Do changes in oxygen metabolism in the unaffected cerebral hemisphere underlie early neurological recovery after stroke? A positron emission tomography study.
OBJECTIVE
Whether an initial depression of function in the unaffected hemisphere ("transcallosal diaschisis") plays a role in early neurological recovery after acute stroke remains controversial. Previous studies were confounded by lack of acute-stage assessment with follow-up and by the problem of defining a suitable control group, since preexisting stroke risk factors may influence prestroke cerebral metabolism. We evaluated with positron emission tomography (PET) the relationships between unaffected-hemisphere (ie, contralateral) oxygen consumption (cCMRO2) and quantitative neurological assessments (and their respective evolution over time) after ischemic stroke.


METHODS
Among 30 consecutive patients with first-ever middle cerebral artery ischemic stroke studied with the (15)O equilibrium method, we selected all survivors (n=19; mean age, 74.6 years) who were investigated both within the first 18 hours after stroke onset (PET1; mean, 11 +/- 4 hours) and 15 to 30 days later (PET2; mean, 24 +/- 10 days), with each patient serving as his/her own control. Neurological deficits were quantified using Orgogozo's middle cerebral artery scale (N score) at each PET session. Neurological changes were calculated as changes in the N score. A late CT scan coregistered with PET provided infarct topography and volume index.


RESULTS
At PET2, we observed the overall expected neurological recovery. There was a nearly significant trend for a decrease in cCMRO2 from PET1 to PET2, especially for the neocortex (P=.08, F test); in a subgroup of eight patients with large infarcts, this CMRO2 decline was significant (P<.05) in the mirror region to the infarct. There was no significant correlation (Spearman's tests) between acute-stage cCMRO2 and same-day N scores or between changes in cCMRO2 versus changes in N score from PET1 to PET2 (any region). There was a nearly significant trend for lower PET2 cCMRO2 in the subgroup of eight patients with large compared with small infarcts (P=.06).


CONCLUSIONS
We found no evidence for an influence of cCMRO2 on acute-stage neurological deficit or for a role of the unaffected hemisphere in early recovery after acute MCA ischemic stroke. The decline in unaffected-hemisphere metabolism from the acute to the subacute stage in the face of overall clinical recovery appears clinically irrelevant. The fact that the neocortical cCMRO2 at PET2 tended to be lower, and declined significantly from PET1 to PET2 in the mirror region in the subgroup of patients with large infarcts, suggests that this delayed effect represents transcallosal fiber degeneration.
Iglesias
S
S
INSERM U320, France.
Marchal
G
G
Rioux
P
P
Beaudouin
V
V
Hauttement
A J
AJ
de la Sayette
V
V
Le Doze
F
F
Derlon
J M
JM
Viader
F
F
Baron
J C
JC
D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging / Q000378:metabolism*; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000378:metabolism; D002536:Cerebral Arteries / Q000000981:diagnostic imaging; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000378:metabolism; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000378:metabolism; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000378:metabolism*; D003337:Corpus Callosum / Q000000981:diagnostic imaging / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009410:Nerve Degeneration; D009412:Nerve Fibers / Q000378:metabolism; D009460:Neurologic Examination; D010101:Oxygen Consumption; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed