From the Clinic of Neurology (M.S., L.M.C., F.P., M.D., G.B.), "Tor
Vergata" University of Rome, and IRCCS "S. Lucia" (M.S.,
G.B.), Rome, Italy.
Correspondence to Mauro Silvestrini, MD, Clinica Neurologica-Ospedale S Eugenio, Universitá di Roma "Tor Vergata," P.le dell'Umanesimo 10, 00144 Roma, Italy.
Background and Purpose—Functional
recovery after cerebral infarction is a complex phenomenon that depends
on various factors. The aim of this study was to investigate changes in
cerebral perfusion during motor activity in stroke patients with very
early recovery of motor function.
Methods—We included 9 consecutive patients hospitalized for
acute-onset hemiparesis who showed complete functional recovery within
24 hours. CT of the brain showed an ischemic or hemorrhagic
cerebral lesion in areas compatible with the symptomatology. Within 36
hours (range, 28 to 36) all patients were examined for the effects of a
thumb-to-finger opposition task on cerebral blood flow in the middle
cerebral arteries, evaluated by means of bilateral
transcranial Doppler ultrasonography. Data were
compared with those of 9 healthy subjects matched for age and sex. In
patients, the evaluation was repeated 2 to 4 months later.
Results—A comparable increase in flow velocity (%
mean±SD) was observed with respect to baseline in the contralateral
middle cerebral artery during motor activity with patients' normal
(8.8±2.0%) and recovered hand (9.7±4.1%) and with both hands of
control subjects (10.6±1.4%). In the middle cerebral artery
ipsilateral to the hand performing the motor task, the increase in flow
velocity was significantly higher (P<0.0001) during
movement of the recovered hand in patients (8.6±2.7%) than during
movement of the normal hand in both patients (2.6±1.6%) and control
subjects (1.4±0.7%). In patients, pattern of changes in flow velocity
during motor performance remained the same in the second
evaluation.
Conclusions—These observations suggest that areas of the healthy
hemisphere can be activated soon after a focal injury and
contribute to the positive evolution of a functional deficit in some
patients. This phenomenon of ipsilateral activation cannot be
considered transient because it is evident months after stroke onset.
© 1998 American Heart Association, Inc.
Original Contributions
Bilateral Hemispheric Activation in the Early Recovery of Motor Function After Stroke
Key Words: motor function • recovery • stroke • ultrasonography, Doppler, transcranial
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