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Diaschisis with cerebral infarction

R Slater, M Reivich, H Goldberg

    Stroke
    |November 1, 1977
    PubMed
    Summary
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    Acute stroke patients showed a progressive decline in cerebral blood flow (CBF) in both brain hemispheres during the first week post-infarction. This CBF reduction suggests complex mechanisms beyond simple neuronal damage, impacting stroke recovery.

    Area of Science:

    • Neurology
    • Cerebrovascular Medicine
    • Medical Imaging

    Background:

    • Acute stroke can lead to significant alterations in cerebral hemodynamics.
    • Understanding changes in cerebral blood flow (CBF) is crucial for managing stroke patients.
    • The phenomenon of diaschisis, involving widespread functional disturbances after focal brain lesions, is not fully understood.

    Purpose of the Study:

    • To investigate serial changes in cerebral blood flow (CBF) in patients with acute stroke.
    • To explore the relationship between CBF decline and clinical factors.
    • To elucidate the underlying mechanisms contributing to altered CBF in both ischemic and non-ischemic hemispheres.

    Main Methods:

    • Utilized the 133Xenon inhalation method for repeated measurements of CBF.

    Related Experiment Videos

  • Included fifteen patients admitted with acute stroke to Philadelphia General Hospital.
  • Monitored CBF in both cerebral hemispheres over the initial week following infarction.

    • Main Results:

    • Twelve out of fifteen patients exhibited a progressive decline in CBF in both hemispheres within the first week post-stroke.
    • The observed decline in CBF was partially attributable to impaired autoregulation.
    • No significant correlation was found between CBF decline and the level of consciousness or PCO2 levels.

    Conclusions:

    • The progressive decline in CBF in the non-ischemic hemisphere suggests a process more complex than previously understood diaschisis.
    • Altered CBF in the non-ischemic hemisphere is likely multifactorial, involving decreased neuronal stimulation, impaired autoregulation, vasoactive substances, and cerebral edema.
    • These findings highlight the dynamic and complex hemodynamic changes occurring after acute stroke, impacting both affected and unaffected brain regions.