Thalamic metabolism and corticospinal tract integrity determine motor recovery in stroke
Thalamic metabolism and corticospinal tract integrity determine motor recovery in stroke
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DOI：
10.1002/ana.410390408
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发表时间：
1996-04-01
影响因子：
11.2
通讯作者：
Freund, HJ
中科院分区：
文献类型：
--
作者：
Binkofski, F;Seitz, RJ;Freund, HJ
我们研究了远端代谢抑制和锥体束受累在首次偏瘫缺血性中风后运动恢复中的作用。23例患者采用正电子发射断层扫描测定脑卒中区域脑糖代谢（rCMRGlu），并用磁共振成像评估脑卒中病变的位置和空间范围。急性期和慢性期（中风后4周）的运动损伤通过运动评分和磁诱发运动电位记录来确定。12例患者明显康复，而11例患者保留致残性偏瘫。与运动恢复良好的患者相比，运动恢复较差的患者病变侧丘脑的rCMRGlu严重抑制。该患者组在磁共振图像上也表现出更严重的锥体束损伤和更明显的磁诱发运动电位幅度降低。脑卒中病变的大小和丘脑外的病变性和远端rCMRGlu下降的空间范围都与丘脑低代谢和运动评分的改善无关。我们得出结论，锥体束和丘脑回路的部分保存是成人急性脑缺血后手部运动恢复质量的主要决定因素。
We studied the role of remote metabolic depressions and pyramidal tract involvement regarding motor recovery following a first hemiparetic ischemic stroke. In 23 patients the regional cerebral glucose metabolism (rCMRGlu) was measured with positron emission tomography and the location and spatial extent of the stroke lesions were assessed by magnetic resonance imaging. Motor impairment during the acute and chronic stages (4 weeks after stroke) was determined by a motor score and recordings of magnetic evoked motor potentials. Twelve patients recovered significantly, whereas 11 patients retained a disabling hemiparesis. In contrast to patients with good motor recovery, rCMRGlu was severely depressed in the thalamus on the lesion side in patients with poor motor recovery. This patient group also showed more severe damage to the pyramidal tract on magnetic resonance images and a more pronounced reduction of the magnetic evoked motor potential amplitude. Neither the size of the stroke lesions nor the spatial extent of the lesional and remote rCMRGlu depressions outside the thalamus correlated with the thalamic hypometabolism and the improvement of the motor score. We conclude that preservation both of parts of the pyramidal tract and of the thalamic circuitry is a major determinant for the quality of hand motor recovery following acute brain ischemia in the adult.