Delayed intrahemispheric remote hypometabolism - Correlations with early recovery after stroke
Delayed intrahemispheric remote hypometabolism - Correlations with early recovery after stroke
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DOI：
10.1159/000016096
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发表时间：
2000-09-01
影响因子：
2.9
通讯作者：
Baron, JC
中科院分区：
文献类型：
--
作者：
Iglesias, S;Marchal, G;Baron, JC
虽然“半球内神经联系联系不全”（即影响梗塞同侧但远离梗塞的大脑半球的代谢减退）通常可能会加剧急性期神经功能缺损并影响早期恢复，但对此的研究很少。在 30 名首次大脑中动脉 (MCA) 区域卒中患者中，我们分析了 19 名幸存者的数据，这些幸存者在急性期（临床发病 5-18 小时内）和亚急性期（约 3 周后）均通过 O-15 正电子发射断层扫描 (PET) 进行调查，对于这些幸存者，慢性期 CT 与 PET 配合可用于评估梗塞地形和大小。 Orgogozo 的 MCA 量表用于评估 PET 研究时的神经功能缺损以及 PET 研究之间的恢复情况。两次 PET 治疗均获得了整个同侧半球（不包括脑室和梗塞）以及丘脑、枕叶和内侧前额叶皮层（即 MCA 区域外的潜在传入神经缺失组织）的耗氧量。在除枕叶皮层之外的所有区域中，第一节和第二节之间的耗氧量显着下降，但与伴随的 MCA 评分变化没有显着相关性。然而，急性期内侧前额叶代谢与神经功能恢复显着相关。此外，第二次治疗时的半球和内侧前额叶代谢均与梗塞面积和伴随的 MCA 评分显着相关，但当考虑到梗塞面积时，后一种关系变得不显着。这项研究没有发现人类大脑中动脉区中风后出现急性半球内联系不全的证据。然而，它首次记录了患者临床康复期间出现延迟性半球内远程低代谢的现象。由于这种继发现象的程度是梗塞面积的函数，因此可能存在受损神经元末梢退化的机制。最后，与其他报道相反，神经功能恢复不是丘脑代谢低下的功能，而是似乎受到急性期内侧额叶代谢的影响，也许是因为该区域是在运动恢复中具有重要代偿作用的网络的一部分。版权所有 (C) 2000 S. Karger AG，巴塞尔。
Although 'intrahemispheric diaschisis' (i.e. a hypometabolism affecting the cerebral hemisphere ipsilateral to but remote from the infarct) may classically exacerbate acute-stage neurological deficit and influence early recovery, it has been studied only rarely. Out of a series of 30 patients with first-ever middle cerebral artery (MCA) territory stroke, we analyzed the data from 19 survivors investigated by O-15 positron emission tomography (PET) both in the acute (within 5-18 h of clinical onset) and subacute (approximately 3 weeks later) stage, and for whom chronic-stage CT coregistered with PET was available to assess infarct topography and size. Orgogozo's MCA scale was used to assess neurological deficits at the time of, and recovery between, the PET studies. Oxygen consumption was obtained for both PET sessions for the whole ipsilateral hemisphere (excluding ventricles and infarct), as well as for the thalamus and the occipital and mesial-prefrontal cortex (i.e. potentially deafferented tissue outside the MCA territory). In all regions except the occipital cortex, the oxygen consumption significantly decreased between the first and the second session, without significant correlation with the concomitant changes in MCA scores. However, acute-stage mesial-prefrontal metabolism was significantly correlated with neurological recovery. Also, both the hemisphere and the mesial-prefrontal metabolism at the second session were significantly correlated with both infarct size and concomitant MCA scores, but the latter relationship became insignificant when infarct size was taken into account. This study reveals no evidence of acute intrahemispheric diaschisis after MCA territory stroke in man. However, it documents for the first time a phenomenon of delayed intrahemispheric remote hypometabolism developing while the patients clinically recover. Because the degree of this secondary phenomenon is a function of infarct size, a mechanism of degeneration of the damaged neuron terminals is likely. Finally, contrary to other reports, neurological recovery was not a function of thalamic hypometabolism, but appeared to be influenced by acute-stage mesial-frontal metabolism, perhaps because this region is part of a network that has an important compensatory role in motor recovery. Copyright (C) 2000 S. Karger AG, Basel.