Ipsilateral thalamic diaschisis after middle cerebral artery infarction

Reuck, Jacques De; Decoo, D; Lemahieu, Ignace; Strijckmans, Karel; Goethals, Patrick; Maele, Georges Van

doi:10.1016/0022-510x(95)00229-2

Cited by 30 publications

(37 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is consistent with another CMRO 2 PET study [58], in which no significant correlation between chronic-stage thalamic metabolism and Orgogozo MCA scores was found.…”

Section: Discussionsupporting

confidence: 82%

Delayed Intrahemispheric Remote Hypometabolism

Iglesias

Marchal²,

Viader³

et al. 2000

Cerebrovasc Dis

View full text Add to dashboard Cite

Although ‘intrahemispheric diaschisis’ (i.e. a hypometabolism affecting the cerebral hemisphere ipsilateral to but remote from the infarct) may classically exacerbate acute-stage neurological deficit and influence early recovery, it has been studied only rarely. Out of a series of 30 patients with first-ever middle cerebral artery (MCA) territory stroke, we analyzed the data from 19 survivors investigated by ¹⁵O positron emission tomography (PET) both in the acute (within 5–18 h of clinical onset) and subacute (approximately 3 weeks later) stage, and for whom chronic-stage CT coregistered with PET was available to assess infarct topography and size. Orgogozo’s MCA scale was used to assess neurological deficits at the time of, and recovery between, the PET studies. Oxygen consumption was obtained for both PET sessions for the whole ipsilateral hemisphere (excluding ventricles and infarct), as well as for the thalamus and the occipital and mesial-prefrontal cortex (i.e. potentially deafferented tissue outside the MCA territory). In all regions except the occipital cortex, the oxygen consumption significantly decreased between the first and the second session, without significant correlation with the concomitant changes in MCA scores. However, acute-stage mesial-prefrontal metabolism was significantly correlated with neurological recovery. Also, both the hemisphere and the mesial-prefrontal metabolism at the second session were significantly correlated with both infarct size and concomitant MCA scores, but the latter relationship became insignificant when infarct size was taken into account. This study reveals no evidence of acute intrahemispheric diaschisis after MCA territory stroke in man. However, it documents for the first time a phenomenon of delayed intrahemispheric remote hypometabolism developing while the patients clinically recover. Because the degree of this secondary phenomenon is a function of infarct size, a mechanism of degeneration of the damaged neuron terminals is likely. Finally, contrary to other reports, neurological recovery was not a function of thalamic hypometabolism, but appeared to be influenced by acute-stage mesial-frontal metabolism, perhaps because this region is part of a network that has an important compensatory role in motor recovery.

show abstract

“…This is consistent with another CMRO 2 PET study [58], in which no significant correlation between chronic-stage thalamic metabolism and Orgogozo MCA scores was found.…”

Section: Discussionsupporting

confidence: 82%

Delayed Intrahemispheric Remote Hypometabolism

Iglesias

Marchal²,

Viader³

et al. 2000

Cerebrovasc Dis

View full text Add to dashboard Cite

show abstract

“…Several analytical methods are useful for the characterization of CCD. These include the direct assay of tissue metabolites; topographic methods for depicting regional patterns of NADH, ATP, glucose, lactate and pH; in vivo spectroscopic methods for analyzing mitochondrial redox state over time; autoradiographic approaches to quantitation of local glucose utilization, blood flow, protein synthesis and pH (3); and the noninvasive methods of positron emission tomography (PET) (4–7), single‐photon emission computed tomography (SPECT) (8–11), brain magnetic resonance imaging (MRI) (2, 12) and electroencephalography (EEG) (13) and also 2,3,5‐triphenyltetrazoliumchloride (TTC) staining (14) in the experimental stroke models.…”

mentioning

confidence: 99%

Biochemical evidence of crossed cerebellar diaschisis in terms of nitric oxide indicators and lipid peroxidation products in rats during focal cerebral ischemia

Serteser

Özben²,

Gümüşlü³

et al. 2001

Acta Neurologica Scandinavica

View full text Add to dashboard Cite

show abstract

“…From thalamic and cerebellar rCBF and rCMRO 2 values of 6 normal subjects an asymmetry index for control purposes had been calculated within 95% confidence limits in a previous study [5]. Thalamic differences greater than 41% for rCBF and/or 39% for rCMRO 2 , and cerebellar differences greater than 24% for rCBF and/or 21% for rCMRO 2 were determined as significant indicators of ITH and CCH for each stroke patient based on the evidence of decreased blood flow and metabolism in the absence of infarction.…”

Section: Methodsmentioning

confidence: 99%

“…There is normally close coupling between the depression of metabolism and blood flow [1]. The clinical significance of the different types of diaschisis has been extensively discussed in the literature [2, 3, 4, 5, 6, 7]. Ipsilateral thalamic hypometabolism (ITH) and crossed cerebellar hypometabolism (CCH) occur respectively in 85 and 69% after middle cerebral artery (MCA) infarction [8, 9].…”

Section: Introductionmentioning

confidence: 99%

Cobalt-55 Positron Emission Tomography of Ipsilateral Thalamic and Crossed Cerebellar Hypometabolism after Supratentorial Ischaemic Stroke

et al. 1999

View full text Add to dashboard Cite

Cobalt-55 (⁵⁵Co) is a positron emission tomography (PET) tracer used to demonstrate brain damage, possibly associated to calcium-mediated processes. The degree of ⁵⁵Co accumulation correlates with the severity of ischaemia in stroke patients. It is still a matter of debate whether ipsilateral thalamic hypometabolism (ITH) and crossed cerebellar hypometabolism (CCH), occurring after middle cerebral artery (MCA) infarcts, represent only a metabolic depression of these remote regions or can lead to structural damage. The present study investigates whether an increased ⁵⁵Co influx can be demonstrated with PET in ITH and CCH after MCA infarcts. About half of the patients with ITH and CCH had a significant degree of ⁵⁵Co uptake in, respectively, the ipsilateral thalamus and the contralateral cerebellar hemisphere. It was observed in patients with severe signs of stroke on admission and poor clinical outcome, and correlated well with the degree of ⁵⁵Co influx within the supratentorial infarct. The present study demonstrates that ITH and CCH after MCA infarction can represent structural damage in these remote areas that occurs during the second week after stroke onset.

show abstract

Ipsilateral thalamic diaschisis after middle cerebral artery infarction

Cited by 30 publications

References 25 publications

Delayed Intrahemispheric Remote Hypometabolism

Delayed Intrahemispheric Remote Hypometabolism

Biochemical evidence of crossed cerebellar diaschisis in terms of nitric oxide indicators and lipid peroxidation products in rats during focal cerebral ischemia

Cobalt-55 Positron Emission Tomography of Ipsilateral Thalamic and Crossed Cerebellar Hypometabolism after Supratentorial Ischaemic Stroke

Contact Info

Product

Resources

About