The cerebrospinal fluid (CSF) protein patterns, in ischemic cerebrovascular disease (ICD), of varying extension were studied by isoelectric focusing (IEF) in 100 patients at different intervals after the onset of symptoms. The diagnoses were based on conventional clinical examinations and CSF spectrophotometry in all cases. Computed tomography was performed on 52 cases.

Computed tomography (CT) has been reported to show normal findings in 13-52% of patients with cerebrovascular diseases. Among factors deciding the diagnostic accuracy are the size and location of the lesion, the time elapsed from onset to examination, the use of contrast enhancement and the type of CT scanner used. To further elucidate these aspects, we designed the present study including 300 consecutive patients, all investigated by CT with a 160 x 160 matrix and cerebrospinal fluid spectrophotometry (CSF-SPE). CT indicated a specific diagnosis in 52.7%. In the majority of the remaining cases, additional subclassification was possible by CSF-SPE, emphasizing the complementary information obtained by combined examinations. CT was also found to be a useful tool for reliable prognostic prediction, irrespective of the initial clinical course.

Two hundred and thirty-one patients with cerebrovascular disease were examined by spectrophotometry of the cerebrospinal fluid (CSF) and by computer tomography. Many were followed by repeated examinations. Specific diagnoses --- bleeding as opposed to non-hemorrhagic or hemorrhagic infactions --- were indicated in 97% by spectrophotometry and in 65% by CT scan in 201 of the 231 cases (excluding 25 patients with transient ischemic attacks and five patients with cerebral tumors with cerebrovascular onset). Comparison between the two methods revealed agreement in most cases, with disagreement in only a few. The specific diagnosis was generally established on only one examination by both methods: repeated examinations were necessary in only a few cases. The results indicated that a combination of the two complementary methods established the diagnosis in almost all cerebrovascular disorders. This was particularly evident if the examinations were performed 24 hours to 21 days after onset of disease.

Twelve patients with 13 cerebrovascular incidents presenting with atypical clinical patterns where the combination of CSF spectrophotometry (CSF-SPE) and computerized transverse axial tomography (CTAT, “EMI-scanning”) showed cerebral haematomas, with or without haemorrhage into the CSF are reported. The high diagnostic significance of CSF-SPE as well as the value of using a combination of CSF-SPE and CTAT examinations in cerebrovascular diseases has previously been established by the authors. The present patient group comprised some 10% of a total series of patients with cerebrovascular disease hitherto studied in this fashion. Conclusive findings were found in only 1 of the 5 cases examined by angiography and in none of the 5 cases studied by isotope scan. Since many cerebral haemorrhages obviously have atypical clinical features as compared with the “classical” pattern, the combined use of CSF-SPE and CTAT examinations in the diagnosis of cerebral haematomas is a prerequisite for rational therapy.

Eighty patients with cerebrovascular diseases were examined by computer tomography and spectrophotometry of CSF, most cases being followed by repeat examinations. Specific diagnoses were obtained in 76 per cent of the cases at tomography and in 95 per cent at spectrophotometry, generally at one examination. In cases examined angiographically or by isotope encephalography, the corresponding figures were 60 and 58 per cent. Twenty patients with confirmed haemorrhage or infarction examined only at tomography further indicated the high diagnostic significance of this method. The combination of tomography and spectrophotometry, being complementary to each other, obviously means a break-through in the diagnosis of cerebrovascular diseases, which is a prerequisite for a more rational therapy of these common and frequently disabling disorders.