Natural history of the spontaneous reperfusion of human cerebral infarcts as assessed by 99mTc HMPAO SPECT
- aDepartment of Clinical Neuroscience, Charing Cross and Westminster Medical School, London, UK, bDepartment of Nuclear Medicine, Charing Cross Hospital, London, UK
- Dr JV Bowler, Department of Clinical Neuroscience, Charing Cross and Westminster Medical School, St Dunstan’s Road, London W6 8RP, UK. Telephone 0044 181 846 7508; fax 0044 181 846 7715; email j.bowler{at}cxwms.ac.uk
- Received 10 April 1997
- Revised 24 June 1997
- Accepted 9 July 1997
Abstract
OBJECTIVE Little is known about the effect of spontaneous reperfusion of human cerebral infarcts. Single photon emission computerised tomography (SPECT) data were analysed from a study using 99Tcm HMPAO (99Tcm hexamethylpropyleneamine oxime) in human cerebral infarction for the frequency of reperfusion and to see if it affected infarct size, oedema, haemorrhagic transformation, or functional outcome.
METHODS Fifty sequential cases of ischaemic stroke were studied with 124 99Tcm HMPAO SPECT at around one day, one week, and three months after stroke along with detailed clinical and functional assessments.
RESULTS Visually apparent reperfusion occurred in 14 of 50 patients (28%) with a mean delay of 5.8 days and reperfusion was seen in seven others in whom it was identified on the basis of changes in perfusion deficit volume. It occurred in 13 of 23 embolic events but only in three of 23 other events. In only two cases did spontaneous reperfusion occur early enough to preserve tissue or function. Reperfusion did not otherwise reduce infarct size, or improve clinical or functional outcome, and was not associated with oedema but an association with haemorrhagic transformation was suggested. Reperfusion significantly decreased the apparent perfusion defect as measured by SPECT one week from the ictus, but was mostly non-nutritional and transient. The mean volume of tissue preserved by nutritional reperfusion was 10 cm3, but this was unequally distributed between cases. Late washout of99Tcm HMPAO from areas of hyperaemic reperfusion may be a good prognostic marker but is a rare phenomenon and too insensitive to be of general applicability.
CONCLUSIONS Spontaneous reperfusion after cerebral infarction occurs in 42% of cases within the first week but is associated with clinical improvement in only 2%. It has few adverse consequences although it may be associated with haemorrhagic transformation.
