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Cognitive activity resulted in increased flow of blood to the cerebral hemispheres. The increase was greater to the left hemisphere for a verbal task and greater to the right hemisphere for a spatial task. The direction and degree of hemispheric flow asymmetry were influenced by sex and handedness, females having a higher rate of blood flow per unit weight of brain, and females and left-handers having a greater percentage of fast-clearing tissue, presumably gray matter.

The distribution of gray matter in the two cerebral hemispheres was determined by the xenon-133 inhalation method. There was more gray matter relative to white matter in the left hemisphere than in the right, particularly in the frontal and precentral regions. This finding suggests that the organization of the left hemisphere, relative to that of the right, emphasizes processing or transfer within regions, or both, rather than transfer across regions.

In 44 patients, we studied the effects of superficial temporal-middle cerebral artery anastomosis on cerebral blood flow (CBF), neurologic examination, and cognitive functions. At 3 months, there was significant improvement in all variables. At 9 months, CBF was no longer significantly greater, but neurologic examination and cognitive functions had further improved. Patients with TIA had significant postoperative decreases in TIA frequency and did not progress to stroke, but had no significant changes in any variable. In stroke patients, we could not separate the effects of surgery from the natural evolution of changes in CBF and examination after stroke. None of the preoperative measurements predicted postoperative clinical improvement.

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