Analysis of Patients with Excellent Motor Recovery after Large Infarction in the Middle Cerebral Artery Territory Including the Cortex

Abstract

We reported 6 cases of excellent motor recovery after a large infarction in the middle cerebral artery territory including the cortex. All patients were men (aged 67 to 80); 4 had left hemiplegia and 2 had right hemiplegia. They had abrupt onset of focal neurologic symptoms and signs, suggesting embolic stroke. The consciousness level, according to the Japan coma scale, was grade II in 4 patients and normal in the other 2. Atrial fibrillation was present in 4 patients and premature atrial and ventricular contractions were seen in 1 each. Hypertension was present in 3 patients and diabetes mellitus in 1. The motor plegia gradually improved after 1 to 3 days and almost completely disappeared at 12 days after onset. All patients were eventually able to walk alone without any aids. Howerver, aphasia persisted in 2 patients with left hemispheric damage and left unilateral spatial neglect in 3 patients with right hemispheric damage. A cerebral blood flow analysis by single photon emssion computed tomography, using 123I isopropyliodoamphetamine or technetium 99m hexamethylpropylenamine oxime, demonstrated increased blood flow in the frontal lobe cortex surrounding the infarcted region in 5 patients. These patients showed good recovery from motor deficit, even though, motor symptoms did not begin to improve until 1 to 3 days after onset of stroke. We suggest that there is a subgroup of stroke patients, whose severe motor deficit starts to improve even 3 days after onset of a large infarction in the middle cerebral artery territory including the cerebral cortex. © 1995, The Japan Geriatrics Society. All rights reserved.