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

From IRCCS "S. Lucia" (Drs. Bragoni, Caltagirone, Troisi, and Matteis), Rome; the Clinica Neurologica (Drs. Caltagirone and Silvestrini), Università di Roma "Tor Vergata"; and AFaR CRCCS: Dipartimento di Neuroscienze (Dr. Vernieri), Ospedale Fatebenefratelli, Isola Tiberina, Rome, Italy.

Address correspondence and reprint requests to Dr. Mauro Silvestrini, Clinica Neurologica, Università di Roma "Tor Vergata," Ospedale S. Eugenio, P.le dell’Umanesimo 10, 00144 Rome, Italy.

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.