[Motor function outcome and changes in motor impairment level of the upper limbs and fingers in patients with acute carotid-system cerebral infarction].
Early diagnosis of motor function status and changes in motor impairment level of the upper limbs and fingers in patients with acute cerebral infarction is important in establishing a treatment plan. This study investigated a method of predicting motor function outcome and changes in motor impairment based on the characteristics of symptoms on admission and severity according to the CT classification. The subjects were 309 patients with carotid-system cerebral infarction admitted on the day of onset of symptoms and who exhibited a low density area in the territory of the middle cerebral artery on CT images within 5 day of the onset of symptoms. The motor function level was evaluated according to Brunnstrom's stage. The findings were as follows: 1) The motor function level of the upper limbs and fingers improved to stage 3 or more in patients without unilateral neglect. 2) Complete recovery of motor impairment of the upper limbs and fingers was observed in 163 patients (54.7%). Motor impairment of the upper limbs recovered within 3 weeks after the onset in 121 patients, and from 22 days to 3 months after the onset in the remaining 42 patients. Similarly, motor impairment of the fingers recovered within 3 weeks after the onset in 113 patients, and between 22 days and 3 months after the onset in the remaining 50 patients. 3) Stage 4 or higher motor impairment grade on admission was seen in 107 (88.4%) of the patients with recovery of impaired motor function in the upper limbs within 3 weeks after the onset. Similarly, stage 4 or higher was seen in 101 (89.4%) patients with recovery of impaired motor function of the fingers within 3 weeks after the onset. 4) Of the 44 patients with recovery of impaired motor function of the upper limbs between 22 days and 3 months after the onset, 30 improved to stage 4 by 2 weeks after the onset and to stage 6 by one month. The remaining 12 patients improved to stage 5 by one month after the onset and to stage 6 by 3 months. Of the 50 patients with recovery of impaired motor function of the fingers between 22 days and 3 months after the onset, 44 improved to stage 4 by 2 weeks after the onset and to stage 6 by one month. The remaining 6 patients improved to stage 5 by one month after the onset and to stage 6 by 3 months. 5) Progressive stroke was observed in 60 patients (20.1%). All patients with progressive stroke showed unilateral neglect on admission. 6) Completed stroke, excludise of progressive stroke, was seen in 75 patients (24.3%). In the patients with completed stroke, there was clearly no improvement in the motor impairment of the limbs and fingers over 3 months after onset. 7) It was difficult to predict motor function level at the time of discharge based on the evaluation of stage on admission and the location of the low density area on CT. 8) Our CT classification was closely correlated with the motor function outcome of the upper limbs and fingers. Therefore, this classification and assessment of whether unilateral neglect is present on admission may be useful in predicting motor function outcome and changes in motor impairment of the upper limbs and fingers early after the onset of acute cerebral infarction.
Itoh
H
H
Department of Neurosurgery, Toyama Red Cross Hospital, Japan.
Oshida
N
N
Shioi
M
M
Nakamura
K
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000503:physiopathology*; D002343:Carotid Artery, Internal; D002544:Cerebral Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D005260:Female; D005385:Fingers / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D013997:Time Factors