Abstract
The pharmacological approach to first-stage recovery in acute stroke is aimed at controlling edema and improving microcirculation and cellular protection in the ischemic penumbra. Limiting lesion size with these early measures may influence outcome significantly. Careful methodology is necessary to measure recovery rates and outcome. The extent of recovery is influenced by initial severity. Lesion size in a stroke population correlates significantly with outcome measures. Recovery in the initial period, the first 3 months, is significantly greater in all groups and in all functional deficits. Evidence appears to indicate that both homologous contralateral and ipsilateral functionally connected hemispheric structures play a role in recovery. Comprehension and semantic processing may have more widespread cerebral compensation than motor and assembly functions of language, which are more left hemisphere dependent. Pharmacological studies in recovery must consider these factors and utilize more precise methodology to define functional deficits.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Astrup, J., Siesjo, B. K., and Symon, L., 1981, Thresholds in cerebral ischemia—the ischemic penumbra, Stroke 12: 723–725.
Awad, I., Little, J. R., Lucas, F., Skrinska, V., Slugg, R., and Lesser, R. P., 1983, Treatment of acute focal cerebral ischemia with prostacyclin, Stroke 14: 203–209.
Bassi, S., Albizzati, M. G., Sbacchi, M., Frattola, L., and Massarotti, M., 1985, Monosialo-ganglioside therapy in stroke, Stroke 16: 899–900.
Bousser, M. G., Eschwege, E., Haguenau, M., Lefaucconnier, J. M., Thibult, N., and Touboul, D., 1983, “AICLA” controlled trial of aspirin and dipyridamole in the secondary prevention of athero-thrombotic cerebral ischemia, Stroke 14:5–14.
Britton, M., de Faire, U., Helmers, C., Miah, K., and Rane, A., 1980, Lack of effect of theophylline on the outcome of acute cerebral infarction, Acta Neurol. Scand. 62: 116–123.
Broida, H., 1977, Language therapy effects in long term aphasia, Arch. Phys. Med. Rehabil. 58: 248–253.
Christensen, M. S., Paulson, O. B., Olesen, J., Alexander, S. C., Skinhoj, E., Dom, W. H., and Lassen, N. A., 1973, Cerebral apoplexy (stroke) treated with or without prolonged artificial hyperventilation. 1. Cerebral circulation, clinical course, and cause of death, Stroke 4: 568–631.
Czopf, J., 1972, Role of the non-dominant hemisphere in the restitution of speech in aphasia, Arch. Psychiatr. Nervenkr. 216: 162–171.
Del Zoppo, G. J., Zeumer, H.. and Harker, L. A., 1986, Thrombolytic therapy in stroke: Possibilities and hazards, Stroke 17: 595–607.
Dennis, M., and Kohn, B., 1975, Comprehension of syntax in infantile hemiplegics after cerebral hemidecortication: Left hemisphere superiority, Brain Lang. 2: 472–482.
Dyken, M., and White, P. T., 1956, Evaluation of cortisone in the treatment of cerebral infarction, J.A.M.A. 132: 1531–1956.
Fieschi, C., Lenzi, G. L., and Rasura, M., 1986, Role of calcium entry blockers in neurological diseases, Eur. Neurol. 25(Suppl. 1 ): 68—71.
Flamm, E. S., Demopoilos, H. B., Seligman, M. L., et al., 1977, Possible molecular mecha-nisms of barbiturate-mediated protection in regional cerebral ischemia, Acta Neurol. Scand. 56 (64): 150–151.
Fletcher, A. P., Alkjaersig, M., Lewis, M., Tulevski, V., Davies, A., Brooks, J. E., Mardin, W. B., Landau, W. M., and Raichle, M. E., 1976, A pilot study of urokinase therapy in cerebral infarction, Stroke 7: 135–142.
Gelners, H. J., 1984, The effects of nimopidine on the clinical course of patients with acute ischemic stroke, Acta Neurol. Scand. 69: 232–239.
Godfrey, C. M., and Douglass, E., 1959, The recovery process in aphasia, Can. Med. Assoc. J. 80: 618–624.
Goodglass, H., and Kaplan, E., 1983, Boston Naming Test, Lea & Febiger, Philadelphia.
Gryglewski, R. J., Nowak, S., Kostka-Trabka, E., Kusmiderski, J., Dembinska-Kiec, A., Bieron, K., Basista, M., and Blaszczyk, B., 1983, Treatment of ischemic stroke with pros-tacyclin, Stroke 14: 197–202.
