Weder B, Knorr U, Herzog H, Nebeling B, Kleinschmidt A, Huang Y, Steinmetz H, Freund H J, Seitz R J
Department of Neurology, Heinrich-Heine-Universität, Düsseldorf, Germany.
Brain. 1994 Jun;117 ( Pt 3):593-605. doi: 10.1093/brain/117.3.593.
We studied the cerebral activations related to restitution of hand function in five patients with first hemiplegic subcortical stroke due to ischaemic infarction in the area of the basal ganglia or thalamus. In two subjects, involvement of the cortico-spinal tract was demonstrated by magnetic evoked potentials. The subjects were requested to discriminate rectangular parallelepipeda of identical mass with their affected hands. Regional cerebral blood flow (rCBF) was measured with PET after intravenous bolus injection of [15O]butanol, at rest and during task execution. Evaluation of the rCBF changes was based on pixel-by-pixel t statistics of spatially standardized and averaged PET images and on a statistical distribution analysis of regions of interest in the individual subjects. For anatomical localization of the significant rCBF changes, a computerized brain atlas (Greitz et al. J Comput Assist Tomogr 1991; 15: 26-38) and a matching procedure that directly aligns individual PET and high resolution magnetic resonance images were used. The rCBF at rest and the task-induced rCBF changes varied from subject to subject, as did the residual neurological deficits at the time of PET scanning. In all subjects there were large activation areas in the motor and the sensory hand area contralateral to the affected hand. Poor performance of the task was correlated with a low rCBF in the contralateral sensorimotor cortex at rest and a bilateral activation of the primary sensorimotor cortex during task performance. The premotor cortex, ipsilateral and anterior cerebellum, contralateral to the affected hand, were also significantly activated. Further activations were observed in the contralateral premotor cortex, supplementary motor area and bilaterally in the posterior cingulate cortex, but were less consistent among the subjects. Our data suggest that recovery from hemiplegic stroke is associated with a marked reorganization of the cerebral activation patterns, including common and subject-specific activation sites. With respect to task-specific information processing a lower discrimination rate of objects compared with controls was associated with diminished activations in parietal lobe.
我们研究了5例因基底节区或丘脑缺血性梗死导致首次偏瘫性皮质下卒中患者与手部功能恢复相关的脑激活情况。在2名受试者中，磁诱发电位显示皮质脊髓束受累。要求受试者用患手辨别质量相同的长方体。在静脉推注[15O]丁醇后，于静息状态和任务执行期间，用正电子发射断层扫描（PET）测量局部脑血流量（rCBF）。基于空间标准化和平均PET图像的逐像素t统计以及个体受试者感兴趣区域的统计分布分析来评估rCBF变化。为了对显著rCBF变化进行解剖定位，使用了计算机脑图谱（Greitz等人，《计算机辅助断层扫描杂志》，1991年；15：26 - 38）以及直接对齐个体PET和高分辨率磁共振图像的匹配程序。静息时的rCBF以及任务诱发的rCBF变化因受试者而异，PET扫描时的残余神经功能缺损情况也如此。在所有受试者中，患手对侧的运动和感觉手部区域均有大片激活区域。任务表现不佳与静息时对侧感觉运动皮层的rCBF较低以及任务执行期间初级感觉运动皮层的双侧激活相关。患手对侧的运动前区、同侧和前小脑也有显著激活。在对侧运动前区、辅助运动区以及双侧后扣带回皮层观察到进一步激活，但在受试者之间不太一致。我们的数据表明，偏瘫性卒中的恢复与脑激活模式的显著重组相关，包括共同和特定于个体的激活位点。就特定任务的信息处理而言，与对照组相比，物体辨别率较低与顶叶激活减少有关。
