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Cerebral blood flow imaging in acute ischemic stroke with functional computed tomography
Abstracts
The 1997 North American Stroke Meeting Montreal, Quebec, Canada October 16-18, 1997
PLATFORM PRESENTATIONS: FRIDAY, OCTOBER 17
Cerebral Blood Row Imaging in Acute Ischemic Stroke with Functional Computed Tomography
Reintegration to Normal Living in the First Year Post-Stroke
AD Firlik, AM Kaufmann, KS Firlik, H Yonas (Pittsburgh, Pennsylvania) Au~o~ PJ Clarke, JM Lawrence, SE Black (Toronto, Ontario)
Background: In acute ischemic stroke, brain computed tomography (CT) scans are frequently normal or reveal only subtle hypodense changes. This study explored the utility and increased sensitivity of xenon-enhanced CT (XeCT) in the diagnosis of acute cerebral ischemia. Methods: Initial CT scans and simultaneous XeCT scans (an additional 4.5 rain of scanning time) were performed within 6 hours of the onset of hemiparesis or hemiplegia (with or without aphasia) in 20 patients. Cerebral blood flow (CBF) in 50 to 60 regions of interest (ROIs) were analyzed in both hemispheres.
Results: CT scans were normal in 10 (50%) of patients. In the 10 patients (50%) with abnormal CT scans, 6 (60%) showed hypodensities in the basat ganglia; 7 (70%) showed cortical hypodensities; 6 (60%) showed hyperdensities (thromboses) in the middle cerebral artery (MCA). XeCT scans were abnormal in all 20 (100%) patients, showing ROIs with CBF < 20 (cc/100 g/rain) in the symptomatic MCA territories. The mean CBF in the symptomatic MCA territories was 15.+.2compared to 34.+.2in the asymptomatic MCA territories (p<0.0005, t-test). The mean percentage of ROIs with CBF_<8in the symptomatic MCA territories was ~ compared to 0.3r in the asymptomatic MCA territories (p<0.0005, t-test). Conclusion: XeCT is more sensitive than CT in detecting acute strokes, providing early quantitative blood flow information that may guide selection of patients for emergent stroke therapy.
456
Background: While stroke-induced disabilities can restrict the life activities of survivors, the potential of individuals to resume valued activities is not well understood. We examined the extent to which survivors return to valued activities in the face of persisting stroke-related sequelae. Methods: 164 hemispheric stroke survivors with adequate cognitive and language function were followed at 3 months and 1 year after stroke onset. The Reintegration to Normal Living Index (RNL) was used to assess survivors' satisfaction with their physical, emotional and social lives at both time periods. Results: Using multivariate analysis of variance, motor disability (Functional Independence Measure) (p<0.03), and depressive symptomatology (Zung Depression Scale) (p<0.01), were associated with lower RNL scores at both follow-up periods. However, survivors demonstrated an improvement in their satisfaction with life activities across all disability levels over time. Mean RNL score for those dependent in motor ability at three months was 14.3 + 19.9, whereas the mean score for those who remained dependent at one year was 46.5 + 25.7. The support of a marital relationship moderated the impact of stroke in one year male survivors (p<0.04). Rehabilitation therapy assisted more disabled survivors in returning to valued activities before 3 months (p<0.0O3). Conclusions: Although physical disability and mood state restrict the return to meaningful life activities, stroke survivors demonstrate resilience and adaptation with the help of social supports and rehabilitation therapy.
Journal of Stroke and Cerebrovascular Diseases, Vol.
6, N o . 6, 1997: p p 4 5 6 - 4 7 6
The 1997 North American Stroke Meeting Montreal, Quebec, Canada October 16-18, 1997
PLATFORM PRESENTATIONS: FRIDAY, OCTOBER 17
Cerebral Blood Row Imaging in Acute Ischemic Stroke with Functional Computed Tomography
Reintegration to Normal Living in the First Year Post-Stroke
AD Firlik, AM Kaufmann, KS Firlik, H Yonas (Pittsburgh, Pennsylvania) Au~o~ PJ Clarke, JM Lawrence, SE Black (Toronto, Ontario)
Background: In acute ischemic stroke, brain computed tomography (CT) scans are frequently normal or reveal only subtle hypodense changes. This study explored the utility and increased sensitivity of xenon-enhanced CT (XeCT) in the diagnosis of acute cerebral ischemia. Methods: Initial CT scans and simultaneous XeCT scans (an additional 4.5 rain of scanning time) were performed within 6 hours of the onset of hemiparesis or hemiplegia (with or without aphasia) in 20 patients. Cerebral blood flow (CBF) in 50 to 60 regions of interest (ROIs) were analyzed in both hemispheres.
Results: CT scans were normal in 10 (50%) of patients. In the 10 patients (50%) with abnormal CT scans, 6 (60%) showed hypodensities in the basat ganglia; 7 (70%) showed cortical hypodensities; 6 (60%) showed hyperdensities (thromboses) in the middle cerebral artery (MCA). XeCT scans were abnormal in all 20 (100%) patients, showing ROIs with CBF < 20 (cc/100 g/rain) in the symptomatic MCA territories. The mean CBF in the symptomatic MCA territories was 15.+.2compared to 34.+.2in the asymptomatic MCA territories (p<0.0005, t-test). The mean percentage of ROIs with CBF_<8in the symptomatic MCA territories was ~ compared to 0.3r in the asymptomatic MCA territories (p<0.0005, t-test). Conclusion: XeCT is more sensitive than CT in detecting acute strokes, providing early quantitative blood flow information that may guide selection of patients for emergent stroke therapy.
456
Background: While stroke-induced disabilities can restrict the life activities of survivors, the potential of individuals to resume valued activities is not well understood. We examined the extent to which survivors return to valued activities in the face of persisting stroke-related sequelae. Methods: 164 hemispheric stroke survivors with adequate cognitive and language function were followed at 3 months and 1 year after stroke onset. The Reintegration to Normal Living Index (RNL) was used to assess survivors' satisfaction with their physical, emotional and social lives at both time periods. Results: Using multivariate analysis of variance, motor disability (Functional Independence Measure) (p<0.03), and depressive symptomatology (Zung Depression Scale) (p<0.01), were associated with lower RNL scores at both follow-up periods. However, survivors demonstrated an improvement in their satisfaction with life activities across all disability levels over time. Mean RNL score for those dependent in motor ability at three months was 14.3 + 19.9, whereas the mean score for those who remained dependent at one year was 46.5 + 25.7. The support of a marital relationship moderated the impact of stroke in one year male survivors (p<0.04). Rehabilitation therapy assisted more disabled survivors in returning to valued activities before 3 months (p<0.0O3). Conclusions: Although physical disability and mood state restrict the return to meaningful life activities, stroke survivors demonstrate resilience and adaptation with the help of social supports and rehabilitation therapy.
Journal of Stroke and Cerebrovascular Diseases, Vol.
6, N o . 6, 1997: p p 4 5 6 - 4 7 6