DOI: https://doi.org/10.22141/2224-0713.5.99.2018.142959

Cerebrospinal and commissural diaschisis in acute stroke patients: case study

S.M. Vinychuk, O.Ye. Fartushna

Abstract


Background. Stroke remains the second leading cause of disability and death with the highest reported age­standardized death rates in Eastern Europe compared to Western Europe and the US. Recovery from stroke has been shown to involve reorganization in motor and premotor cortical areas. The resolution of diaschisis has been suggested as a mechanism of early spontaneous recovery. However, there are not enough published prospective studies on the clinical analysis and comparison of different types of cerebral diaschisis, especially in acute stroke patients. We aimed to carry out follow­up analysis of clinical characteristics of cerebrospinal and commissural cerebral diaschisis in acute ischemic stroke patients, to present clinical cases. Materials and methods. We have conducted a prospective, hospital­based, cohort study of acute stroke patients (n = 124) who were admitted to the department of cerebrovascular diseases of the University Hospital (Oleksandrivska Clinical Hospital, Kyiv, Ukraine) within the first 24 hours after the stroke. All cases were reviewed by at least two board­certified neurologists trained in cerebrovascular diseases. All participants underwent comprehensive clinical, neurological, laboratory, ultrasound, and neuroimaging examination. Results. Among 124 patients, 26 were diagnosed with cerebral diaschisis (cerebrospinal (n = 22) and commissural (n = 4)). We have provided detailed clinical analysis of cerebral diaschisis in acute stroke patients. We have described specific neurological changes in variants of territorial cerebral infarctions and mirror brain infarctions caused by diaschisis. Conclusions. Semiotics of acute cerebral stroke is determined, not only by the primary brain infarction, but also by the diaschisis that causes more severe neurological deficit. Cerebral diaschisis is associated with the mirror brain infarction development, depression of tendon and periosteal reflexes, limb muscle atony. During therapy, a sluggish stage of hemiplegia in most cases was followed by the spastic hemiplegia within 9 to 14 days after stroke development.


Keywords


diaschisis; cerebral diaschisis; cerebrospinal diaschisis; commissural diaschisis; clinical features; stroke; acute ischemic stroke; case; case report

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References


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