[Analysis of patients with excellent motor recovery after large infarction in the middle cerebral artery territory including the cortex].
We reported 6 cases of excellent motor recovery after a large infarction in the middle cerebral artery territory including the cortex. All patients were men (aged 67 to 80); 4 had left hemiplegia and 2 had right hemiplegia. They had abrupt onset of focal neurologic symptoms and signs, suggesting embolic stroke. The consciousness level, according to the Japan coma scale, was grade II in 4 patients and normal in the other 2. Atrial fibrillation was present in 4 patients and premature atrial and ventricular contractions were seen in 1 each. Hypertension was present in 3 patients and diabetes mellitus in 1. The motor plegia gradually improved after 1 to 3 days and almost completely disappeared at 12 days after onset. All patients were eventually able to walk alone without any aids. However, aphasia persisted in 2 patients with left hemispheric damage and left unilateral spatial neglect in 3 patients with right hemispheric damage. A cerebral blood flow analysis by single photon emission computed tomography, using [123I] isopropyliodoamphetamine or technetium 99m hexamethylpropylenamine oxime, demonstrated increased blood flow in the frontal lobe cortex surrounding the infarcted region in 5 patients. These patients showed good recovery from motor deficit, even though, motor symptoms did not begin to improve until 1 to 3 days after onset of stroke. We suggest that there is a subgroup of stroke patients, whose severe motor deficit starts to improve even 3 days after onset of a large infarction in the middle cerebral artery territory including the cerebral cortex.
Sakashita
Y
Y
Department of Neurology, Tonami General Hospital.
Asayama
K
K
Sugimoto
T
T
D000368:Aged; D002540:Cerebral Cortex / Q000098:blood supply*; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000534:rehabilitation*; D002560:Cerebrovascular Circulation; D006801:Humans; D008297:Male; D009068:Movement; D010243:Paralysis / Q000534:rehabilitation*; D011379:Prognosis; D015899:Tomography, Emission-Computed, Single-Photon