MOTOR RECOVERY AFTER STROKE - MORPHOLOGICAL AND FUNCTIONAL BRAIN ALTERATIONS

The aim of this study was to evaluate the relationships of morphologic al and CBF patterns with both the severity and the evolution of the mo tor deficit in the late phase of stroke and, in particular to identify morphological and/or functional brain alterations associated with a p ersistent severe motor deficit or a pool, delayed motor recovery. We a nalysed CT/MRI and single photon emission tomography (SPET) findings f rom 37 patients studied in the chronic phase of stroke (mean duration/-SD=3.6+/-1.6 months), whom we were able to follow clinically for a p eriod of 3 months. The eventual degree of motor recovery correlated si gnificantly (negatively) with the rime since stroke at entry, but nor with the severity of neurological impairment at entry. The volume side and location (cortical or subcortical) of the infarct did not correla te with either the severity or the evolution of the motor deficit Pati ents with a CT/MRI lesion of the parietal lobe (n = 8) showed a more s evere motor deficit than those with other cortical locations. The seve rity of the motor deficit correlated significantly (negatively) with C BF values in the supplementary motor area (SMA) and parietal areas of the damaged hemisphere, and in the contralateral undamaged primary mot or cortex. The degree of motor improvement correlated significantly (p ositively) with CBF values in the contralateral undamaged thalamus, le ntiform and caudate nuclei, and premotor cortex. In the late phase of stroke, the severity of the motor deficit may be positively associated with the functional impairment of associative parietal and frontal ar eas of the damaged hemisphere. The functional impairment of the basal ganglia-frontal network in the undamaged hemisphere seems to be relate d to a pool; delayed motor recovery.