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(Stroke. 1997;28:2518-2527.)
© 1997 American Heart Association, Inc.
Articles |
A Functional MRI Study of Subjects Recovered From Hemiparetic Stroke
From the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (S.C.C., G.N., J.D.K., D.N.K., S.P.F.); The Neurorecovery Program, Massachusetts General Hospital and Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Mass (S.C.C., G.N., J.D.K., S.A.F.); The Clinical Investigator Training Program, Harvard-MIT Division of Health Sciences and Technology and Beth Israel-Deaconess Medical Center in collaboration with Pfizer Inc. (S.C.C.); The MGH-NMR Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (S.C.C., R.R.B., K.K.K., D.N.K., B.R.R.); Biometrics Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (R.A.P.); The Center for Morphometric Analysis, Massachusetts General Hospital, Harvard Medical School, Charlestown, Mass (D.N.K.); and Department of Neurology, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Mass (G.N., J.D.K.).
Correspondence to Steven C. Cramer, MD, VA Medical Center, Department of Neurology (127), 1660 S Columbian Way, Seattle, WA 98108. E-mail cramers{at}uwashington.edu
Background and Purpose Stroke recovery mechanisms remain incompletely understood, particularly for subjects with cortical stroke, in whom limited data are available. We used functional magnetic resonance imaging to compare brain activations in normal controls and subjects who recovered from hemiparetic stroke.
Methods Functional magnetic resonance imaging was performed in ten stroke subjects with good recovery, five with deep, and five with cortical infarcts. Brain activation was achieved by index finger-tapping. Statistical parametric activation maps were obtained using a t test and a threshold of P<.001. In five bilateral motor regions, the volume of activated brain for each stroke subject was compared with the distribution of activation volumes among nine controls.
Results Control subjects activated several motor regions.
During recovered hand finger-tapping, stroke subjects activated
the same regions as controls, often in a larger brain volume. In the
unaffected hemisphere, sensorimotor cortex activation was increased in
six of nine stroke subjects compared with controls. Cerebellar
hemisphere contralateral and premotor cortex ipsilateral to this
region, as well as supplementary motor areas, also had increased
activation. In the stroke hemisphere, activation exceeding controls was
uncommon, except that three of five cortical strokes showed
peri-infarct activation foci. During unaffected hand finger-tapping,
increased activation by stroke subjects compared with controls was
uncommon; however, decreased activation was seen in unaffected
sensorimotor cortex, suggesting that this region's responsiveness
increased to the ipsilateral hand and decreased to contralateral hand
movements. Use of a different threshold for defining activation
(P<.01) did not change the overall findings (
=.75).
Conclusions Recovered finger-tapping by stroke subjects activated the same motor regions as controls but to a larger extent, particularly in the unaffected hemisphere. Increased reliance on these motor areas may represent an important component of motor recovery. Functional magnetic resonance imaging studies of subjects who recovered from stroke provide evidence for several processes that may be related to restoration of neurologic function.
Key Words: stroke outcome • magnetic resonance imaging • motor activity
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