Remote effects in MCA territory ischemic infarction: a study of regional cerebral blood flow and oxygen metabolism using positron computed tomography and 15O labeled gases.

Using positron computed tomography (PCT) and the 15O labeled gas steady-state inhalation technique, regional cerebral blood flow (rCBF), cerebral oxygen consumption (rCMRO2), and oxygen extraction fraction (rOEF) can be measured quantitatively in humans. We quantitatively examined the relationship between focal ischemic lesions and intact regions as detected by X-ray CT in such areas as the territory of the contralateral middle cerebral artery (MCA), thalami, pons, and cerebellar hemispheres. Twenty-three PCT measurements in 13 patients with unilateral ischemic infarction in the MCA territory as detected by X-ray CT were performed. Remote effects from cerebral infarction of the MCA territory were observed in the contralateral MCA territory, ipsilateral thalamus, brainstem, and contralateral cerebellar hemisphere. Slight depression of rCBF and rCMRO2 was also observed in the contralateral thalamus and ipsilateral cerebral hemisphere; rOEF was normal in these areas. Though the depression of rCBF and rCMRO2 due to remote effects was detected in all periods, it was mildly observed 0 to 6 days after onset. The reduction of rCBF and rCMRO2 due to remote effects was less than the morphological as well as the functional threshold. The phenomenon is probably caused by neuronal deactivation, and the regions with depressed blood flow and metabolism may be in a "resting" state.