This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Wolf-Dieter Heiss, MD; Josef Kessler, PhD; Hans Karbe, MD; Gereon R. Fink, MD; Gunter Pawlik, MD

Arch Neurol. 1993;50(9):958-964.

Abstract
• Objective.
—The recovery of language function seen in poststroke aphasia is significantly related to the severity of the initial neurologic deficit. However, a great deal of variability still remains in the improvement that is actually achieved. To detect predictors that will help in explaining this variability, positron emission tomography (PET) and fludeoxyglucose F 18 (18-F-fluorodeoxyglucose) were used and the results were analyzed by stepwise regression.

Design.
—Using PET imaging after injection of fludeoxyglucose F 18, the regional changes in glucose metabolism in 26 patients at a period of 12 to 18 days following an ischemic stroke involving the left middle cerebral artery were examined. A second PET examination was performed on 17 of our 26 patients who were able to perform speech activation exercises. All patients received an initial and a 4-month follow-up evaluation of languange performance.

Setting.
—During the two PET studies and the first language assessment, the patients were hospitalized in a neurologic clinic. The follow-up evaluation of language performance was performed when the patients were ambulatory.

Patients.
—Twenty-six patients (10 women, 16 men; aged 38 to 77 years; mean±SD, 60±9.2 years) were selected in the study. Their aphasias were of various types and of varying severity ranging from mild impairment to severe global aphasia.

Main Outcome Measures.
—For the stepwise regression analysis of variables, the following variables were analyzed in resting and activation PET to explain residual variance from the first to the second Token Test: regional cerebral metabolic rate for glucose of infarct and mirror region, left and right cerebral and cerebellar hemispheres, left and right Broca's area, left and right Wernicke's area, and left and right temporoparietal cortex.

Results.
—As was expected, early and late Token Tests exhibit a high correlation (.85). The stepwise regression analysis shows that only the left cerebral hemisphere glucose value of the resting PET had significant effect on the residual variance of the Token Test regression. Regional metabolic rates during speech activation had the largest contribution to a significant recovery from aphasia. The infarct area and its corresponding mirror region, the left Broca's area, and the entire left cerebral hemisphere accounted for 80% of the residual variance.

Conclusions.
—These results emphasize not only the application of PET activation studies in the prediction of a tissue's potential reserve capacity but also the importance of left hemisphere integrity in the recovery of functional language.

Author Affiliations
From the Max-Planck-Institut für Neurologische Forschung and Neurologische Universitätsklinik Köln (Germany).

Footnotes
Accepted for publication December 8, 1992.

Reprint requests to Max-Planck-Institut für Neurologische Forschung, Gleueler Str 50, 5000 Köln 41, Germany (Dr Heiss).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Contrasting acute and slow-growing lesions: a new door to brain plasticity
Desmurget et al.
Brain 2007;130:898-914.
ABSTRACT | FULL TEXT  

The Right Inferior Frontal Gyrus and Poststroke Aphasia: A Follow-Up Investigation
Winhuisen et al.
Stroke 2007;38:1286-1292.
ABSTRACT | FULL TEXT  

Brain Recovery and Rehabilitation
Heiss and Teasel
Stroke 2006;37:314-316.
FULL TEXT  

Right anterior superior temporal activation predicts auditory sentence comprehension following aphasic stroke
Crinion and Price
Brain 2005;128:2858-2871.
ABSTRACT | FULL TEXT  

Role of the Contralateral Inferior Frontal Gyrus in Recovery of Language Function in Poststroke Aphasia: A Combined Repetitive Transcranial Magnetic Stimulation and Positron Emission Tomography Study
Winhuisen et al.
Stroke 2005;36:1759-1763.
ABSTRACT | FULL TEXT  

Neural correlates of recovery from aphasia after damage to left inferior frontal cortex
Rosen et al.
Neurology 2000;55:1883-1894.
ABSTRACT | FULL TEXT  

Piracetam Improves Activated Blood Flow and Facilitates Rehabilitation of Poststroke Aphasic Patients
Kessler et al.
Stroke 2000;31:2112-2116.
ABSTRACT | FULL TEXT  

Cortical Language Activation in Stroke Patients Recovering From Aphasia With Functional MRI
Cao et al.
Stroke 1999;30:2331-2340.
ABSTRACT | FULL TEXT  

Training-induced brain plasticity in aphasia
Musso et al.
Brain 1999;122:1781-1790.
ABSTRACT | FULL TEXT  

Recovery of Neglect After Right Hemispheric Damage: H215O Positron Emission Tomographic Activation Study
Pizzamiglio et al.
Arch Neurol 1998;55:561-568.
ABSTRACT | FULL TEXT  

Worsening of Partially Recovered Aphasia After a Right Occipital Stroke
Nelles et al.
Neurorehabil Neural Repair 1998;12:105-110.
ABSTRACT  

A 36-Year-Old Woman Recuperating From a Stroke
Alexander
JAMA 1997;277:1970-1976.
ABSTRACT  

Recovery of Cognitive Function After Stroke
Desmond et al.
Stroke 1996;27:1798-1803.
ABSTRACT | FULL TEXT  

Role of the Nondominant Hemisphere and Undamaged Area During Word Repetition in Poststroke Aphasics : A PET Activation Study
Ohyama et al.
Stroke 1996;27:897-903.
ABSTRACT | FULL TEXT  

Long-term Prognosis of Poststroke Aphasia Studied With Positron Emission Tomography
Karbe et al.
Arch Neurol 1995;52:186-190.
ABSTRACT