Alterations in regional cerebral hemodynamics and metabolism produced by focal cerebral ischemia.

Since diffuse changes in blood flow and metabolism occur in the brain following a focal ischemic insult, changes of cerebral blood flow on the side opposite a cerebral infarction were observed. We have examined the course of the cerebral hemodynamic changes occurring in 15 patients with unilateral acute strokes. In 12 of these patients, significant blood flow changes (over 15%) occurred in the nonischemic hemisphere during the period of observation. A similar time course of change was found in the ischemic hemisphere and the flow changes in the two hemispheres appeared parallel to one another (diaschisis). Thus we have demonstrated a significant reduction in flow in the contralateral cortex following a unilateral ischemic insult. This reduction in flow was of the order of 38% from the control value which agrees quite well with the reduction in cortical glucose consumption of the order of 31%. We postulate that these changes are the hemodynamic and metabolic concomitants of diaschisis and may in part be due to a transneuronal depression of function.