the infarction, although there were a couple of exceptional cases, who developed hemorrhage over 2 weeks after the onset. Scattered type hemorrhagic infarction did not show mass effect and was always found after more than 8 days from the onset and no clinical evidence of symptomatic deterioration was encountered. Partial type hemorrhagic infarction appeared from within 4 days to 3 weeks after the onset. Mass effect was exceptional and symptomatic change was infrequent. Overall mortality of the non-hemorrhagic infarction was 15.3%, whereas it was 13% with hemorrhagic infarction, and the mass effect was the principal cause of mortality. Cardiac diseases were found to be the main risk factor in developing hemorrhagic infarction, while hypertension and diabetes mellitus did not appear to be significantly related to hemorrhagic changes of the cerebral infarction. Aspirin and other anticoagulant medication showed no significance either in this study. It is suggested that the causes of hemorrhage are different in massive type and partial or scattered type hemorrhagic cerebral infarctions.