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Brain stem infarction and diaschisis. A SPECT cerebral perfusion study
F Fazekas1, F Payer, H Valetitsch
1Department of Neurology, Karl-Franzens University, Graz, Austria.
Stroke
|August 1, 1993
Summary
Brain stem infarction can cause remote blood flow changes in the brain and cerebellum. These changes depend on the infarction site, not the neurological deficit, impacting corticopontocerebellar pathways.
Area of Science:
- Neurology
- Neuroimaging
- Cerebrovascular Disease
Background:
- Pure unilateral brain stem infarction is a specific type of stroke.
- Understanding remote blood flow changes is crucial for prognosis.
Purpose of the Study:
- To investigate the association between remote cerebral and cerebellar blood flow alterations and the location of brain stem damage.
- To explore the relationship between infarction site and observed perfusion changes.
Main Methods:
- Single-photon emission computed tomography (SPECT) with [123I]iodoamphetamine was used to assess regional blood flow.
- Magnetic resonance imaging (MRI) identified infarction locations.
- Image analysis included qualitative assessment and asymmetry indexes.
Main Results:
- Significant perfusion asymmetries were observed in patients with upper pons infarction.
- These asymmetries included contralateral cerebellar and ipsilateral supratentorial hypoactivity, predominantly in the frontoparietal cortex.
- No clear correlation was found between perfusion patterns and specific neurological deficits.
Conclusions:
- Remote perfusion changes (infratentorial and supratentorial) following brain stem infarction are lesion-site dependent, not deficit-dependent.
- Damage to corticopontocerebellar pathways is confirmed as a key factor in crossed cerebellar diaschisis.
- Mechanisms of ipsilateral cerebral hemispheric diaschisis require further investigation.