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Yamauchi H, Kagawa S, Kusano K, Ito M, Okuyama C. Neuronal Alterations in Secondary Thalamic Degeneration Due to Cerebral Infarction: A
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C-Flumazenil Positron Emission Tomography Study. Stroke 2022; 53:3153-3163. [PMID: 35862203 PMCID: PMC9508960 DOI: 10.1161/strokeaha.122.038846] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Studies using animal experiments have shown secondary neuronal degeneration in the thalamus after cerebral infarction. Neuroimaging studies in humans have revealed changes in imaging parameters in the thalamus, remote to the infarction. However, few studies have directly demonstrated neuronal changes in the thalamus in vivo. The purpose of this study was to determine whether secondary thalamic neuronal damage may manifest as a decrease in central benzodiazepine receptors in patients with cerebral infarction and internal carotid artery or middle cerebral artery disease.
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Affiliation(s)
- Hiroshi Yamauchi
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan (H.Y.)
| | - Shinya Kagawa
- Division of PET Imaging, Shiga Medical Centre Research Institute, Moriyama, Japan (S.K., K.K., M.I., C.O.)
| | - Kuninori Kusano
- Division of PET Imaging, Shiga Medical Centre Research Institute, Moriyama, Japan (S.K., K.K., M.I., C.O.)
| | - Miki Ito
- Division of PET Imaging, Shiga Medical Centre Research Institute, Moriyama, Japan (S.K., K.K., M.I., C.O.)
| | - Chio Okuyama
- Division of PET Imaging, Shiga Medical Centre Research Institute, Moriyama, Japan (S.K., K.K., M.I., C.O.)
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Dondi F, Bertoli M, Volpi G, Bertagna F, Giubbini R. 18F-FDG PET/CT Demonstrating Crossed Cerebellar Diaschisis Due to Germ Cell Tumor of the Basal Ganglia: A Case Report. Clin Nucl Med 2022; 47:e455-e456. [PMID: 35507437 DOI: 10.1097/rlu.0000000000004175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Germ cell tumors of the basal ganglia are rare neoplasms that usually present with hemiparesis or other neurological symptoms. MR and PET/CT with different tracers have demonstrated their usefulness for the correct assessment of disease. Crossed cerebellar diaschisis refers to a depression in metabolism of a cerebellar hemisphere as a result of contralateral supratentorial lesions. We present a case in which MR and PET/CT were crucial for the assessment of left basal ganglia germ cell tumors with the presence of crossed cerebellar diaschisis.
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Sotome W, Ito Y, Higuchi N, Asami Y, Satomi N. Increased Accumulation of 18F-FDG Incidentally Observed in Hyperacute Cerebral Infarction. Clin Nucl Med 2022; 47:439-440. [PMID: 35025813 DOI: 10.1097/rlu.0000000000004003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 75-year-old man with lung cancer undertook an 18F-FDG PET/CT for staging. He presented neurological symptoms immediately after the 30-minute scan. An emergent MRI study revealed hyperacute cerebral infarction with occlusion of a left MCA branch. At PET/CT, an increased 18F-FDG uptake was observed in the corresponding areas of infarction. In literature, acceleration of compensatory anaerobic glycolysis has been proposed as 1 of the causes of increased uptake in the penumbra of acute cerebral infarction, and a similar process was hypothesized in this case. In addition, a decreased 18F-FDG uptake in the ipsilateral thalamus was noted on the PET/CT images.
