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Brain, Vol. 118, No. 5, 1329-1338, 1995
© 1995 Guarantors of Brain

research-article

Prolonged muscular flaccidity after stroke Morphological and functional brain alterations

Patrizia Pantano1, Rita Formisano2, Monica Ricci1, Vittorio Di Piero1, Umberto Sabatini1, Piero Barbanti1, Marco Fiorelli1, Luigi Bozzao1 and Gian Luigi Lenzi1

1Department of Neurological Sciences, University of Rome ‘La Sapienza’ IRCCS Rome, Italy 2Centro Residenziale Clinica S.Lucia IRCCS Rome, Italy

Correspondence to: Patrizia Pantano, Department of Neurological Sciences, University of Rome ‘La Sapienza’, Viale dell'Università 30, 00185 Rome, Italy

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-pons-cerebellum-thalamus-cortex, are more widely and more severely affected in patients with prolonged muscular flaccidity.

prolonged muscular flaccidity; motor deficit; stroke; single photon emission tomography; cerebral blood flow

Received December 29, 1994. Revised March 8, 1995. Accepted May 5, 1995.


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