Prediction of Clinical Outcomes in Patients with Acute Ischemic Stroke by Measurements of Motor Evoked Potentials / 대한뇌혈관외과학회지

OBJECTIVE: The integrity of the motor pathways can be assessed objectively and quantitatively by measuring the motor evoked potentials (MEPs). However, the early prognostic application of MEPs for assessing the motor and functional recovery of patients with acute ischemic stoke has yielded contradictory results. Therefore, we assessed the value of MEPs for predicting the clinical outcomes of acute ischemic stroke patients. METHODS: Thirty three stroke patients with different degrees of hemiparesis were enrolled in this study. The stroke severity and outcome were assessed using the National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) at admission and at 3 months. The MEPs were measured at the adductor pollicis brevis and adductor hallucis muscles and the relationships between the NIHSS, the mRS and the MEP findings were analysed. RESULTS: In the acute phase of stroke, the presence of MEPs in the upper or lower extremities was correlated with a better clinical outcome (NIHSS: 9.12+/-5.86->2.81+/-1.47, mRS: 2.81+/-1.47->1.62+/-1.31) than the absence of an MEP in at least one extremity (NIHSS: 11.47+/-5.53->8.88+/-6.02, mRS: 3.70+/-1.31->2.94+/-1.67). Especially, there was significant clinical improvement after 3 months in the large territorial infarction patients according to the presence of MEPs. The sensitivity of the presence of MEPs for predicting clinical improvement (motor grade> or =III) was 71.4%, while the specificity was 72.7% in severe hemiplegic patients (motor grade

Characteristics of Dizziness in Supratentorial Infarctions

BACKGROUND: Dizziness due to brain lesions manifests mainly in infratentorial lesions, with few cases related to supratentorial lesions having been reported. This study aimed to elucidate the clinical characteristics and demographic factors of patients with dizziness caused by cerebral infarction and to determine the site of the brain where supratentorial lesions are most prevalent. METHODS: Patients with prominent dizziness who visited the emergency room of Gachon University Gil Hospital between July 2006 and July 2007 were included. Among them, 101 patients with acute cerebral infarction were categorized into supratentorial (n=51) and infratentorial (n=50) groups based on brain MRI. Demographics and clinical characteristics of dizziness in each group were compared, and common brain sites of the supratentorial group were assessed. RESULTS: The nature of the dizziness differed between the supratentorial group (vertigo, 27.4%; presyncope, 5.9%; disequilibrium, 29.4%; ocular, 11.8%; and nonspecific, 25.5%) and the infratentorial group (vertigo, 50.0%; presyncope, 6.0%; disequilibrium, 32.0%; ocular, 0%; and nonspecific, 12.0%; p=0.02). The duration of dizziness was shorter in the supratentorial than the infratentorial group (p<0.01). In the supratentorial group, common sites of the lesion were the thalamus (19.6%) and frontoparietal lobe (15.7%). The lesion usually appeared in the left hemisphere (60.8%). CONCLUSIONS: Dizziness from supratentorial lesions manifests in different ways, and its duration is shorter than that from infratentorial lesions. The central vestibular pathway may be located in the thalamus and frontoparietal lobe.