Long-term Functional Outcome After Stroke: The Impact Of MRI-detected Lesion Characteristics

Main Category: Stroke
Also Included In: Neurology / Neuroscience
Article Date: 26 Mar 2007 - 8:00 PDT

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For the rehabilitation physician as well as for the neurologist, a valid early prognosis of functional outcome for the individual stroke patient is required to inform patient and relatives adequately, to facilitate discharge planning, and to initiate an optimal (task-specific and goalorientated) rehabilitation program with realistic therapeutic goals. The objective of this thesis was to gain a better understanding of the relationship between ischemic lesion characteristics (volume and localization) and long-term functional outcome of the middle cerebral artery stroke survivor.

Lesion characteristics were assessed on conventional MRI scans. Outcome was assessed at the levels of body functions, activities and participation (International Classification of Functioning, ICF) and quality of life. We evaluated if lesion-characteristics have added value in prediction of outcome alongside (clinical) patient variables.

To define the impact of lesion localization, its association with long-term motor recovery of the hand and its relationship with long-term deficits in episodic memory were investigated.

Stroke volume is a reflection of damaged brain tissue. A larger infarction leads to more deterioration of body functions, more activity limitations and a lesser capacity to participate, as well as an impaired quality of life, although this relationship is only moderately strong. Besides to its volume, the location of the lesion is important, especially for the outcome of the upper paretic limb as for long-term episodic memory disorders. The strength of the correlation between lesion characteristics and functional outcome weakens after a longer follow-up period post stroke.

Patient characteristics and good clinical assessment of functioning in the early phase post stroke are sufficient to predict long-term functional outcome. Neuro-imaging information does not have added predictive value compared to this clinical information. Nevertheless, imaging information is vital if the clinician is to gain a better understanding of the patient's functional deficits and insights into the recovery of body functions and activities after stroke.

PhD Thesis
Sven Schiemanck
Long-term functional outcome after stroke: the impact of MRI-detected lesion characteristics
Supervisors
A.J.H. Prevo, M.W.M. Post en G. Kwakkel
Sven Schiemanck started his PhD in October 1998 after he finished his medical training. He is currently employed as rehabilitation physician at the Academic Medical Center Amsterdam. He did his PhD training in collaboration with the department of Rehabilitation and Sports medicine. He completed his thesis in the section of Cerebrovascular Disorders.

The Rudolf Magnus Institute is dedicated to Neuroscience

The institute was named after the first professor of Pharmacology in the Netherlands, Rudolf Magnus.

In 1968, on the initiative of David De Wied, the Department of Pharmacology was renamed "Rudolf Magnus Institute of Pharmacology", to commemorate the 60th anniversary of the first chair for Pharmacology in The Netherlands.

Under the directorship of De Wied's successor, Willem Hendrik Gispen, who was director in 1988-2000, the Rudolf Magnus Institute was transformed into a Neuroscience institute, aptly named Rudolf Magnus Institute of Neuroscience, which encompassed many research groups from three Faculties of Utrecht University.

The present director Jan M. van Ree (director since 2001), has taken on himself the task to redefine the aims of the research within the institute. To this end, functional Sections were formed, each around a defined research topic, to maximise the use of resources and research output. The new elan of the Institute is among others expressed in the modernised logo.

http://www.rudolfmagnus.nl

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