Blood Flow and Clinical Course in Patients with Ischemic Stroke without Cerebrospecifíc Therapy
To evaluate the course of cerebral tissue perfusion in patients with acute focal cerebral ischemia of the supratentorial compartment regional cerebral blood flow (rCBF) was measured on day 0, 7, 14, 21, and 28 in 132 patients using the 133 Xenon stationary inhalation technique. Ischemic events of the brainstem and hemorrhagic complications were excluded. The clinical status was evaluated using a modified Mathew score.
In 34 patients no hemodilution, anti-edema therapy, or Ca++ antagonists were used but otherwise best medical therapy was applied. These patients represented the so called “natural course” of cerebral ischemia.
In 30/34 patients on day 0 (within 16 hours after onset of symptoms) focal flow abnormalities were found in the involved side. In 9 of these 30 patients and in 1 of the remaining ischemia was observed in the contralateral side. rCBF above normal (relative luxury perfusion) despite pathologic neurologic findings was observed in 8/34 patients on day 3–7. Eight patients presented on day 3–7 with normal flow which later became ischemic again without evidence of another symptomatic episode. Correlation between severity of clinical findings and actual rCBF was low from day 3 to 7 but close on day 0. From day 14–21 hemispheric CBF correlated well with the total neurologic score but focal clinical findings had a lower correlation with focal flow as compared to day 0 and day 28.
Contralateral ischemia was never found after day 14. In 5 other cases with “natural course” described above, a transitory decrease of rCBF below the initial ischemia level was found between day 3 and 14. In all these patients CCT presented with development of severe brain edema requesting antiedema therapy. It was concluded that rCBF measurements reflect focal clinical status in acute cerebral ischemia only at the beginning and at the end of a 4-week period.
KeywordsCerebral infarction regional cerebral blood flow 133Xenon inhalation clinical correlation
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- 2.Chopra JS et al (eds) (1990) Progress in cerebrovascular dis ease, Vol 3. Amsterdam, ElsevierGoogle Scholar
- 4.Mathew T, Meyer JS, Rivera VM, Charney JZ, Hartmann A (1972) Double-blind evaluation of glycerol therapy in acute cerebral infarction. Lancet 1327–1329Google Scholar
- 5.Hsu CY, Norris JW, Hogan EL, Bladin P, Dinsdale HB, Yatsu FM, Earnest MP, Scheinberg P, Caplan LR, Karp HR, Swanson PD, Feldman RG, Cohen MM, Mayman CI, Cobert B, Savitsky JP (1988) Pentoxifylline in acute nonhemorrhagic stroke — a randomized placebo-controlled double blind trial. Stroke 19: 716–722PubMedCrossRefGoogle Scholar