脑卒中急性期的脑功能重塑观察

Functional MRI observation of brain reorganization in patients with acute stroke

目的观察急性脑卒中患者脑皮层功能重塑。方法采用被动运动任务对12例急性脑卒中患者进行BOLD- fMRI成像。运用脑功能分析软件SPM2对功能资料进行分析。受试患者分为脑皮层卒中组(A组)及传导通路卒中组(B组),通过记录各组患者的脑激活区情况,观察不同部位卒中急性期脑功能重组过程,并与追踪所得的患者肢体运动功能康复的情况进行比较,分析两者的相关性。结果脑皮层卒中患者急性期以卒中区域周围脑区以及患侧顶叶代偿为主,急性期脑功能重组与患者恢复程度之间无明显相关。传导通路卒中组内追踪证实恢复不佳的患者,急性期主要见患侧大脑半球激活,恢复情况较好的患者则在急性期以健侧大脑半球激发为主,其中可见健侧SM1皮层激发。结论脑卒中急性期患者的脑功能重塑具有一定的规律性,并可能与预后有关;健侧大脑半球对患者的恢复的确存在一定的作用。

Objective To explore the cortical reorganization process in patients with acute stroke. Methods Twelve acute stroke patients were examined by BOLD-fMRI using passive finger movement at Philips Intera Gyrosean 1.5T MR scanner. The fMRI data were postprocessed by SPM2. According to the affected area, the patients were divided into the cortex involved （group A） and pyramidal tract involved group （group B）. By recording the brain activation area, acute stroke reorganization process in different brain structures was analyzed. Results The peripheral affected area and contralateral parietal lobe were activated in the group A, and there was no significant correlation between the activated location and the motor recovery degree. In group B, it was mainly the contralateral hemisphere that activated, and it was the ipsilateral hemisphere that activated from the better recovered patients. The ipsilateral SM1 was activated in part. Conclusion The brain functional reorganization process in acute stroke has certainly rules which may be correlated with rehabilitation prognosis. The hemieerebrum on the healthy side plays some role in the reorganization process of the diseased side.