Predictors for the degree of clinical recovery after stroke are still poorly defined. In this study we tried to assess the predictive value of clinical data and of lesion size for motor recovery after ischemic stroke. In 52 hemiparetic patients we monitored the course of clinical recovery by a dedicated score of sensorimotor hand function after their first stroke. The course of the lesion size was measured in proton density magnetic resonance images. Three groups of patients were identified. Patients with moderate initial motor deficit recovered almost completely within 9 days (17/17, group 1). From the patients with severe initial motor deficit, about equal numbers recovered (16/35, group 2) or remained severely impaired during the entire observation period of more than 6 months (19/35, group 3). There was no correlation between changes of lesion size and motor deficit. Logistic regression of probability of good clinical outcome on initial lesion size, initial motor score and subcortical versus cortical location of lesion showed that only the initial motor score was predictive (p = 0.006). A relative improvement of the initial motor score of about 20% in the first 4 weeks after stroke appeared to be a relevant cut point for good outcome. The data indicate that patients with mild initial motor deficits recover well, whereas severely affected patients may differ in outcome. Since lesion size was not correlated with outcome the amount of spared residual function appeared as major determinant for the capacity for motor recovery.

Keywords:
Infarction, Hemiparesis, Lesion volume
1.
Gresham GE: The rehabilitation of the stroke survivor; in Barnett HJM, Stein BM, Mohr JP, Yatsu FM (eds): Stroke: Pathophysiology, Diagnosis, and Management. New York, Churchill Livingstone, 1986, pp 121–128.
2.
Duncan PW, Goldstein LB, Matchar D, Divine GW, Feussner J: Measurement of motor recovery after stroke. Outcome assessment and sample size requirements. Stroke 1992;23:1084–1089.
3.
Donnan GA, Bladin PF, Berkovic SF, Longley WA, Saling MM: The stroke syndrome of striatocapsular infarction. Brain 1991;114:51–70.
4.
Kwakkel G, Wagenaar RC, Kollen BJ, Lankenhorst GJ: Predicting disability in stroke – A critical review of the literature. Age Ageing 1996;25:479–489.
5.
Seitz RJ: Recovery of executive functions; in Boller F, Grafman J (eds): Action and Cognition. Handb Neuropsychol. Amsterdam, Elsevier, 1997, vol 16, pp 185–207.
6.
Pendelbury ST, Blamire AM, Lee MA, Styles P, Matthews PM: Axonal injury in the internal capsule correlates with motor impairment after stroke. Stroke 1999;30:956–962.
7.
Fries W, Danek A, Scheidtmann K, Hamburger C: Motor recovery following capsular stroke: Role of descending pathways from multiple motor areas. Brain 1993;116:369–382.
8.
Binkofski F, Seitz RJ, Arnold S, Classen J, Benecke R, Freund H-J: Thalamic metabolism and corticospinal tract integrity determine motor recovery in stroke. Ann Neurol 1996;39:460–470.
9.
Furlan M, Marchal G, Viader F, Derlon J-M, Baron J-C: Spontaneous neurological recovery after stroke and the fate of the ischemic penumbra. Ann Neurol 1996;40:216–226.
10.
Baird AE, Benfield A, Schlaug G, Siewert B, Lovblad KO, Edelman RR, Warach S: Enlargement of human cerebral ischemic lesion volumes measured by diffusion-weighted magnetic resonance imaging. Ann Neurol 1997;41:581–591.
11.
Lövblad KO, Baird AE, Schlaug G, Benfield A, Siewert B, Voetsch B, Connor A, Burzynski C, Edelman RR, Warach S: Ischemic lesion volumes in acute stroke by diffusion-weighted magnetic resonance imaging correlate with clinical outcome. Ann Neurol 1997;42:164–170.
12.
Tong DC, Yenari MA, Albers GW, O’Brien M, Marks MP, Moseley ME: Correlation of perfusion- and diffusion-weighted MRI with NIHSS score in acute (<6.5 hour) ischemic stroke. Neurology 1998;50:864–870.