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Affiliation(s)
- Wataru Sotome
- From the Department of Radiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
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Ilves N, Lõo S, Ilves N, Laugesaar R, Loorits D, Kool P, Talvik T, Ilves P. Ipsilesional volume loss of basal ganglia and thalamus is associated with poor hand function after ischemic perinatal stroke. BMC Neurol 2022; 22:23. [PMID: 35022000 PMCID: PMC8753896 DOI: 10.1186/s12883-022-02550-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 12/28/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Perinatal stroke (PS) is the leading cause of hemiparetic cerebral palsy (CP). Involvement of the corticospinal tract on neonatal magnetic resonance imaging (MRI) is predictive of motor outcome in patients with hemiparetic CP. However, early MRI is not available in patients with delayed presentation of PS and prediction of hemiparesis severity remains a challenge. AIMS To evaluate the volumes of the basal ganglia, amygdala, thalamus, and hippocampus following perinatal ischemic stroke in relation to hand motor function in children with a history of PS and to compare the volumes of subcortical structures in children with PS and in healthy controls. METHODS Term born PS children with arterial ischemic stroke (AIS) (n = 16) and with periventricular venous infarction (PVI) (n = 18) were recruited from the Estonian Pediatric Stroke Database. MRI was accuired during childhood (4-18 years) and the volumes of the basal ganglia, thalamus, amygdala and hippocampus were calculated. The results of stroke patients were compared to the results of 42 age- and sex-matched healthy controls. Affected hand function was evaluated by Assisting Hand Assessment (AHA) and classified by the Manual Ability Classification System (MACS). RESULTS Compared to the control group, children with AIS had smaller volumes of the ipsi- and contralesional thalami, ipsilesional globus pallidus, nucleus accumbens and hippocampus (p < 0.005). Affected hand function in children with AIS was correlated with smaller ipsilesional thalamus, putamen, globus pallidus, hippocampus, amygdala and contralesional amygdala (r > 0.5; p < 0.05) and larger volume of the contralesional putamen and hippocampus (r < - 0.5; p < 0.05). In children with PVI, size of the ipsilesional caudate nucleus, globus pallidus, thalamus (p ≤ 0.001) and hippocampus (p < 0.03) was smaller compared to controls. Smaller volume of the ipsi- and contralesional thalami and ipsilesional caudate nucleus was correlated with affected hand function (r > 0.55; p < 0.05) in children with PVI. CONCLUSIONS Smaller volume of ipsilesional thalamus was associated with poor affected hand function regardless of the perinatal stroke subtype. The pattern of correlation between hand function and volume differences in the other subcortical structures varied between children with PVI and AIS. Evaluation of subcortical structures is important in predicting motor outcome following perinatal stroke.
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Affiliation(s)
- Nigul Ilves
- Radiology Clinic, Tartu University Hospital, Tartu, Estonia.
- Department of Radiology, University of Tartu, L. Puusepa 8, 51014, Tartu, Estonia.
| | - Silva Lõo
- Department of Pediatric Neurology, University of Helsinki; Helsinki University Hospital, Helsinki, Finland
- Department of Pediatrics, University of Tartu, Tartu, Estonia
| | - Norman Ilves
- Radiology Clinic, Tartu University Hospital, Tartu, Estonia
- Department of Radiology, University of Tartu, L. Puusepa 8, 51014, Tartu, Estonia
| | - Rael Laugesaar
- Department of Pediatrics, University of Tartu, Tartu, Estonia
- Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Dagmar Loorits
- Radiology Clinic, Tartu University Hospital, Tartu, Estonia
| | - Pille Kool
- Department of Radiology, University of Tartu, L. Puusepa 8, 51014, Tartu, Estonia
| | - Tiina Talvik
- Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Pilvi Ilves
- Radiology Clinic, Tartu University Hospital, Tartu, Estonia
- Department of Radiology, University of Tartu, L. Puusepa 8, 51014, Tartu, Estonia
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van Niftrik CHB, Sebök M, Muscas G, Wegener S, Luft AR, Stippich C, Regli L, Fierstra J. Investigating the Association of Wallerian Degeneration and Diaschisis After Ischemic Stroke With BOLD Cerebrovascular Reactivity. Front Physiol 2021; 12:645157. [PMID: 34248656 PMCID: PMC8264262 DOI: 10.3389/fphys.2021.645157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/24/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Wallerian degeneration and diaschisis are considered separate remote entities following ischemic stroke. They may, however, share common neurophysiological denominators, since they are both related to disruption of fiber tracts and brain atrophy over time. Therefore, with advanced multimodal neuroimaging, we investigate Wallerian degeneration and its association with diaschisis. Methods In order to determine different characteristics of Wallerian degeneration, we conducted examinations on seventeen patients with chronic unilateral ischemic stroke and persisting large vessel occlusion, conducting high-resolution anatomical magnetic resonance imaging (MRI) and blood oxygenation-level dependent cerebrovascular reactivity (BOLD-CVR) tests, as well as Diamox 15(O)–H2O–PET hemodynamic