The diagnosis and medical treatment of cerebral ischemia are becoming more important due to the increase in the prevalence of cerebrovascular disease. However, conventional methods of evaluating cerebral perfusion have several drawbacks: they are invasive, require physical restraint, and the equipment is not portable, which makes repeated measurements at the bedside difficult. An alternative method is developed using near-infrared spectroscopy (NIRS). NIRS signals are measured at 44 positions (22 on each side) on the fronto-temporal areas in 20 patients with cerebral ischemia. In order to extract the pulse-wave component, the raw total hemoglobin data recorded from each position are band-pass filtered (0.8 to 2.0 Hz) and subjected to a fast Fourier transform to obtain the power spectrum of the pulse wave. The ischemic region is determined by single-photon emission computed tomography. The pulse-wave power in the ischemic region is compared with that in the symmetrical region on the contralateral side. In 17 cases (85%), the pulse-wave power on the ischemic side is significantly lower than that on the contralateral side, which indicates that the transmission of the pulse wave is attenuated in the region with reduced blood flow. Pulse-wave power might be useful as a noninvasive marker of cerebral ischemia.
ObjectiveTo examine the role of primary motor cortex in gait through exploring the dissociation of impaired voluntary leg muscle contraction and preserved rhythmic activities during gait in a patient who had a stroke.Subject and methodsA 49-year-old man with an infarct in the primary motor cortex exhibited automatic-voluntary dissociation in the paretic leg. Functional studies were conducted using surface electromyography (EMG) and near-infrared spectroscopy (NIRS).ResultsThe patient was incapable of voluntary contraction of individual leg muscles on the paretic right side but was able to walk automatically while contracting those muscles rhythmically. Surface EMG confirmed the earlier findings objectively. The preserved automatic activities helped recovery of gait capability, but NIRS showed no functional recovery in the corresponding motor cortex during treadmill gait. We considered that the loss of voluntary leg muscle contraction and the preserved gait capacity in this patient represented a form of automatic-voluntary dissociation.ConclusionsThe preserved gait capability suggests that the leg representation of the primary motor cortex may not play a major functional role in gait, but other components of the nervous system, including the spinal central pattern generator, would serve important functions to maintain gait capability.
Abstract. Conventional methods presently used to evaluate cerebral hemodynamics are invasive, require physical restraint, and employ equipment that is not easily transportable. Therefore, it is difficult to take repeated measurements at the patient's bedside. An alternative method to evaluate cerebral hemodynamics was developed using near-infrared spectroscopy (NIRS) with oxygen inhalation. The bilateral fronto-temporal areas of 30 normal volunteers and 33 patients with cerebral ischemia were evaluated with the NIRS system. The subjects inhaled oxygen through a mask for 2 min at a flow rate of 8 L∕ min. Principal component analysis (PCA) was applied to the data, and a topogram was drawn using the calculated weights. NIRS findings were compared with those of single-photon-emission computed tomography (SPECT). In normal volunteers, no laterality of the PCA weights was observed in 25 of 30 cases (83%). In patients with cerebral ischemia, PCA weights in ischemic regions were lower than in normal regions. In 28 of 33 patients (85%) with cerebral ischemia, NIRS findings agreed with those of SPECT. The results suggest that transmission of the changes in systemic SpO 2 were attenuated in ischemic regions. The method discussed here should be clinically useful because it can be used to measure cerebral ischemia easily, repeatedly, and noninvasively.
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