Prolonged muscular flaccidity after stroke morphological and functional brain alterations

Patrizia Pantano, Rita Formisano, Monica Ricci, Vittorio Di Piero, Umberto Sabatini, Piero Barbanti, Marco Fiorelli, Luigi Bozzao, Gian Luigi Lenzi

Research output: Contribution to journalArticle

Abstract

Patients with a motor deficit due to ischaemic stroke usually develop muscular spasticity, but in some cases they may remain with a prolonged muscular flaccidity which impairs their recovery. Little is known about the causes of these two different functional outcomes. We correlated CT/MRI and 99mTc HM-PAO SPECT with clinical findings in 42 patients at a mean time interval of 3 months after stroke. The patients were divided into two cohorts with either flaccid (prolonged muscular flaccidity) or spastic (muscular spasticity) hemiparesis. Although patients with prolonged muscular flaccidity had a greater motor deficit, the mean structural volume of the ischaemic lesion was similar to that of the muscular spasticity cohort. There was a significantly higher prevalence of structural involvement of the lentiform nucleus in prolonged muscular flaccidity cases. Relative perfusion in the lentiform nucleus, thalamus and contralateral cerebellar hemisphere was significantly lower in prolonged muscular flaccidity than in muscular spasticity patients. A subgroup with only subcortical structural lesions also showed significantly lower relative perfusion in the ipsilateral frontal association areas. A primary involvement of the lentiform nucleus by the structural lesion seems to be crucial for the persistence of flaccidity after stroke. However, cerebral blood flow (CBF) changes in other structurally intact regions indicate their additional role. It is likely that both subcortical-cortical loops involved in motor control, i.e. cortex-basal ganglia-thalamus-cortex and cortex-ponscerebellum-thalamus-cortex, are more widely and more severely affected in patients with prolonged muscular flaccidity.

Original languageEnglish
Pages (from-to)1329-1338
Number of pages10
JournalBrain
Volume118
Issue number5
Publication statusPublished - Oct 1995

Keywords

  • Cerebral blood flow
  • Motor deficit
  • Prolonged muscular flaccidity
  • Single photon emission tomography
  • Stroke

ASJC Scopus subject areas

  • Neuroscience(all)
  • Statistics, Probability and Uncertainty
  • Applied Mathematics
  • Mathematics(all)
  • Statistics and Probability
  • Agricultural and Biological Sciences (miscellaneous)
  • Clinical Neurology

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    Pantano, P., Formisano, R., Ricci, M., Di Piero, V., Sabatini, U., Barbanti, P., Fiorelli, M., Bozzao, L., & Lenzi, G. L. (1995). Prolonged muscular flaccidity after stroke morphological and functional brain alterations. Brain, 118(5), 1329-1338.