examinations. Wallerian degeneration was determined using a cerebral peduncle asymmetry index (% difference of volume of ipsilateral and contralateral cerebral peduncle) of more than two standard deviations away from the average of age-matched, healthy subjects (Here a cerebral peduncle asymmetry index > 11%). Diaschisis was derived from BOLD-CVR to assess the presence of ipsilateral thalamus diaschisis and/or crossed cerebellar diaschisis. Results Wallerian degeneration, found in 8 (47%) subjects, had a strong association with ipsilateral thalamic volume reduction (r2 = 0.60) and corticospinal-tract involvement of stroke (p < 0.001). It was also associated with ipsilateral thalamic diaschisis (p = 0.021), No cerebral peduncular hemodynamic differences were found in patients with Wallerian degeneration. In particular, no CBF decrease or BOLD-CVR impairment was found. Conclusion We show a strong association between Wallerian degeneration and ipsilateral thalamic diaschisis, indicating a structural pathophysiological relationship.
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Affiliation(s)
- C H B van Niftrik
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M Sebök
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - G Muscas
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurosurgery, Careggi University Hospital, University of Florence, Florence, Italy
| | - S Wegener
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - A R Luft
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - C Stippich
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - L Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - J Fierstra
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Xia C, Zhou J, Lu C, Wang Y, Tang T, Cai Y, Ju S. Characterizing Diaschisis-Related Thalamic Perfusion and Diffusion After Middle Cerebral Artery Infarction. Stroke 2021; 52:2319-2327. [PMID: 33971741 DOI: 10.1161/strokeaha.120.032464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Cong Xia
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Jiaying Zhou
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Chunqiang Lu
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Yuancheng Wang
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Tianyu Tang
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Yu Cai
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Shenghong Ju
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
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Reidler P, Mueller F, Stueckelschweiger L, Feil K, Kellert L, Fabritius MP, Liebig T, Tiedt S, Puhr-Westerheide D, Kunz WG. Diaschisis revisited: quantitative evaluation of thalamic hypoperfusion in anterior circulation stroke. NEUROIMAGE-CLINICAL 2020; 27:102329. [PMID: 32629166 PMCID: PMC7334597 DOI: 10.1016/j.nicl.2020.102329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/02/2020] [Accepted: 06/21/2020] [Indexed: 11/21/2022]
Abstract
CT perfusion reveals thalamic hypoperfusion in acute anterior circulation stroke. This indirect phenomenon is referred to as ipsilateral thalamic diaschisis (ITD). Quantitative analysis indicates that ITD is a non-binary phenomenon. ITD is associated with lesion extent and involvement of the lentiform nucleus. Stroke outcome was not associated with ITD parameters.
Purpose Ipsilateral thalamic diaschisis (ITD) refers to the phenomenon of thalamic hypoperfusion or hypometabolism due to a distant cerebral injury. To further investigate the characteristics and spectrum of ITD, we analyzed quantitative measurements of thalamic hypoperfusion in acute anterior circulation stroke. Methods We selected consecutive patients with large-vessel occlusion (LVO) anterior circulation stroke and available CT perfusion (CTP) examination on admission who underwent endovascular thrombectomy. Thalamic perfusion parameters on CTP were tested between ipsi- and contralesional thalamus and ischemic territory. Values were compared with thresholds from CTP analysis software. Associations of thalamic perfusion parameters with acute imaging and clinical data were determined in uni- and multivariate logistic regression analyses. Results Ninety-nine patients were included. All perfusion parameters indicated significant non-ischemic hypoperfusion of the thalamus, not reaching the levels of ischemia in the middle cerebral artery territory due to LVO (all p < 0.002). Multiple perfusion parameters exhibited significant association with ischemic lesion extent (relative cerebral blood flow [CBF]: β = − 0.23, p = 0.022; Δtime to drain: β = 0.33, p < 0.001; ΔTmax: β = − 0.36, p < 0.001) and involvement of the Lentiform Nucleus (Δmean transit time: β = 0.64, p = 0.04; Δtime to drain: β = 0.81, p = 0.01; ΔTmax: β = − 0.82, p = 0.01). Symptom severity on admission exhibited minor significant association with reduction of thalamic CBF in uncorrected analysis (Odds ratio: 0.05, p = 0.049), but short- and long-term outcomes were unaffected by perfusion status. ITD reached guideline-based software-threshold levels in only one patient. Conclusions ITD in acute stroke is a non-binary phenomenon affected by lesion extent and involvement of the lentiform nucleus. We found uncorrected association of ITD with early clinical presentation, but no association with short- or long-term outcome was evident. Relevant misclassification of ITD by guideline-based CTP software was not indicated, which needs further dedicated testing.
