[Location of lesion on CT and motor functional outcome of the upper and lower limbs in patients with cerebral infarction].
The early diagnosis of the motor functional outcome of the upper and lower limbs in patient with cerebrovascular disease is important in establishing a treatment plan. The purpose of this study was to establish a method to evaluate the severity of low density areas on CT scans in patients with hemiparesis caused by cerebral infarction. The subjects were 186 patients who were admitted on the day of onset, showed a low density area on CT images within 5 days of onset. Of these patients, 111 had cerebral infarction, and the other 75 had reversible ischemic neurological deficit (RIND). On CT images, the low density area in the slice of corpus calosum splenium (S-1) and that of ventricular body (S-2) was measured, and its relationship with motor functional results at the time of discharge was evaluated. The motor functional level was evaluated using Brunnstrom's stage. The findings are as follows: 1) Discriminant analysis was performed using an explanatory variable of 1 and an error rates of 5% or less. The severity of the low density area could be classified into 4 major types in S-1: I-IV; and into 3 subtypes in S-2: a, b, c. The 186 patients were topographically classified using the major types and subtypes. 2) The 75 patients with type I a, b, c and II a motor function recovered within 3 weeks (RIND). Of 16 patients with type II b, 10 recovered after rehabilitation for 3 weeks or more, but the other 6 showed remaining of motor impairment in the upper limbs. Of 29 patients with type II c, 5 recovered, but the other 15 showed remaining of motor impairment in the upper limbs. 3) Of patients with type III, none recovered completely. All patients with III c had hemiparesis. 4) In 3 patients with type IV b, Stage 1.2 paresis remained in the upper limbs and Stage 4.3 in the lower limbs. Of 38 patients with type IV c, 23 showed remaining of Stage 1.2 paresis in both upper and lower limbs, and the other 10 showed Stage 1.2 paresis in the upper limbs. 5) The severity classification of the low density area on CT images was closely related to the motor functional outcome of the upper and lower limbs. Therefore, this classification is useful for determining the treatment method early after onset.
Department of Neurosurgery and Rehabilitation Medicine, Toyama Red Cross Hospital, Japan.
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Itoh
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Shioi
D002544:Cerebral Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D003337:Corpus Callosum / Q000000981:diagnostic imaging; D005121:Extremities / Q000503:physiopathology*; D006801:Humans; D009043:Motor Activity / Q000502:physiology*; D011379:Prognosis; D014057:Tomography, X-Ray Computed