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Results for “Neurologic Recovery”

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PubMed1995

Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS)

OBJECTIVE: To evaluate the efficacy and safety of intravenous thrombolysis using recombinant tissue plasminogen activator (rt-PA) in patients with acute ischemic stroke. DESIGN: Randomized, prospective, multicenter, double-blind, placebo-controlled clinical trial. SETTING: A total of 75 hospitals in 14 European countries. PATIENTS: A total of 620 patients with acute ischemic hemispheric stroke and moderate to severe neurologic deficit and without major early infarct signs on initial computed tomography (CT). INTERVENTION: Patients were randomized to treatment with 1.1 mg per kilogram of body weight of rt-PA (alteplase) or placebo within 6 hours from the onset of symptoms. OUTCOME MEASURES: Primary end points included Barthel Index (BI) and modified Rankin Scale (RS) at 90 days. Secondary end points included combined BI and RS, Scandinavian Stroke Scale (SSS) at 90 days, and 30-day mortality. Tertiary end points included early neurologic recovery (SSS) and duration of in-hospital stay. Safety parameters included mortality and incidence of intracranial or extracranial hemorrhage. RESULTS: The distribution of demographic variables was similar among patients in the rt-PA and placebo treatment arms in both the intention-to-treat (ITT) analysis and the explanatory analysis for the target population (TP). A total of 109 patients (17.4%) were included in the trial despite major protocol violations but excluded from the TP. There was no difference in the primary end points in the ITT analysis, while the TP analysis revealed a significant difference in the RS in favor of rt-PA-treated patients (P = .035). Of the secondary end points, the combined BI and RS showed a difference in favor of rt-PA-treated patients in both analyses (P < .001). Neurologic recovery at 90 days was significantly better for rt-PA-treated patients in the TP (P = .03). The speed of neurologic recovery assessed by the SSS was significantly better up to 7 days in the ITT analysis and up to 30 days for the TP in the rt-PA treatment arm. In-hospital stay was significantly shorter in the rt-PA treatment arm in both analyses. There were no statistically significant differences in the mortality rate at 30 days or in the overall incidence of intracerebral hemorrhages among the rt-PA and placebo treatment arms in either analysis. However, the occurrence of large parenchymal hemorrhages was significantly more frequent in the rt-PA-treated patients. CONCLUSIONS: Intravenous thrombolysis in acute ischemic stroke is effective in improving some functional measures and neurologic outcome in a defined subgroup of stroke patients with moderate to severe neurologic deficit and without extended infarct signs on the initial CT scan. However, the identification of this subgroup is difficult and depends on recognition of early major CT signs of early infarction. Therefore, since treating ineligible patients is associated with an unacceptable increase of hemorrhagic complications and death, intravenous thrombolysis cannot currently be recommended for use in an unselected population of acute ischemic stroke patients.

Acute Disease↗

PubMed2002

Effects of LF 16-0687 Ms, a bradykinin B(2) receptor antagonist, on brain edema formation and tissue damage in a rat model of temporary focal cerebral ischemia.

Bradykinin, an endogenous nonapeptide produced by activation of the kallikrein-kinin system, promotes neuronal tissue damage as well as disturbances in blood-brain barrier function through activation of B(2) receptors. LF 16-0687 Ms, a non-peptide competitive bradykinin B(2) receptor antagonist, was recently found to decrease brain swelling in various models of traumatic brain injury. We have investigated the influence of LF 16-0687 Ms on the edema formation, neurological outcome, and infarct size in temporary focal cerebral ischemia in rats. Sprague-Dawley rats were subjected to MCA occlusion for 90 min by an intraluminal filament. Local CBF was bilaterally recorded by laser Doppler flowmetry. Study I: animals were assigned to one of three treatment arms (n=11 each): (a) vehicle, (b) LF 16-0687 Ms (12.0 mg/kg per day), or (c) LF 16-0687 Ms (36.0 mg/kg per day) given repetitively s.c. over 3 days. The neurological recovery was examined daily. The infarct volume was assessed histologically 7 days after ischemia. Study II: brain swelling and bilateral hemispheric water content were determined at 48 h post ischemia in eight rats, subjected to the low dose regimen as described above, and in eight vehicle-treated control animals. All treated animals showed tendency to exhibit improved neurological recovery throughout the observation period as compared to the vehicle-treated controls, while this improvement was only significant within the low dose group from postischemic days 3 to 4. Low dose LF 16-0687 Ms significantly attenuated the total and cortical infarct volume by 50 and 80%, respectively. Furthermore, postischemic swelling (-62%) and increase in water content of the infarcted brain hemisphere (-60.5%) was significantly inhibited. The present findings provide strong evidence for an involvement of bradykinin-mediated secondary brain damage following from focal cerebral ischemia. Accordingly, specific inhibition of bradykinin B(2) receptors by LF 16-0687 Ms attenuated postischemic brain swelling, improved the functional neurological recovery, and limited ischemic tissue damage, raising its potential for clinical evaluation in patients with acute stroke.