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Affiliation(s)
- Paul Reidler
- Department of Radiology, University Hospital, LMU Munich, Germany
| | | | | | - Katharina Feil
- Department of Neurology, University Hospital, LMU Munich, Germany
| | - Lars Kellert
- Department of Neurology, University Hospital, LMU Munich, Germany
| | | | - Thomas Liebig
- Department of Neuroradiology, University Hospital, LMU Munich, Germany
| | - Steffen Tiedt
- Institute for Stroke and Dementia Research, LMU Munich, Germany
| | | | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Germany.
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Cao Z, Harvey SS, Bliss TM, Cheng MY, Steinberg GK. Inflammatory Responses in the Secondary Thalamic Injury After Cortical Ischemic Stroke. Front Neurol 2020; 11:236. [PMID: 32318016 PMCID: PMC7154072 DOI: 10.3389/fneur.2020.00236] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/12/2020] [Indexed: 12/12/2022] Open
Abstract
Stroke is one of the major causes of chronic disability worldwide and increasing efforts have focused on studying brain repair and recovery after stroke. Following stroke, the primary injury site can disrupt functional connections in nearby and remotely connected brain regions, resulting in the development of secondary injuries that may impede long-term functional recovery. In particular, secondary degenerative injury occurs in the connected ipsilesional thalamus following a cortical stroke. Although secondary thalamic injury was first described decades ago, the underlying mechanisms still remain unclear. We performed a systematic literature review using the NCBI PubMed database for studies that focused on the secondary thalamic degeneration after cortical ischemic stroke. In this review, we discussed emerging studies that characterized the pathological changes in the secondary degenerative thalamus after stroke; these included excitotoxicity, apoptosis, amyloid beta protein accumulation, blood-brain-barrier breakdown, and inflammatory responses. In particular, we highlighted key findings of the dynamic inflammatory responses in the secondary thalamic injury and discussed the involvement of several cell types in this process. We also discussed studies that investigated the effects of blocking secondary thalamic injury on inflammatory responses and stroke outcome. Targeting secondary injuries after stroke may alleviate network-wide deficits, and ultimately promote stroke recovery.
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Affiliation(s)
- Zhijuan Cao
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States.,Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, United States
| | - Sean S Harvey
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States.,Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, United States
| | - Tonya M Bliss
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States.,Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, United States
| | - Michelle Y Cheng
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States.,Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, United States
| | - Gary K Steinberg
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States.,Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, United States
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Okamoto K, Shiga H, Nakamura H, Matsui M, Miwa T. Relationship Between Olfactory Disturbance After Acute Ischemic Stroke and Latent Thalamic Hypoperfusion. Chem Senses 2020; 45:111-118. [PMID: 31873732 DOI: 10.1093/chemse/bjz077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Odor detection, recognition, and identification were assessed in 19 acute ischemic stroke patients who had no magnetic resonance imaging-detectable thalamic lesions but in whom technetium-99m ethyl cysteinate dimer single photon emission tomography revealed thalamic hypoperfusion. Although these patients were unaware of reduced olfactory function, they exhibited significantly lower scores in tests for odor identification and recognition threshold as compared with 9 ischemic stroke controls that had normal thalamic hypoperfusion. However, absolute odor detection thresholds were similar in the 2 groups. These results demonstrate the usefulness of cerebral perfusion scintigraphy in assessing sensory loss after ischemic stroke and provide further evidence for the role of the thalamus in olfaction.