Hachinski, V., and Norris, J. W., 1985, The Acute Stroke, F. A. Davis, Philadelphia.
Hass, W. K., 1979, Drug effects in regional cerebral blood flow in focal cerebrovascular disease, J. Neurol. Sci. 19: 461.
Henschen, S. E., 1920-1922, Klinische und anatomische Beitrage zur Pathologic des Gehirns, Volumes 5-7, Nordiska Bokhandel, Stockholm.
Hossman, V., Heiss, W., Bewermeyer, H., and Wiedemann, G., 1983, Controlled trial of ancrod in ischemic stroke, Stroke 40: 803–808.
Huczynski, J., Kostka-Trabka, E., Sotowska, K., Bieron, L., Grodzinska, L., Dembinska- Kiec, A., Pykosz-Mazur, E., Peczak, E., and Gryglewski, R. J., 1985, Double-blind controlled trial of the therapeutic effects of prostacyclin in patients with completed ischemic stroke, Stroke 16: 810–813.
Jabally, J., and Davis, J. N., 1984, Naloxone administration to patients with acute stroke, Stroke 15: 36–39.
Kertesz, A., 1979, Aphasia and Associated Disorders, Grune & Stratton, New York.
Kertesz, A., 1982, The Western Aphasia Battery, Grune & Stratton, New York.
Kertesz, A., Black, S. E., Polk, M., and Howell, J., 1986, Cerebral asymmetries on magnetic resonance imaging, Crotex 22: 117–127.
Kertesz, A., Harlock, W., and Coates, R., 1979, Computer tomographic localization, lesion size and prognosis in aphasia, Brain Lang. 8: 34–50.
Kertesz, A., and McCabe, P., 1977, Recovery patterns and prognosis in aphasia, Brain 100:1- 18.
Kinsbourne, M., 1971, The minor cerebral hemisphere as a source of aphasic speech, Arch. Neurol. 25: 302–306.
Knopman, D. S., Rubens, A. B., Seines, O. A., Klassen, A. C., and Meyer, M. W., 1984, Mechanisms of recovery from aphasia: Evidence from serial xenon 133 cerebral blood flow studies, Ann. Neurol. 15 (6): 530–535.
Knopman, D. S., Seines, O. A., Niccum, N., and Rubens, A. B., 1983, A longitudinal study of speech fluency in aphasia: CT scan correlates of recovery and persistent nonfluency, Neurology (N.Y.) 33: 1170–1178.
Lassen, N. A., and Palvolgyi, R., 1968, Cerebral steal during hypercapnia and the inverse reaction during hypocapnia observed by the 133-xenon technique in man, Scand. J. Clin. Lab. Invest. 22: 13D.
Lemay, M., and Kido, D. K., 1978, Asymmetries of the cerebral hemispheres on computed tomograms, J. Comput. Assist. Tomogr. 2: 471–476.
Levine, D. M., and Mohr, J. P., 1979, Language after bilateral cerebral infarctions: Role of the minor hemisphere, Neurology (Minneap.) 29: 927–938.
Lomas, J., and Kertesz, A., 1978, Patterns of spontaneous recovery in aphasic groups: A study of adult stroke patients, Brain Lang. 5: 388–401.
Ludlow, C., Rosenberg, J., Fair, C., Buck, D., Schesselman, S., and Salazar, A., 1986, Brain lesions associated with nonfluent aphasia fifteen years following penetrating head injury, Brain 109: 55–80.
Matthews, W. B., Oxbury, J. M., Grainger, M. R., and Greenhall, R. C. D., 1976, A blind controlled trial of Dextran 40 in the treatment of ischemic stroke, Brain 99: 193–206.
Meyer, J. S., et al., 1965, Therapeutic thrombolysis in cerebral thrombus-embolism. Ran domized evaluation of intravenous streptokinase, in: Cerebral Vascular Diseases ( C. H. Milli- kan, R. G. Siekert, and J. Whisnant, eds.), Grune & Stratton, New York, pp. 200–213.
Meyer, J. S., Fukuuchi, Y., Shimazu, K., Ohuchi, T., and Ericsson, A. D., 1972, Abnormal hemispheric blood flow and metabolism in cerebrovascular disease, ii. Therapeutic trials with 5% C02 inhalation, hyperventilation and intravenous infusion of THAM and mannitol, Stroke 3: 157–167.