Animals↗

PubMed2005

Advances in spinal cord repair techniques.

Daily US accidents result annually in over 20,000 cases of traumatic spinal cord injury associated with complete and permanent paraplegias and quadriplegias frequently associated chronic pain. This amounts to new annual health care a costs of dollar 3.2 billion, and a total annual cost for all such individuals in the US of dollar 96 billion. Tens of thousands of additional people suffer lesser degrees of permanent debilitating lost spinal cord function. To help these people recover neurological functions, and simultaneously reduce the enormous suffering, and the associated medical expenses, requires developing techniques that induce the regeneration of lesioned adult human spinal cord axons. A number of techniques lead to varying degrees of axon regeneration and neurological recovery in the rat, but the recovery is invariably limited. While other approaches show potential, they have not led reliable neurological recovery. Most spinal cord repair techniques cannot be applied clinically because they require materials that are not FDA-approved. However, several FDA-approved materials are available that hold great promise for inducing axon regeneration, especially when used simultaneously. Here we review efforts to induce the regeneration of spinal cord axons, how what is known about promoting regeneration of axons across peripheral nerve gaps may be applied to repairing spinal cord lesions, and finally, how several readily available materials may induce axons to regenerate in the spinal cord and restore neurological function.

Axons↗

PubMed1986

Protection against experimental ischemic spinal cord injury.

The authors have studied the protection against ischemic damage to rabbit spinal cord by pretreatment with agents that block neuronal activity and directly or indirectly reduce tissue metabolism. Hypothermia, thiopental, magnesium, lidocaine, and naloxone were used to pretreat the spinal cord prior to ischemia. Hypothermia and thiopental provided comparable protection: they each increased the duration of ischemia required to produce neurological deficits in 50% of the animals from 26 to 41 minutes. They also increased from 10 to 30 minutes the time that the postsynaptic waves of the spinal somatosensory evoked potential (SSEP) could be absent and the animal still have neurological recovery. Hypothermia and thiopental, when used together, increased the duration of ischemia required to produce neurological deficits to 57 minutes in 50% of the animals. Naloxone increased the duration of ischemia required to produce neurological deficits to 36 minutes in 50% of the animals, and increased to 20 minutes the time that the postsynaptic waves of the SSEP could be absent and the animal still have neurological recovery. Magnesium pretreatment improved neurological outcome, possibly by improving collateral circulation as the SSEP did not fail completely during aortic occlusion in all animals. Lidocaine was not beneficial, perhaps because of the prolonged hypotension that resulted.

Animals↗

PubMed2004

Results of surgical treatment for degenerative cervical myelopathy: anterior cervical corpectomy and stabilization.

