Incomplete cerebral infarction--focal incomplete ischemic tissue necrosis not leading to emollision.

UNTIL THE ADVENT OF GT SCANNING, the diagnosis of cerebral infarction was based mainly on clinical criteria with lumbar puncture, angiography, and Tc scans affording supplementary evidence. Autopsy showed that the diagnosis often was in error. In particular, a clear differentiation between ischemic infarction and a smaller intracerebral hemorrhage was impossible. Today this situation has changed, as completely infarcted tissue is readily seen as hypodense areas on CT scans. True, diagnostic problems still exist with smaller lesions and with special locations, But a positive diagnosis, based on direct visualization of the localization and size of the infarct in vivo, is now available. This has led to the mental image that the lesion in ischemic stroke is precisely what we see on CT scan: the evolving emollision — the area of complete cerebral infarction. Once more we are, by pragmatic necessity, slaves of the tools available. We tend to forget the well known fact that ischemia may damage the brain and kill many neurones without completely destroying the tissue's structure. ' 'The well known fact'' — these words seem appropriate because classical pathoanatomical descriptions of ischemic infarction abound with comments on incomplete or partial tissue damage around areas of complete necrosis. As will be argued below, it may be important to recognize incomplete cerebral infarction clinically. Sometimes it may dominate over complete infarction, or perhaps even be the only manifestation of the ischemic damage.