Contribution of Diaschisis to the Clinical Deficit in Human Cerebral Infarction

Bowler, John V.; Wade, John; Jones, Barbara E.; Nijran, K. S.; Jewkes, R. F.; Cuming, R.; Steiner, TJ

doi:10.1161/01.str.26.6.1000

Cited by 42 publications

(21 citation statements)

References 48 publications

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“…The loss of anisotropy associated with hemispheric atrophy contralateral to MCA infarcts strongly supports that secondary degeneration and demyelination spread to the contralateral hemisphere during the first 6 months after the occurrence of a MCA infarction. Only functional modifications have been previously reported in the contralateral hemisphere after MCA infarcts using SPECT (Bowler et al, 1995) or PET (Iglesias et al, 1996), the role of which in clinical recovery is now debated. Remarkably, a significant increase in FA was also detected in the hemisphere ispilateral to the ischemic lesion with histograms and a similar trend was found in the contralateral hemisphere at M3 before the final loss of anisotropy measured at M6.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Diffusion Changes in Cerebral Hemispheres after MCA Infarcts

Buffon

Molko

Hervé

et al. 2005

J Cereb Blood Flow Metab

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Diffusion tensor imaging can be used in vivo to assess the longitudinal and regional microstructural changes occurring after middle cerebral artery (MCA) infarcts in humans. Nine patients were investigated 1 week (D7), 1 (M1), 3 (M3), and 6 months (M6) after the occurrence of an isolated MCA infarction. First, an overall analysis was performed using histograms of mean diffusivity (MD) and fractional anisotropy (FA) in each hemisphere. Thereafter, the regional pattern of diffusion changes was investigated voxel by voxel with statistical parametric mapping 99. In the hemisphere ipsilateral to the infarction, histogram analysis revealed a significant decrease in FA between D7 and M6 associated with a progressive increase in MD from D7 to M3. Remote from the MCA territory, the voxel by voxel analyses detected a significant increase in MD within the thalamus at M3 and M6 and a reduction in FA along the pyramidal tract at M6. In the contralateral hemisphere, between D7 and M6, a significant hemispheric atrophy was observed in association with a global reduction in anisotropy, in the absence of distinctive regional diffusion changes. These results suggest that micro-and macrostructural tissue modifications can be detected with diffusion tensor imaging in regions remote from the ischemic area in both hemispheres.

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Section: Discussionmentioning

confidence: 99%

Longitudinal Diffusion Changes in Cerebral Hemispheres after MCA Infarcts

Buffon

Molko

Hervé

et al. 2005

J Cereb Blood Flow Metab

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“…ischemia [6, 7, 8, 9, 10, 11, 21, 22]. Diaschisis has been predominantly observed in 3 types of ischemic strokes: (a) in the cerebellum contralateral to a supratentorial lesion [10, 21, 23, 24]; (b) in the unaffected hemisphere as a result of a cortical lesion [6, 7, 8, 9, 10, 11, 12], and (c) in the cortex after a deep …”

Section: Discussionmentioning

confidence: 99%

“…The few clinical CBF studies on acute stroke have focused only on the injured hemisphere, without concern for the remote effects of the infarct in the unaffected brain [1, 2, 3, 4, 5]. More data are available in the subacute and chronic time periods, where a reduction of the CBF in the contralateral hemisphere [6, 7, 8, 9, 10, 11, 12]or in the whole brain [13, 14]has been reported. It is unknown, however, if transhemispheric depression of the blood flow is present in the first few hours of the stroke.…”

Section: Introductionmentioning

confidence: 99%

Remote Effects of Acute Ischemic Stroke: A Xenon CT Cerebral Blood Flow Study

Rubin

Levy²,

Scarrow³

et al. 2000

Cerebrovasc Dis

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Objective: The purpose of this study was to verify transhemispheric diaschisis in the early hours after an ischemic event. Methods: XeCT cerebral blood flow (CBF) studies within 8 h of stroke were studied in 23 patients. Mean CBF was evaluated in the ischemic area, contralateral hemisphere and ipsilateral cerebellum. Results: A severe CBF reduction was found in the ischemic area (mean 9 ± 3 ml/100 g/min). The mean CBF in the unaffected hemisphere (33 ± 10 ml/100 g/min) was 35% less compared to the normal mean value. CBF was decreased in the cerebellum ipsilateral to the stroke (mean 31 ± 12 ml/100 g/min) suggesting a blood flow depression of the whole brain. Conclusions: During the initial hours of cerebral ischemia, the asymptomatic hemisphere demonstrated CBF depression that was part of the global flow reduction.

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“…Although the posterior circulation appeared normal on MRA in all patients, it cannot be excluded that flow and flow-related variables in the cerebellum did change, depending on the severity of ICA lesions. However, because no significant perfusion asymmetries in the cerebellum were found that might have been caused by cerebellar diaschisis, [42][43][44] we assumed that any disturbance in cerebellar perfusion is small compared with the changes in cerebral perfusion.…”

Section: Limitationsmentioning

confidence: 99%

Long-Term Hemodynamic Effects of Carotid Endarterectomy

Kluytmans¹,

Eikelboom²,

Viergever³

1998

Stroke

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Background and Purpose-The presence and importance of hemodynamic factors to the beneficial effect of carotid endarterectomy (CEA) in patients with severe stenosis of the internal carotid artery (ICA) is unclear. The purpose of this study was to investigate possible hemodynamic changes caused by a severe ICA stenosis and the subsequent changes after CEA. Methods-Hemodynamic parameters were acquired with dynamic susceptibility contrast MRI. Regional cerebral blood volume (rCBV), mean transit time (MTT), time of appearance, and time to peak were determined in 19 patients with severe stenosis (Ͼ70%) of the ICA before and after CEA and in 33 control subjects. Four patients had an occlusion of the contralateral ICA. Corresponding T2-weighted MRI and inversion recovery MRI scans were used for segmentation of gray and white matter regions. Results-In the hemisphere ipsilateral to the stenosed ICA, no significant differences were found for the rCBV or MTT between patients and control subjects. Also, no significant alterations in these two parameters were observed after CEA. In the hemisphere contralateral to the stenosed ICA, hemodynamic changes were observed only in patients with an ICA occlusion contralateral to the stenosed ICA. In these patients, rCBV, MTT, time of appearance, and time to peak were all increased in the contralateral hemisphere. After CEA, all hemodynamic parameters fell in the normal range. Conclusions-Although CEA does improve the cerebral circulation in patients with a severe stenosis and a contralateral ICA occlusion, the hemodynamic effects of CEA in patients with severe stenosis without a contralateral ICA occlusion are negligible. (Stroke. 1998;29:1567-1572.)

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Contribution of Diaschisis to the Clinical Deficit in Human Cerebral Infarction

Abstract: Diaschisis does not independently add to the clinical deficit after stroke. It is more likely that it simply represents part of the damage done by the stroke.

Cited by 42 publications

References 48 publications

Longitudinal Diffusion Changes in Cerebral Hemispheres after MCA Infarcts

Longitudinal Diffusion Changes in Cerebral Hemispheres after MCA Infarcts

Remote Effects of Acute Ischemic Stroke: A Xenon CT Cerebral Blood Flow Study

Long-Term Hemodynamic Effects of Carotid Endarterectomy

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