STUDY DESIGN: This retrospective study involves 26 patients with degenerative cervical myelopathy who were surgically treated by anterior corpectomy, titanium mesh cage (TMC) filled with autogenous bone, and anterior plate +/- posterolateral plate and fusion. OBJECTIVES: This study was conducted to determine the indications, efficacy, and complication rate associated with performing corpectomy to achieve anterior decompression of neural elements or for removing anterior lesions. SUMMARY OF BACKGROUND DATA: This retrospective study involves patients with degenerative cervical myelopathy who were surgically treated by > or =2-level anterior corpectomy, TMC filled with autogenous bone, and anterior plate +/- posterolateral plate and fusion. The purpose was to evaluate and compare the results in terms of neurologic recovery and function and effectivity of TMC as a structural support. METHODS: Twenty-six patients with degenerative cervical myelopathy who had surgical treatment and average 30 months (range, 24-52 months) follow up were included. The mean age was 64.9 years (range, 55-74 years) and average period between myelopathic symptoms and surgery was 2.8 years (range, 6 months-5 years). Preoperative evaluation of every patient consisted of anterior-posterior, lateral, bilateral oblique, flexion, and extension radiographs, computed tomography reconstructions and magnetic resonance imaging of the cervical spine, Doppler ultrasound of the carotid arteries, vertebral artery magnetic resonance angiography, neurologic examination, and electromyography. Degree of pre- and postoperative myelopathy was determined according to the scoring systems developed by Nurick and Japanese Orthopedic Association (JOA). Twelve patients had a mild balance problem and difficulty while walking but were able to perform their daily activities. Fourteen patients had spastic quadriparesis ambulating on either crutches or with wheelchairs. Of these, 11 experienced bladder disturbance as well. Surgical treatment in 18 patients consisted of anterior decompressive corpectomy, structural TMC, and anterior plate stabilization in 14 patients who had 2-level corpectomy. Posterior plate stabilization without laminectomy was added to this procedure in another 4 patients who had 3- or more level corpectomy. The remaining 8 patients had first laminectomy and posterolateral plate, then anterior corpectomy, TMC, and anterior plate on the same stage. Corpectomy levels were between C3 and T1, and anterior corpectomy, structural TMC, and anterior plating was the procedure that all patients had in common. RESULTS: Mean sagittal Cobb angle (C2-C7) was 9 degrees (range, 0-23 degrees) before surgery, 17.1 degrees (range, 11-22 degrees) on the third postoperative month, and 16.9 degrees (range, 10-22 degrees) at last follow-up. The difference in sagittal alignment on the third month and last follow up was not statistically significant (P > 0.05). Average preoperative Nurick score was 3.5 (range, 2-5) and JOA score was 7 (range, 1-14). Major and statistically significant neurologic recovery was within the first 3 months, and average Nurick and JOA scores at 3 months were 2 (range, 0-3) and 11 (range, 8-17) (P < 0.001), respectively. All patients had improved neurologic status at final follow up. As confirmed by plain radiographs and computed tomography reconstructions, solid fusion was achieved across the TMC with no settling or migration, and we had no implant-related complication or failure. As major complications, 1 (3.8%) early deep posterior infection developed but responded to early debridement and antibiotics. Also, 3 patients (11.5%) had transient C5 nerve root injury. At final follow up, all patients were able to ambulate without support and maintain their daily activities. CONCLUSIONS: Anterior decompression provides good neurologic recovery in patients with degenerative cervical myelopathy. TMC provides good structural support, and solid fusion can be achieved with TMC and anterior plate (for < or =2-level corpectomy) and/or posterior plate (> or =3-level corpectomy). There is increased risk of C5 nerve root injury when first laminectomy and posterolateral plate stabilization are performed.

Aged↗

PubMed2006

Neurological outcome of septic cardioembolic stroke after infective endocarditis.

BACKGROUND AND PURPOSE: The aim of this study was to evaluate mortality and neurological outcomes of cardioembolic cerebral stroke in infective endocarditis (IE) patients requiring cardiac surgery. METHODS: A consecutive series of 214 patients undergoing cardiac surgery for IE was followed up for 20 years. In 65 patients (mean age, 52 years), IE was complicated by computed tomography- or magnetic resonance imaging-verified stroke (n=61) or transient ischemic attack (n=4). Perioperative (30-day) and long-term mortality was assessed with regression models adjusting for age. Complete neurological recovery of IE survivors was defined by a modified Rankin score of < or = 1 and a Barthel index of 20 points. RESULTS: Fifty of 61 stroke patients (81.9%) survived surgery. In comparison with nonstroke patients, the age-adjusted perioperative mortality risk was 1.70-fold (95% CI, 0.73 to 3.96, P=0.22) higher and long-term mortality risk was 1.23-fold (95% CI, 0.72 to 2.11, P=0.45) higher in stroke patients. Patients with complicated stroke (meningitis, hemorrhage, or brain abscess) showed a higher perioperative mortality rate (38.9% vs 8.5%, P=0.007) but no higher neurological complication rate than patients with uncomplicated ischemic stroke. Complete neurological recovery was achieved in 35 IE survivors (70%, 95% CI, 55% to 82%). However, in the case of middle cerebral artery stroke, recovery was only 50% and was significantly lower compared with non-middle cerebral artery stroke (P=0.012). CONCLUSIONS: Uncomplicated IE-related stroke showed a favorable prognosis with regard to both long-term survival and neurological recovery. The formidable risk of secondary cerebral hemorrhage due to cardiac surgery seems to be much lower than previously thought.

