The effect of nimodipine on the evolution of human cerebral infarction studied by PET

A. M. Hakim, A. C. Evans, L. Berger, H. Kuwabara, K. Worsley, G. Marchal, C. Biel, R. Pokrupa, M. Diksic, E. Meyer, A. Gjedde, S. Marrett

Research output: Contribution to journalReview articlepeer-review

Abstract

Fourteen patients were studied by positron emission tomography (PET)O within 48 h of onset of a hemispheric ischemic stroke and again 7 days later. After the first set of PET scans, the patients were randomized to receive either nimodipine (n = 7) or a carrier solution (n = 7) by intravenous infusion. The infusions were maintained until the end of the second PET studies. CBF, cerebral blood volume (CBV), oxygen extraction ratio (OER), CMRO2, and CMR(glc) were measured each time. These metabolic and perfusion measurements were performed by standard methods. A surface map of each metabolic and perfusion measurement in the cortical mantle was generated by interpolating between the available slices. The various surface maps representing the physiological characteristics determined in the same or subsequent studies were aligned so that all data sets could be analyzed identically using an array of square regions of interest (ROIs). The functional status of each ROI was recorded at the two intervals following the cerebrovascular accident to characterize the evolution of the infarct, penumbra, and normal brain regions. We presumed the ischemic penumbra to be cortical regions in the proximity of the infarct and perfused at CBF values between 12 and 18 ml/100 g/min on the first PET scan, while densely ischemic regions had CBF of <12 nl/100 g/min and normally perfused brain > 18 ml/100 g/min. In the densely ischemic zone, CBF increased more in the nimodipine-treated group than in the carrier group. As well, in this region nimodipine reversed the decline in CMRO2 noted in the carrier group, the difference in the changes being significant. In the penumbra zone, comparable trends were noted in OER and CMRO2 but the difference in the changes between the two groups did not reach statistical significance. Changes in CMR(glc) and CBV were comparable between the two groups in both cortical regions.

Original languageEnglish (US)
Pages (from-to)523-534
Number of pages12
JournalJournal of Cerebral Blood Flow and Metabolism
Volume9
Issue number4
DOIs
StatePublished - 1989

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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