Meyer, J. S., Gotoh, F., Gilroy, J., 1965, Improvement in brain oxygenation and clinical improvement in patients with stroke treated with papaverine hydrochloride. JAMA 194:957- 961.
Meyer, J. S., and Mathew, N. T., 1974, Medical management in cerebral ischemia, in: Contro-versy in Internal Medicine, Volume 2 ( F. Ingelfmger, ed.), W. B. Saunders, Philadelphia, p. 111.
Monakow, C. von, 1914, Die Lokalisation im Grosshirn und der Abbau der Funktionen durch corticale Herde, Bergmann, Wiesbaden.
Norris, J. W,, and Hachinski, V. C., 1985, Megadose steroid therapy in ischemic stroke, Stroke 16: 150.
Peerless, S. J., Ishikawa, R., Hunter, I. G., and Peerless, M. J., 1981, Protective effect of Fluosol-DA in acute cerebral ischemia, Stroke 12: 558–563.
Peerless, S. J., Nakamura, R., Rodriguez-Salazar, A., and Hunter, I. G., 1985, Modification of cerebral ischemia with Fluosol, Stroke 16: 38–43.
Pieniadz, J. M., Naeser, M. A., Koff, E., and Levine, H. L., 1983, CT scan cerebral hemi-spheric asymmetry measurements in stroke cases with global aphasia: Atypical asymmetries associated with improved recovery, Cortex 19: 371–393.
Plum, F., 1983, What causes infarction in ischemic brain? Neurology (N.Y.) 33:222- 233.
Sabel, B. A., Slavin, M. D., and Stein, D. G., 1984, GMI ganglioside treatment facilitates behavioral recovery from bilateral brain damage, Science 225: 340–342.
Seines, O. A., Knopman, D. S., Niccum, N., and Rubens, A. B., (1983), CT scan correlates of auditory comprehension deficits in aphasia: A prospective recovery study, Ann. Neurol. 13:558- 566.
Smith, A., 1966, Speech and other functions after left (dominant) hemispherectomy, J. Neurol. Neurosurg. Psychiatry 29: 467–471.
Smith, A. L., Hoff, J. T., and Nielsen, S. L., 1974, Barbiturate protection in acute focal cerebral ischemia, Stroke 5: 1–7.
Stein, H. D., Rosen, J. J., and Butters, N., 1974, Plasticity and Recovery of Function in the Central Nervous System, Academic Press, New York.
Stoessl, A. J., Young, G. B., and Feasby, T. E., 1985, Intracerebral hemorrhage and an-giographic beading following ingestion of catecholaminergics, Stroke 16: 734–736.
Strand, T., Asplund, K., Eriksson, S., Hagg, E., Lithner, F., and Wester, P., 1984, A ran-domized controlled trial of hemodilution therapy in acute ischemic stroke, Stroke 15: 980–989.
TIMI Study Group, 1985, Special report: The thrombolysis in myocardial infarction (TIMI) trial, N. Engl. J. Med. 312: 932–936.
Wauquier, A., 1984, Effect of calcium entry blockers in models of brain hypoxia, in: Calcium Entry Blockers in Cardiovascular and Cerebral Dysfunctions ( Godfraind, Herman, and Well- ens, eds.), Martinus Nijhoff, The Hague, pp. 241–254.
Woods, B. T., and Teuber, H. L., 1978, Changing patterns of childhood aphasia, Ann. Neurol. 3: 273–280.
Zaidel, E., 1976, Auditory vocabulary in the right hemisphere following brain bisection or hemidecortication, Cortex 12: 191–211.
Zivin, J. A., and Venditto, J. A., 1984, Experimental CNS ischemia: Serotonin antagonists reduce or prevent damage, Neurology (N.Y.) 34: 469–474.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1988 Plenum Press
About this chapter
Cite this chapter
Kertesz, A. (1988). Recovery from Stroke. In: Stein, D.G., Sabel, B.A. (eds) Pharmacological Approaches to the Treatment of Brain and Spinal Cord Injury. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-0927-7_17
Download citation
DOI: https://doi.org/10.1007/978-1-4613-0927-7_17
Publisher Name: Springer, Boston, MA
Print ISBN: 978-1-4612-8249-5
Online ISBN: 978-1-4613-0927-7
eBook Packages: Springer Book Archive