Aged↗

PubMedDate not supplied

Peripheral nerve transplantation: the effects of predegenerated grafts and immunosuppression.

Research involving nerve transplantation has shown that tissue rejection limits the neurologic recovery unless the host is immunosuppressed. This study investigates an alternative to permanent or temporary immunosuppression using a rat model with nerve transplants from Brown-Norway rat donors to bridge defects in the sciatic nerve of Lewis rat recipients as these two inbred strains differ at both major and minor histocompatibility loci. The specific aim of this study was to evaluate if predegenerated nerve grafts decreased the tissue rejection and improved the neurologic recovery of animals with allogenic nerve grafts to avoid the problems associated with either short- or long-term immunosuppression. The animals in the experimental groups received cyclosporin-A, predegenerated grafts, both, or neither. The predegenerated grafts were produced by division of the nerve three weeks prior to grafting to allow for Wallerian degeneration to occur. The outcome was assessed by measurements stressing functional recovery (sensory testing, gait analysis, joint flexion contracture), studies of muscle recovery (muscle weight and hydroxyproline concentration), and histologic studies (axonal counts and inflammatory reaction). The animals receiving the predegenerated grafts without cyclosporin did have an improved recovery (joint flexion contracture 35 degrees +/- 8 degrees and hydroxyproline ratio 1.52 +/- 0.16) as compared to the joint flexion contractures and hydroxyproline ratios of the allograft group of animals without either cyclosporin-A or pretreatment and the ungrafted control group (47 degrees +/- 18 degrees, 1.68 +/- 0.34, and 53 degrees +/- 15 degrees, 4.50 +/- 0.27, respectively, p less than 0.01). However, all the isograft groups and allograft groups with cyclosporin-A, regardless of whether the graft had been predegenerated or not, had greater neurologic recovery than the allograft group with predegenerated grafts but without cyclosporin-A by the same parameters (p less than 0.01). Allograft groups with short-term immunosuppression with cyclosporin-A did as well as isograft groups, and isograft groups with predegenerated grafts did not do any better than isografts without pretreatment (p less than 0.01).

Animals↗

PubMed2006

Prognostic influence and computed tomography findings in dysautonomic crises after traumatic brain injury.

BACKGROUND: Dysautonomic crises represent a relatively unknown complication in patients with severe traumatic brain injury (TBI). Few studies have been undertaken of their pathophysiology and prognostic repercussions. We studied the prevalence of dysautonomic crises after TBI, their radiologic substrate, influence on the clinical course in the intensive care unit (ICU), and effect on neurologic recovery. METHODS: A case-control study involving 11 patients with dysautonomic crises admitted with TBI during a span of 1 year and 26 patients admitted with TBI but no crises during the first 3 months of the same year. The initial severity was assessed from Apache II, Glasgow Coma Scale (GCS) scores, and computed tomography (CT) during the first 24 hours. Complications were assessed by the duration of ICU stay, days on mechanical ventilation, need for tracheotomy, and number of infectious complications. Neurologic recovery was assessed with the GCS at discharge from the ICU and with the Glasgow Outcome Scale 12 months later. RESULTS: Both groups were similar at admission. The prevalence of dysautonomic crises was 9.3%. Patients with dysautonomic crises had more focal lesions on cranial CT than patients without crises, a significantly longer ICU stay, and a tendency to have a worse level of consciousness at discharge from the ICU but not 12 months later. CONCLUSIONS: Almost 10% of patients with severe TBI have dysautonomic crises during their ICU stay. Patients with dysautonomia were more likely to have focal intraparenchymal lesions, and crises were associated with greater morbidity and a longer ICU stay. Dysautonomic crises determined a worse short-term neurologic recovery.

Adolescent↗

PubMedDate not supplied

Analysis of patient variables affecting neurologic outcome after traumatic cervical facet dislocation.

