We investigated shrinkage of the ipsilateral thalamus following infarction in the territory of the middle cerebral artery in 33 patients who were admitted £2 days after the stroke and who were followed by computed tomography for >1 year with no recurrences. The thalamic area was measured on the computed tomograms, and the ratio of the ipsilateral area to the contralateral area was calculated. All values were compared with values from the initial computed tomogram taken <2 days after the stroke. The values of the ratio on follow-up computed tomograms decreased gradually in 15 patients. In these cases, the area of the ipsilateral thalamus was significantly reduced after 1 year (/xO.Ol) and marked atrophy was observed. These results demonstrate the significance of remote changes over a long period of time after focal cerebral infarction. (Stroke 1991^22:615-618) I t has been widely believed that neuronal alterations following cerebral ischemia progress rapidly. 1 Therefore, the main issue of neuropathologic studies after cerebral ischemia has been acute neuronal changes in the ischemic area. In 1982, Kirino 2 found a strikingly slow process of neuronal change in the hippocampal CA1 subfield following brief cerebral ischemia, which he called "delayed neuronal death." Since then, delayed neuropathologic changes following cerebral ischemia have attracted widespread attention. These changes are also found in the area exposed to ischemia.The aim of this study was to analyze neuropathologic changes in a distant, nonischemic area after focal cerebral ischemia. We particularly focused on delayed neuropathologic changes of the ipsilateral thalamus following infarction in the territory of the middle cerebral artery (MCA).
Subjects and MethodsA total of 109 patients with cerebral infarction were admitted to our clinic from 1985 through 1989.From the Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan.Supported in part by a grant-in-aid for scientific research from the Ministry of Education, Science and Culture of Japan and by a research grant for cardiovascular diseases from the Ministry of Health and Welfare.Address for correspondence: Akira Tamura, MD, Department of Neurosurgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173, Japan.Received November 7, 1990; accepted January 31, 1991. From among these patients, we selected 33 who 1) were admitted <,2 days after the first attack of stroke, 2) had a single low-density area on an initial or follow-up computed tomogram (CT film) in the MCA territory, 3) were followed by symmetrical CT at the level of the thalamus for > 1 year, and 4) developed no symptomatic or asymptomatic recurrence of stroke on CT. In these patients, the area of the thalamus on each side was randomly measured with a computerized digitizer on the CT films at the level of the thalamus according to a CT atlas 3 1, 3, and 6 months and 1 and 2 years after the stroke. The CT films were taken in parallel planes at an angle of 15° to the infraorbitomeatal lin...