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Remote effects of subcortical cerebrovascular lesions: a SPECT cerebral perfusion study
D Perani1, V Di Piero, G Lucignani
1Department of Biomedical Technology, University of Milan, Italy.
Insights
Small strokes in the brain
Area of Science:
- Neurology
- Radiology
- Neuroscience
Background:
- Subcortical cerebrovascular lesions can cause remote effects.
- The mechanisms and clinical significance of these remote effects are not fully understood.
Purpose of the Study:
- To evaluate remote effects of subcortical strokes using SPECT and CBF imaging.
- To investigate the correlation between remote effects and clinical presentation, stroke type, and lesion characteristics.
Main Methods:
- Cerebral blood flow (CBF) study using SPECT and I-123 HIPDM tracer.
- Involved 34 patients with acute or chronic subcortical stroke.
- Assessed cortical and cerebellar perfusion asymmetries.
Main Results:
- 21/34 patients showed ipsilateral cortical hypoperfusion.
- 14/34 patients exhibited contralateral cerebellar hypoperfusion.
- Remote effects correlated with clinical severity and, for hematomas, with the acute phase.
Conclusions:
- Remote CBF effects are detectable noninvasively after subcortical stroke.
- These effects are related to neurological status and may aid in assessing functional impairment.
Abstract:
The remote effects of small unilateral cerebrovascular lesions confined to subcortical structures were evaluated by single photon emission computerized tomography (SPECT) and a CBF tracer, I-123 HIPDM. A CBF study was performed in 34 patients presenting with subcortical stroke either in the acute or in the chronic stages. Twenty-one of the 34 patients showed areas of cortical hypoperfusion ipsilateral to the subcortical lesion. In 14 patients, asymmetry of perfusion was also observed at the cerebellar level, perfusion being significantly reduced in the cerebellar hemisphere contralateral to the lesion. There was no correlation between the degree and extension of these remote effects and the type of stroke (ischemic or hemorrhagic), the patency of cerebral arteries, or the size and site of the lesion by transmissive computerized tomography (TCT). Subcortical hematomas showed a correlation between occurrence of remote effects and time interval from the onset of stroke, occurring more frequently in the acute phase. A correlation was observed between cortical and cerebellar remote effects and the severity of clinical presentation. The causes of remote effects are still unclear and have been extensively debated. Our data indicate that there is a relationship of remote effect to the neurological status. It is possible to show, by noninvasive, low-cost methods, remote CBF effects after stroke that may contribute to the assessment of brain functional impairment.