BACKGROUND CONTEXT: Traumatic cervical facet dislocation accounts for a disproportionate rate of neurologic disability. The relative importance of patient and management variables, including the timing of spinal reduction, in ultimate neurologic outcome has not been well defined. PURPOSE: To analyze data from a cohort of patients sustaining traumatic cervical facet dislocation to determine the relative importance of several patient and management variables in neurologic recovery after injury. STUDY DESIGN/SETTING: A retrospective study was conducted at a major referral center for spinal-cord-injured patients. PATIENT SAMPLE: Forty-five patients sustaining traumatic cervical facet dislocation. OUTCOME MEASURES: Using improvement in American Spinal Injury Association (ASIA) motor score as the primary outcome measure, patient data were used to construct a statistical model allowing the analysis of several clinically relevant variables. METHODS: The records of patients sustaining a traumatic cervical facet dislocation over a 5-year period were reviewed. Clinical data were collected for all patients with adequate follow-up. The data were used to construct a statistical model designed to analyze the contribution of the variables age, gender, time to reduction of the spine and initial motor score to neurologic improvement (the outcome measure). In addition, the effect of variable interaction was studied. RESULTS: Most patients demonstrated neurologic improvement over the course of follow-up after cervical facet dislocation. For this data set, the variables age and initial motor score were significantly associated with neurologic improvement. However, time to reduction of the spine did not demonstrate a significant independent relationship to neurologic outcome. No significant interaction was found between patient age or gender and the time to reduction with regard to predicting neurologic recovery. CONCLUSION: The present study uses a statistical model to determine the relative importance of clinically relevant variables for a population of patients after traumatic cervical facet dislocation. This model confirms the clinical impression that younger patients with lesser degrees of neurologic injury tend to achieve the best neurologic recovery after a traumatic facet dislocation. Although a strong benefit from earlier spinal column reduction did not emerge from the present data set, additional study is needed to define those patients who would benefit from immediate reduction of the spinal column.

Adult↗

PubMed1988

Magnetic resonance imaging of acute spinal cord trauma: preliminary report.

Forty-three magnetic resonance studies were performed on 28 patients with suspected spinal cord injury using a 1.5 Tesla magnet and surface coils. Imaging was performed between day 1 and day 16 post injury. In several patients, repeat magnetic resonance studies were performed to evaluate the resolution of the cord lesions. Three types of magnetic resonance signal patterns were seen in association with the cord injuries. Patients with intraspinal hemorrhage did not have significant neurological recovery, whereas patients with cord edema/contusion recovered significant neurological function. Magnetic resonance imaging appears to be useful in the diagnosis of acute cord injury and also appears to demonstrate the potential for predicting neurological recovery.

Adolescent↗

PubMed1990

Gunshot wounds to the cervical spine.

A retrospective review was performed on 28 patients with low-velocity gunshot wounds to the cervical spine. These composed 31% of all spinal gunshot wounds seen during the study period between 1979 and 1988. Surgical decompression did not seem to improve neurologic recovery in either the incomplete or complete patients. Neurologic recovery also appeared to be unaffected by the presence of retained intracanal bullet fragments. The authors found no advantage to routine neck exploration of this penetrating injury. Complications were seen in 93% of the patients. Most complications were thromboembolic, pulmonary, and urinary tract infections. No cases of instability occurred as a direct result of the gunshot wound. No deaths occurred in this series. Two cases of posttraumatic syrinxes were diagnosed. The authors' current treatment recommendations for these patients include selective wound management and observation of retained intracanal bullet fragments in patients with complete lesions. Surgical decompression after this injury is not recommended.

Adolescent↗

PubMed1988

Surgery for malignant extradural tumours of the spine.

We have reviewed 41 patients with malignant extradural tumours of the spine treated by anterior decompression for cord compression, or uncontrolled back pain or both. An anterior operation alone was performed in 37 cases, four had combined or staged anterior and posterior decompression. An anterior operation on its own achieved major neurological recovery in 18 of the 33 cases with neurological loss (56%); only four remained unchanged. Eleven had minor improvement but not enough to allow them to walk or to regain bladder function. No patient with complete paraplegia gained a useful neurological recovery. Back pain was improved in 30 of the 41 patients (73%), sound internal fixation being important in this respect. There were four early deaths and another 23 died from disseminated disease after a mean survival of 4.1 months. Fourteen patients are still alive with a mean survival of 14 months.

Adult↗

PubMed1989

[Preliminary report on the use of MRI in acute spinal trauma].

