Cerebral blood flow in anterior choroidal artery infarcts. Anatomical and functional correlates.

We have investigated the cortical and subcortical regional cerebral blood f low (rCBF) disorders resulting from infarcts of the anterior choroidal arte ry (AChA), and correlations with the severity of lesions, the physical and cognitive deficits and the functional impairment. Eighteen patients present ing with recent anterior choroidal artery infarct without any other brain i njury were examined at the secondary phase post-stroke using the single pho ton emission computed tomography technique and 133 Xenon inhalation. The rC BF and asymmetry indexes (Al) were calculated for 12 symmetrical hemispheri c areas, and the cerebellum. The Al values were compared with those of 24 c ontrol subjects. The severity of the lesions was evaluated from CT scans or MRI. The neurological status (Orgogozo scale, walking disorders, MMSE atte ntion impairment, aphasia) and disability (functional independance measure: FIM) were assessed for each patient at the same time period. The relations hips between rCBF disorders and brain lesions, and between the results of c linical investigations and rCBF disorders and brain lesions were assessed b y linear regression analyses (stepwise variable selections, p=0.05). The Al values were significantly increased in the cerebral hemispheres, and this was most severe in the internal capsule (direct effect of the lesion) and t he dorsolateral hemispheric cortex (diaschisis). Individual evaluations sho wed that Al were significantly increased in 13 patients in at least one ROI of the cerebral hemispheres, and in 3 patients in the internal capsule. St epwise variable selections revealed that Al were best explained by the seve rity of the lesions in the internal capsule and the internal temporal area. The Al of the external temporal area and the internal capsule also-helped explain the clinical (physical and cognitive) deficits. Thus, AChA infarcts may have relatively large effects on the central part of the lateral and d orsal cortex of the ipsilateral hemisphere. Subcortical and cortical conseq uences both contribute to explain the motor and cognitive deficits and disa bility.