Micturitional disturbance after acute hemispheric stroke: analysis of the lesion site by CT and MRI

• Published in: Journal of the neurological sciences Vol. 137; no. 1; pp. 47 - 56
• Main Authors: Sakakibara, Ryuji, Hattori, Takamichi, Yasuda, Kosaku, Yamanishi, Tomonori
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier B.V 01.04.1996; Elsevier Science
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cerebrovascular accident; Cerebrovascular Disorders - complications; Cerebrovascular Disorders - diagnostic imaging; Detrusor hyperreflexia; Detrusor-sphincter dyssynergia; Female; Frontal lobe; Frontal Lobe - blood supply; Frontal Lobe - physiopathology; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Micturitional disturbance; Middle Aged; Neurology; Stroke; Tomography, X-Ray Computed; Uninhibited sphincter relaxation; Urinary Bladder - innervation; Urinary Bladder - physiopathology; Urination Disorders - etiology; Urodynamic study; Urodynamics - physiology; Vascular diseases and vascular malformations of the nervous system; Uninhibited sphincter relaxation; Stroke; Frontal lobe; Micturitional disturbance; Detrusor-sphincter dyssynergia; Cerebrovascular accident; Detrusor hyperreflexia; Urodynamic study; Human; Nervous system diseases; Urinary system disease; Radiodiagnosis; Acute; Cardiovascular disease; Exploration; Nuclear magnetic resonance imaging; Cerebral disorder; Vascular disease; Voiding dysfunction; Central nervous system disease; Computerized axial tomography; Cerebrovascular disease; Brain (vertebrata)
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/0022-510X(95)00322-S

Micturitional histories and urodynamic studies were performed in 72 acute hemispheric stroke patients. Within 3 months from the onset, 53% of the patients had urinary symptoms including irritative as well as obstructive, and the most common symptom was nocturnal urinary frequency in 36%, which was followed by urge urinary incontinence in 29% and difficulty of voiding in 25% of the patients. We found a correlation between micturitional disturbance with hemiparesis ( p < 0.05) and not with hemianopsia ( p < 0.05). Micturitional disturbance was more common in lesions of the frontal lobe ( p < 0.05) than in those of the occipital lobe. Brain CT or MRI in symptomatic patients showed lesions of anterior and medial surface of the frontal lobe, anterior edge of the paraventricular white matter, genu of the internal capsule and large lesions of putamen or thalamus. Urodynamic studies of 22 symptomatic patients revealed various findings in 91% of them, including detrusor hyperreflexia in 68%, detrusor-sphincter dyssynergia (DSD) in 14% and uninhibited sphincter relaxation in 36%. Patients with urinary retention had atonic cystometrogram and DSD. Detrusor hyperreflexia was noted in lesions of the frontal lobe as well as the basal ganglia, uninhibited sphincter relaxation in the frontal lobe, and detrusor-sphincter dyssynergia common in the basal ganglia. Above findings seem to indicate that anteromedial frontal lobe and its descending pathway, and the basal ganglia seem to be mainly responsible for supranuclear types of pelvic and pudendal nerve dysfunction in our patients with stroke.