Stroke, Vol 24, 1784-1788, Copyright © 1993 by American Heart Association
WD Heiss, HG Emunds and K Herholz
BACKGROUND AND PURPOSE: Permanent neurological deficits after ischemic
stroke are primarily determined by the location and size of an infarct, but
social recovery and rehabilitation also depend on the functional status of
brain tissue outside the infarct. Since neuronal loss and functional
deactivation in peri-infarct tissue are reflected as changes in flow and
metabolism, measurement of glucose consumption may yield an additional
measure of rehabilitative capacity. METHODS: Seventy-six nondiabetic
patients (48 men, 28 women; mean age, 56.7 +/- 14.37 years) with a first
unilateral supratentorial ischemic infarct were consecutively enrolled. At
stable neurological and clinical condition 9 +/- 7.2 days after the attack,
cerebral metabolic rate of glucose (CMRglu) in noninfarcted brain regions
was measured by positron emission tomography of fluorodeoxyglucose. Outcome
was assessed 21 to 77 (mean, 50.5 +/- 11.7) months after the stroke with a
rehabilitation index for daily life activities. RESULTS: At time of
assessment of outcome 16 patients had died (score, 0), 22 were completely
recovered (score, 200), and 38 had partially improved (rehabilitation
score, 5 to 195). Younger age, absence of arterial hypertension and cardiac
disease, but also higher global, ipsilateral, and contralateral CMRglu were
significantly related to a better final outcome (P = .001), whereas sex and
neurological deficits in the subacute stage after stroke were not related
to final outcome. To evaluate the significance of CMRglu further after
adjustment for clinical prognostic variables, a multiple regression
analysis of the effect of age and CMRglu on rehabilitation score in
homogeneous subgroups of partially recovered patients was performed. It
revealed a significant positive correlation of CMRglu (P = .016) with
recovery in hypertensive subjects, while age was the dominant prognostic
factor (P = .07) in patients with normal blood pressure. CONCLUSIONS: These
results demonstrate that outcome after stroke is significantly influenced
by several factors incapacitating brain function in addition to the
ischemic attack. In addition to age and cardiac disease, hypertension is an
important factor leading to widespread arteriopathy with neuronal loss and
tissue damage. The significant correlation of CMRglu outside the infarct
with functional recovery in hypertensive subjects probably reflects the
extent of hypertensive tissue damage and subsequently reduced capacity to
compensate for the focal ischemic insult.
ARTICLES
Cerebral glucose metabolism as a predictor of rehabilitation after ischemic stroke
Max-Planck-Institut fur neurologische Forschung, Koln, FRG.
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