Forty three Magnetic Resonance (MR) studies were performed on 28 patients using a 1.5 Tesla magnet and surface coil. Imaging was performed between day 1 and day 16 after suspected cord injury. In several patients, repeat MR studies were performed to evaluate the resolution of the cord lesions. Three types of MR signal patterns were seen in association with the cord injuries. Patients with intraspinal hemorrhage did not have significant neurological recovery while patients with cord edema/contusion recovered significant neurological function. MR imaging would seem extremely useful in the diagnosis of acute cord injury and also appears to demonstrate the potential for predicting neurological recovery.

Acute Disease↗

PubMed1997

Short-course chemotherapy in the treatment of Pott's paraplegia: report on five year follow-up.

OBJECTIVE: To assess the efficacy of 9-month short-course chemotherapy (SCC) and to study the pattern of neurological recovery in patients with Pott's paraplegia. DESIGN: Patients with recent onset of spastic paraplegia due to clinically and radiologically active spinal tuberculosis involving vertebral bodies of level D4-L1 were treated with streptomycin, rifampicin, isoniazid and ethambutol daily for the first 2 months, followed by rifampicin plus isoniazid twice weekly for the next 7 months. The study was conducted in 2 phases. In the first phase 10 patients were admitted to the open trial where all patients had undergone modified Hong Kong surgery in addition to chemotherapy. In the next phase 23 patients enrolled in the study were randomly allocated to receive either chemotherapy alone or surgery plus chemotherapy. All the patients were followed for 5 years from the start of treatment. A scoring system was devised to predict neurological recovery. RESULTS: In all, 33 patients were admitted and treated with SCC. Thirteen patients were allocated to the chemotherapy (CHEM) regimen; of these 3 patients had to be operated upon for clinical deterioration; the remaining 20 had surgery plus chemotherapy; 4 were excluded for various reasons, leaving 29 patients in the analysis. None relapsed requiring treatment. CONCLUSION: A combination of surgery (when indicated) and SCC of 9 months' duration is effective in the treatment of Pott's paraplegia. All patients had neurological recovery by the end of 9 months; 8 recovered with chemotherapy alone. Complete motor recovery was seen in 62% by the 3rd month and 90% by the 6th month.

Adolescent↗

PubMed2001

Recovery and neurological examination after remifentanil-desflurane or fentanyl-desflurane anaesthesia for carotid artery surgery.

We studied 44 patients undergoing carotid endarterectomy (CEA) to compare recovery after general anaesthesia with desflurane supplemented with either remifentanil or fentanyl. Remifentanil was infused at 0.1 microg kg(-1) min(-1) and desflurane was adjusted at 2 vol% end-tidal. Fentanyl was given as a bolus dose of 2 microg kg(-1) before induction and repeated at skin incision; desflurane was adjusted as needed. Times for early recovery and response to simple neurological tests (digit symbol substitution test (DSST) and Trieger dot test (TDT)) were measured 30, 60 and 90 min after operation. Emergence from remifentanil-desflurane anaesthesia was significantly quicker than that from fentanyl-desflurane anaesthesia: mean times to extubation were 4.1 (SD 1.7) and 8.2 (4.9) min, respectively; mean times for patients to state their name correctly were 6.0 (2.8) and 13.8 (9.0) min, respectively. Patients in the remifentanil-desflurane group successfully performed neurological tests significantly earlier than those in the fentanyl-desflurane group; for example, patients in the former group completed the arm holding test at 7.9 (3.0) min, while those in the latter group did this at 20.6 (19.7) min (P < or = 0.01). Intermediate recovery was less impaired at 30 min (DSST, TDT) and at 60 min (DSST). More rapid awakening and an earlier opportunity for neurological examination suggest that remifentanil-desflurane is a suitable alternative to a standard fentanyl-based general anaesthetic technique in patients undergoing CEA.

Adult↗

PubMed2000

Correlation of cerebral hemodynamic changes during mental activity and recovery after stroke.