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Affiliation(s)
- Kazuhiro Okamoto
- Department of Medical Technology, Kanazawa Medical University Hospital, Uchinada, Japan
| | - Hideaki Shiga
- Department of Otolaryngology, Kanazawa Medical University, Uchinada, Japan
| | - Hisako Nakamura
- Department of Central Clinical Laboratory, Kanazawa Medical University Hospital, Uchinada, Japan
| | - Makoto Matsui
- Department of Neurology, Kanazawa Medical University, Uchinada, Japan
| | - Takaki Miwa
- Department of Otolaryngology, Kanazawa Medical University, Uchinada, Japan
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Hendrik Bas van Niftrik C, Sebök M, Muscas G, Piccirelli M, Serra C, Krayenbühl N, Pangalu A, Bozinov O, Luft A, Stippich C, Regli L, Fierstra J. Characterizing ipsilateral thalamic diaschisis in symptomatic cerebrovascular steno-occlusive patients. J Cereb Blood Flow Metab 2020; 40:563-573. [PMID: 30755133 PMCID: PMC7026850 DOI: 10.1177/0271678x19830532] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/03/2019] [Accepted: 01/15/2019] [Indexed: 11/17/2022]
Abstract
The clinical significance of ipsilateral thalamic diaschisis (ITD) occurring after stroke is unknown. To characterize ITD, we investigate its hemodynamic, structural, and clinical implications. A single-institution prospective cross-sectional study was conducted using 28 symptomatic cerebrovascular steno-occlusive patients undergoing both BOLD-CVR and Diamox-challenged 15(O)-H2O-PET. Follow-up was at least three months. In addition, 15 age-matched healthy subjects were included. ITD was diagnosed based on a BOLD-CVR thalamic asymmetry index (TAI) > +2 standard deviations from healthy subjects. Cerebral blood flow differences were assessed using a PET-based TAI before and after Diamox challenge. Thalamic volume masks were determined using Freesurfer. Neurological status at symptom onset and after three months was determined with NIHSS and mRS scores. ITD was diagnosed in 15 of 28 (57%) patients. PET-TAI before and after Diamox challenge were increased in patients with ITD, indicating an ipsilateral thalamic blood flow decrease. Patients with ITD exhibited a marked ipsilateral thalamic volume decrease as compared to patients without ITD and healthy subjects. Furthermore, patients with ITD had worse NIHSS and mRS at symptom onset and after three months follow-up, even after adjustment for stroke volume. The presence of ITD is characterized by thalamic volume reduction, reduced thalamic blood flow, and worse neurological performance unrelated to stroke volume.
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Affiliation(s)
- Christiaan Hendrik Bas van Niftrik
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Giovanni Muscas
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
- Department of Neurosurgery, Careggi University Hospital, Florence, University of Florence, Italy
| | - Marco Piccirelli
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Carlo Serra
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Niklaus Krayenbühl
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Athina Pangalu
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Andreas Luft
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
- Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland
| | - Christoph Stippich
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
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11
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Gutiérrez-Vargas JA, Cardona-Gómez GP. Considering risk factors for the effectiveness of translational therapies in brain stroke. J Neurol Sci 2020; 408:116547. [PMID: 31683050 DOI: 10.1016/j.jns.2019.116547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/10/2019] [Accepted: 10/18/2019] [Indexed: 11/17/2022]
Abstract
Multiple studies on cerebral ischemia have been performed in animal models to propose different strategies of neuroprotection that mitigate either the early or late consequences of the disease. These therapies have been successful in reducing the volume of infarction, the proinflammatory cascade, and the amount of free radicals, as well as reversing markers of neurodegeneration, among other events. However, when those strategies are translated to clinical studies, their effectiveness is not reproduced. This review will focus on highlighting some of the main limitations of the animal models of stroke that lead to unsuccessful translational therapies and the common risk factors in humans that should be carefully considered in the experimental design of future studies to generate a more realistic spatiotemporal physiopathology and improve therapeutic efficacy in cerebral ischemia.