13.
Beaulieu C, de Crespigny A, Tong DC, Moseley ME, Albers GW, Marks MP: Longitudinal magnetic resonance imaging study of perfusion and diffusion in stroke: Evolution of lesion volume and correlation with clinical outcome. Ann Neurol 1999;46:568–578.
14.
Neumann-Häfelin T, Wittsack HJ, Wenserski F, Siebler M, Seitz RJ, Modder U, Freund HJ: Diffusion- and perfusion-weighted MRI. The DWI/PWI mismatch in acute stroke. Stroke 1999;30:1591–1597.
15.
Hanston L, De Weerdt W, De Keyser J, Diener HC, Franke C, Palm R, Van Orshoven M, Schoonderwalt H, De Klippel N, Herroelen L, Feys H: The European Stroke Scale. Stroke 1994;25:2215–2219.
16.
Brott T, Adams HP, Olinger CP: Measurements of acute cerebral infarction: A clinical examination scale. Stroke 1989;20:864–879.
17.
Mahoney FI, Barthel DW: Functional evaluation: The Barthel index. Md State Med J 1965;14:61–65.
18.
Rödén-Jüllig A, Gustafsson C, Fugl-Meyer A: Validation of four scales for the acute stage of stroke. J Intern Med 1994;236:125–136.
19.
Kunesch E, Binkofski F, Steinmetz H, Freund H-J: The pattern of motor deficits in relation to the site of stroke lesions. Eur Neurol 1995;35:20–26.
20.
Taub E, Miller NE, Novack TA, Cook EW III, Fleming WC, Nepomuceno CS, Conneil JS, Crago JE: Technique to improve chronic motor deficit after stroke. Arch Phys Med Rehabil 1993;74:347–354.
21.
Wolf SL, Lecraw DE, Barton LA, Jann BB: Forced use of hemiplegic upper extremities to reverse the effects of learned nonuse among chronic stroke and head-injured patients. Exp Neurol 1989;104:125–132.
22.
Heinemann AW, Roth EJ, Cichowski K, Betts HB: Multivariate analysis of improvement and outcome following stroke rehabilitation after ischemic stroke. Stroke 1987;24:1784–1788.
23.
Macdonnel RAL, Donnan GA, Bladin PF: A comparison of somatosensory evoked and motor evoked potentials in stroke. Ann Neurol 1989;25:68–73.
24.
Heald A, Bates D, Cartlidge NEF, French JM, Miller S: Longitudinal study of motor conduction time following stroke. 2. Central motor conduction measured within 72 h after stroke as a predictor of functional outcome at 12 months. Brain 1993;116:1371–1385.
25.
Stephan KM, Netz J, Hömberg V: Prognostic value of MEP and SSEP in patients with chronic UMN lesions after stroke. Cerebrovasc Dis 1995;5:407–412.
26.
Warabi T, Inoue K, Noda H, Murakami S: Recovery of voluntary movement in hemiplegic patients. Brain 1990;113:177–189.
27.
Fukui K, Iguchi I, Kito A, Watanabe Y, Sugita K: Extent of pontine pyramidal tract Wallerian degeneration and outcome after supratentorial hemorrhagic stroke. Stroke 1994;25:1207–1210.
28.
Chollet F, Di Piero V, Wise RJS, Brooks DJ, Dolan RJ, Frackowiak RSJ: The functional anatomy of motor recovery after stroke in humans: A study with positron emission tomography. Ann Neurol 1991;29:63–71.
29.
Weiller C, Chollet F, Friston KJ, Wise RJS, Frackowiak RSJ: Functional reorganisation of the brain in recovery from striatocapsular infarction in man. Ann Neurol 1992;31:463–472.
30.
Weder B, Knorr U, Herzog H, Nebeling B, Kleinschmidt A, Huang Y, Steinmetz H, Freund H-J, Seitz RJ: Tactile exploration of shape after subcortical ischemic infarction studied with positron emission tomography. Brain 1994;117:593–605.
31.