OBJECTIVE: To investigate the correlation between changes in cerebral functional activity during mental engagement and the potential for neurologic recovery after stroke. BACKGROUND: Transcranial Doppler ultrasonography (TCD) makes it possible to detect the dynamic adjustment of cerebral perfusion related to functional neuronal changes. METHODS: TCD monitoring of flow velocity changes in the middle cerebral artery of 29 ischemic stroke patients was performed during an object recognition task. The study took place within 4 weeks from stroke onset. Based on recovery occurring after 2 months, the patients were divided into four groups depending on the side of hemispheric lesion and the presence or absence of neurologic recovery. Ten healthy subjects served as control subjects. RESULTS: During the recognition task, control subjects showed a bilateral increase in flow velocity with respect to the rest phase (right side, 7.02 +/- 1.3%; left side, 6.65 +/- 1. 1%), with no side-to-side difference. In patients who experienced recovery, a similar pattern of bilateral activation was observed, irrespective of the side of the lesion. Conversely, in patients with no recovery, the increase of flow velocity was significantly higher on the side contralateral to the brain lesion (p < 0.0001) with respect to the lesion side. Performance during the recognition task was comparable in the four groups of patients. CONCLUSIONS: These findings suggest that satisfactory recovery from a neurologic deficit requires the persistence of functional activity in the damaged hemisphere despite the presence of an anatomic lesion. The possibility of obtaining early prognostic indications with TCD may be relevant for an early selection of patients with the best probability of benefiting from rehabilitation therapy.

Aged↗

PubMed1980

Augmentation of postischemic brain damage by severe intermittent hypertension.

The neurological recovery and histological changes were studied in monkeys after intermittent postischemic arterial hypertension after 16 min of global brain ischemia. Ischemia was produced with a high pressure (1500 mm Hg) neck tourniquet and systemic arterial hypotension. Intensive care and life support, including monitoring of physiological variables, were provided for 7 days. Postischemia all monkeys were immobilized; ventilation was controlled and mean arterial pressure was maintained between 85--115 mm Hg for the first 48 hours. Immediately postischemia in four monkeys, intermittent arterial hypertension (i.e., 150--190 mm Hg) was induced by norepinephrine infusion for 3--5 min. Hypertensive episodes were repeated at 15, 30, 60, and 120 min postischemia, once every hour for the first 24 hours and once every 2 hours between 24 and 48 hours. Thereafter, the monkeys were allowed to breathe spontaneously. Four control monkeys were similarly treated except that arterial hypertension was not induced. Neurological recovery was evaluated by EEG, intracranial pressure, neurological deficit scoring, and histological examination of the brain after killing on day 7 postischemia. The neurological deficit score (100 % = brain death; 50% = vegetative state; 0% = normal) in control monkeys on day 7 was 17.8 +/- 1.8 (SEM) % compared to 46.3 +/- 6.5% (p less than 0.05) in the hypertension group. EEG recovery was delayed and the postischemic increase in intracranial pressure was prolonged in the hypertension group. Histological damage scores in the brain correlated with neurological deficit scores. Severe intermittent hypertension has a deleterious effect on neurological recovery after global brain ischemia.

Animals↗

PubMed2001

Beneficial effects of nitric oxide synthase inhibition on the recovery of neurological function after spinal cord injury in rats.

We have demonstrated recently that treatment with N(G)-monomethyl-L-arginine (L-NMMA) accelerates electrophysiological recovery after transient spinal cord ischaemia in anaesthetized cats. To determine whether nitric oxide synthase (NOS) inhibition in the acute phase of spinal cord injury results in better functional recovery in the chronic phase, we evaluated the influence of L-NMMA on the time course of changes of neurological function and the histopathological changes after spinal cord compression in rats. Experimental spinal cord injury was produced in anaesthetized rats by short-term (5 min) compression with a thread placed around the spinal cord at T13. The recovery of motor function was assessed by a treadmill test 10, 20 and 30 days after spinal cord compression. The latency of potentials evoked by hindlimb stimulation was measured at the funiculus posterior at C1 10 days after the spinal cord injury in anaesthetized rats. Histological examinations were also performed at the same time. The compression-induced spinal cord injury resulted in motor dysfunction of hindlimbs, an increase in the latency of the evoked potentials and neuronal degeneration in funiculus posterior at T13. Repeated administration of L-NMMA for 1 day significantly accelerated the recovery of the motor function, shortened the latency of the evoked potentials and attenuated the myelin vacuolization in the spinal cord. These beneficial effects of L-NMMA on neurological function and histopathological changes were abolished by coadministration of L- but not D-arginine. These results suggest that NOS inhibition during the early stage of spinal cord injury has beneficial effects on the recovery of neurological function and the histopathological changes in the chronic stage.

Animals↗