Brunnstrom Stages and Wallerian Degenerations: A Study Using MRI.

Abstract

Kanagawa 243WATANABE, H. and TASHIRO, K. Brunnstrom Stages and Wallerian Degenerations : A Study Using MRI. Tohoku J. Exp. Med., 1992, 166 (4), [471][472][473] We studied the relationship between the Brunnstrom stages obtained after rehabilitations and Wallerian degenerations detected by magnetic resonance imaging (MRI). Forty-nine hemiplegic patients were retrospectively studied. The patients were grouped into a low stage group (30 patients) demonstrating Brunnstrom stages I -IV and a high stage group (19 patients) demonstrating stages V -VI . MRI detected Wallerian degenerations as changes of signal intensity in corticospinal tracts on T2-weighted images. The signals were hypointense or hyperintense compared to the normal side according to the intervals between the MRI examinations and the ictuses. MRI showed Wallerian degenerations in 27 of 30 patients in the low stage group and 5 of 19 patients in the high stage group . The difference between the two groups was significant (p <0.005).Brunnstrom stage ; Wallerian degeneration ; MRI There are several measures to evaluate functional recovery states of hemiplegic (Arsenault et al. 1988). Although the Brunnstrom staging (Brunnstrom 1970) is believed to be one of the most useful measures, pathological and physiological explanations of the measures are still incomplete. Magnetic resonance imaging (MRI) is useful in the imaging of central nervous diseases and can be used to detect Wallerian degenerations following strokes (Matthew et al. 1988(Matthew et al. , 1989. This report focuses on a retrospective study of the relationship between the Brunnstrom stages obtained following rehabilitations and Wallerian degenerations evaluated by MRI. MATERIALS AND METHODSSeventy-three hemiplegic patients were admitted and received MRI examinations between October 1990 and June 1991 in Nanasawa Rehabilitation Hospital . Forty-nine hemilegic patients (29 men, 20 women) were selected according to the following conditions of the Brunnstrom staging and of MRI examinations. The age of the patients was 58.0± 10.1 (mean±s.D.).Little neurological improvements occur after 12 weeks of the ictuses (Newmann 1972) . Hence, in this study, Brunnstrom stages I-IV were determined after the 90th day of the ictuses. Brunnstrom stagings were performed for arms, fingers and legs of each patient , thus each patient has three Brunnstrom stages, namely the stages of the arm, the fingers and the leg. Then those patients were grouped into a low stage group (stages I-IV) and a high stage group (V-VI) in the analysis of the data of this study. Cases were selected so that all the three stages of those patients in the low stage group consisted of stage I -IV , while

Sarcopenia as a predictor of activities of daily living capability in stroke patients undergoing rehabilitation

“…The pre‐stroke required level of care was confirmed through certification for public long‐term care insurance, with categories ranging from “Care level 1”– can perform almost all ADL, but partial care is required, to “Care level 5” – must be aided in all situations and had difficulty with communication. We evaluated the degree of lower limb motor paralysis by using the Brunnstrom recovery stage system (BRS) . In our current study, the patients were classified by this approach into three groups; Brunnstrom recovery stage I–IV, Brunnstrom recovery stage V–VI and “absence.” Lower limb motor paralysis and FIM status were evaluated by physical therapists.…”

“…We evaluated the degree of lower limb motor paralysis by using the Brunnstrom recovery stage system (BRS). 18,19 In our current study, the patients were classified by this approach into three groups; Brunnstrom recovery stage I-IV, Brunnstrom recovery stage V-VI and "absence." Lower limb motor paralysis and FIM status were evaluated by physical therapists.…”

Detection and Predictive Value of Fractional Anisotropy Changes of the Corticospinal Tract in the Acute Phase of a Stroke

“…4, 8–15 Furthermore, evidence of CST atrophy and other signal changes thought to be indicative of WD on conventional MRI 16 have been correlated with poor motor outcome in chronic stroke patients. 17, 18 It seems that these changes develop at later stages and might be too subtle to be quantified in the acute stroke phase and therefore might not be useful as a prognostic tool for clinicians, patients, and caregivers. 19 One prospective study found a decrease in the apparent diffusion coefficient (ADC) of the ipsilesional CST within 12 hours of stroke in patients with initial severe motor impairment 20 , but predictions of outcome were not very strong.…”

Poststroke Cerebral Peduncular Atrophy Correlates with a Measure of Corticospinal Tract Injury in the Cerebral Hemisphere

“…The patients in our study were specifically recruited for mildto-moderate chronic hemiparesis and, thus, were likely to have CST injury. [20][21][22][23] We hypothesized that in such patients the hemispheric extent of lesion to the CST would significantly correlate with the extent of cerebral peduncular atrophy and to a greater extent than would the volume of the infarction. Such a finding would suggest that a simple, predictable relationship exists between the amount of postinfarction structural injury at discrete and widely separated portions of the same fiber tract.…”