Cramer SC, Nelles G, Benson RR, Kaplan JD, Parker RA, Kwong KK, Kennedy DN, Finklestein SP, Rosen BR: A functional MRI study of subjects recovered from hemiparetic stroke. Stroke 1997;28:2518–2527.
32.
Cao Y, D’Olhaberriague L, Vikingstad EM, Levine SR, Welch KMA: Pilot study of functional MRI to assess cerebral activation of motor function after poststroke hemiparesis. Stroke 1998;29:112–122.
33.
Seitz RJ, Höflich P, Binkofski F, Tellmann L, Herzog H, Freund H-J: Role of premotor cortex in recovery from middle cerebral artery infarction. Arch Neurol 1998;55:1081–1088.
34.
Pause M, Kunesch E, Binkofski F, Freund H-J: Sensorimotor disturbances in patients with lesions of the parietal cortex. Brain 1989;112:1599–1625.
35.
Seitz RJ, Roland PE, Bohm C, Greitz T, Stone-Elander S: Somatosensory discrimination of shape: Tactile exploration and cerebral localization. Eur J Neurosci 1991;3:481–492.
36.
Binkofski F, Dohle C, Posse S, Stephan KM, Hefter H, Seitz RJ, Freund H-J: Human anterior intraparietal area subserves prehension. A combined lesion and functional MRI activation study. Neurology 1998;50:1253–1259.
37.
Stephan KM, Binkofski F, Halsband U, Dohle C, Wunderlich G, Schnitzler A, Tass P, Posse S, Herzog H, Sturm V, Zilles K, Seitz RJ, Zilles K: The role of ventral medial wall motor areas for bimanual coordination: A combined lesion and activation study. Brain 1999;122:351–368.
38.
Warach S, Dashe JF, Edelman RR: Clinical outcome in ischemic stroke predicted by early diffusion-weighted and perfusion magnetic resonance imaging: A preliminary analysis. J Cerebr Blood Flow Metab 1996;16:53–59.
39.
Lövblad KO, Baird AE, Schlaug G, Benfield A, Siewert B, Voetsch B, Connor A, Burzynski C, Edelman RR, Warach S: Ischemic lesion volumes in acute stroke by diffusion-weighted magnetic resonance imaging correlate with clinical outcome. Ann Neurol 1997;42:164–170.
40.
Barber PA, Darby DG, Desmond PM, Yang Q, Gerraty RP, Jolley D, Donnan GA, Tress BM, Davis SM: Prediction of stroke outcome with echoplanar perfusion- and diffusion-weighted MRI. Neurology 1998;51:418–426.
41.
Tong DC, Yenari MA, Albers GW, O’Brien M, Marks MP, Moseley ME: Correlation of perfusion- and diffusion-weighted MRI with NIHSS score in acute (<6.5 hour) ischemic stroke. Neurology 1998;50:864–870.
42.
Azari N, Binkofski F, Pettigrew KD, Freund H-J, Seitz RJ: Enhanced regional metabolic (rCMRglu) interactions in thalamic circuitry predicts motor recovery in hemiparetic stroke. Hum Brain Mapping 1996;4:240–253.
43.
Seitz RJ, Knorr U, Azari NP, Herzog H, Freund H-J: Recruitment of a visuomotor network in stroke recovery. Restor Neurol Neurosci 1999;14:25–33.
44.
Rothwell JC, Traub MM, Day BL, Obeso JA, Thomas PK, Marsden CD: Manual motor performance in a deafferent man. Brain 1982;105:515–542.
45.
Rothi LJG, Heilman KM: Acquisition and retention of gestures by apraxic patients. Brain Cogn 1984;4:426–437.
46.
Poeck K: Klinische Neuropsychologie. Stuttgart, Thieme, 1989.
47.
Laplane D, Degos JD: Motor neglect. J Neurol Neurosurg Psychiatry 1983;46:152–158.
48.
Castaigne P, Laplane D, Degos JD: Trois cas de négligence motrice par lésion rétrorolandique. Rev Neurol (Paris) 1970;122:233–242.
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2001
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