Pantano P, Formisano R, Ricci M, Di Piero V, Sabatini U, Di Pofi B, Rossi R, Bozzao L, Lenzi G L
Department of Neurological Sciences, University of Rome La Sapienza, Italy.
Brain. 1996 Dec;119 ( Pt 6):1849-57. doi: 10.1093/brain/119.6.1849.
The aim of this study was to evaluate the relationships of morphological and CBF patterns with both the severity and the evolution of the motor deficit in the late phase of stroke and, in particular, to identify morphological and/or functional brain alterations associated with a persistent severe motor deficit or a poor, delayed motor recovery. We analysed CT/MRI and single photon emission tomography (SPET) findings from 37 patients studied in the chronic phase of stroke (mean duration +/- SD = 3.6 +/- 1.6 months), whom we were able to follow clinically for a period of 3 months. The eventual degree of motor recovery correlated significantly (negatively) with the time since stroke at entry, but not with the severity of neurological impairment at entry. The volume, side and location (cortical or subcortical) of the infarct did not correlate with either the severity or the evolution of the motor deficit. Patients with a CT/MRI lesion of the parietal lobe (n = 8) showed a more severe motor deficit than those with other cortical locations. The severity of the motor deficit correlated significantly (negatively) with CBF values in the supplementary motor area (SMA) and parietal areas of the damaged hemisphere, and in the contralateral undamaged primary motor cortex. The degree of motor improvement correlated significantly (positively) with CBF values in the contralateral undamaged thalamus, lentiform and caudate nuclei, and premotor cortex. In the late phase of stroke, the severity of the motor deficit may be positively associated with the functional impairment of associative parietal and frontal areas of the damaged hemisphere. The functional impairment of the basal ganglia-frontal network in the undamaged hemisphere seems to be related to a poor, delayed motor recovery.
本研究的目的是评估形态学和脑血流量（CBF）模式与中风后期运动功能缺损的严重程度及进展之间的关系，尤其是识别与持续性严重运动功能缺损或运动功能恢复不佳、延迟相关的形态学和/或功能性脑改变。我们分析了37例中风慢性期患者（平均病程±标准差=3.6±1.6个月）的CT/MRI和单光子发射断层扫描（SPET）结果，这些患者我们能够进行为期3个月的临床随访。最终的运动恢复程度与入组时距中风的时间显著（负）相关，但与入组时神经功能缺损的严重程度无关。梗死灶的体积、侧别和位置（皮质或皮质下）与运动功能缺损的严重程度或进展均无相关性。顶叶有CT/MRI病变的患者（n = 8）比其他皮质部位病变的患者运动功能缺损更严重。运动功能缺损的严重程度与受损半球辅助运动区（SMA）和顶叶区域以及对侧未受损的初级运动皮层的CBF值显著（负）相关。运动改善程度与对侧未受损的丘脑、豆状核、尾状核和运动前皮层的CBF值显著（正）相关。在中风后期，运动功能缺损的严重程度可能与受损半球联合顶叶和额叶区域的功能损害呈正相关。未受损半球基底神经节-额叶网络的功能损害似乎与运动功能恢复不佳、延迟有关。
