Improved functional outcome in patients with hemorrhagic stroke in putamenand thalamus compared with those with stroke restricted to the putamen or thalamus

Background and Purpose-We analyzed the effect of late intensive inpatient r ehabilitation on the functional outcome of patients with subcortical hemorr hagic stroke. Methods-Patients who were nonambulatory with hemorrhagic stroke in the inte rnal capsule and putamen (n=55), the thalamus (n=24), or all 3 regions (n=1 5) underwent intensive inpatient rehabilitation. Patients with surgical int ervention or an episode of ventricular hemorrhage were excluded. Lesion loc ation was evaluated by MRI 4 months after the ictus. Results-Demographic data, initial disability, and impairment measures were comparable in the 3 groups. Functional outcome demonstrated significant dif ferences in mobility subscores (P<0.05) of the Functional Independence Meas ure such that patients with injury in the 3 regions were more likely to amb ulate independently than were patients in the other groups. Lesion location data demonstrated that the ventral anterior nucleus of the thalamus was al ways spared; the ventral posterior (lateral and medial) nucleus was always damaged, and the ventral lateral nucleus was frequently damaged. Putaminal damage always included the postcommissural area. In addition, the entire po sterior half limb of the internal capsule was always damaged. Conclusions-Subcortical lesions to multiple structures in the basal ganglia -thalamocortical motor circuits permitted enhanced motor recovery. Lesion l ocation predicted the level of independent ambulation and the rate of recov ery in patients with stroke who were nonambulatory before neurorehabilitati on therapy.