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Affiliation(s)
| | - Gloria Patricia Cardona-Gómez
- Grupo de Neurociencias de Antioquia, Área de Neurobiología Celular y Molecular, Facultad de Medicina, SIU, Universidad de Antioquia, Calle 70 No. 52-21, Medellín, Colombia
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12
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Craig BT, Carlson HL, Kirton A. Thalamic diaschisis following perinatal stroke is associated with clinical disability. Neuroimage Clin 2019; 21:101660. [PMID: 30639178 PMCID: PMC6412070 DOI: 10.1016/j.nicl.2019.101660] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/26/2018] [Accepted: 01/04/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Perinatal stroke causes most hemiparetic cerebral palsy and leads to lifelong disability. Understanding developmental neuroplasticity following early stroke is increasingly translated into novel therapies. Diaschisis refers to alterations brain structures remote from, but connected to, stroke lesions. Ipsilesional thalamic diaschisis has been described following adult stroke but has not been investigated in perinatal stroke. We hypothesized that thalamic diaschisis occurs in perinatal stroke and its degree would be inversely correlated with clinical motor function. METHODS Population-based, controlled cohort study. Participants were children (<19 years) with unilateral perinatal stroke (arterial ischemic stroke [AIS] or periventricular venous infarction [PVI]), anatomical magnetic resonance imaging (MRI) >6 months of age, symptomatic hemiparetic cerebral palsy, and no additional neurologic disorders. Typically developing controls had comparable age and gender proportions. T1-weighted anatomical scans were parcellated into 99 regions of interest followed by generation of regional volumes. The primary outcome was thalamic volume expressed as ipsilesional (ILTV), contralesional (CLTV) and thalamic ratio (CLTV/ILTV). Standardized clinical motor assessments were correlated with thalamic volume metrics. RESULTS Fifty-nine participants (12.9 years old ±4.0 years, 46% female) included 20 AIS, 11 PVI, and 28 controls. ILTV was reduced in both AIS and PVI compared to controls (p < .001, p = .029, respectively). Ipsilesional thalamic diaschisis was not associated with clinical motor function. However, CLTV was significantly larger in AIS compared to both controls and PVI (p = .005, p < .001, respectively). CLTV was inversely correlated with all four clinical motor assessments (all p < .003). CONCLUSION Bilateral thalamic volume changes occur after perinatal stroke. Ipsilesional volume loss is not associated with clinical motor function. Contralesional volume is inversely correlated with clinical motor function, suggesting the thalamus is involved in the known developmental plasticity that occurs in the contralesional hemisphere after early unilateral injury.
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Affiliation(s)
- Brandon T Craig
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Calgary Pediatric Stroke Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Helen L Carlson
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Calgary Pediatric Stroke Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Calgary Pediatric Stroke Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Reidler P, Thierfelder KM, Fabritius MP, Sommer WH, Meinel FG, Dorn F, Wollenweber FA, Duering M, Kunz WG. Thalamic Diaschisis in Acute Ischemic Stroke. Stroke 2018. [DOI: 10.1161/strokeaha.118.020698] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Paul Reidler
- From the Department of Radiology (P.R., K.M.T., M.P.F., W.H.S., W.G.K.) and Department of Neuroradiology (F.D.), University Hospital, LMU Munich, Germany; Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Germany (K.M.T., F.G.M.); and Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Germany (F.A.W., M.D.)
| | - Kolja M. Thierfelder
- From the Department of Radiology (P.R., K.M.T., M.P.F., W.H.S., W.G.K.) and Department of Neuroradiology (F.D.), University Hospital, LMU Munich, Germany; Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Germany (K.M.T., F.G.M.); and Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Germany (F.A.W., M.D.)
| | - Matthias P. Fabritius
- From the Department of Radiology (P.R., K.M.T., M.P.F., W.H.S., W.G.K.) and Department of Neuroradiology (F.D.), University Hospital, LMU Munich, Germany; Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Germany (K.M.T., F.G.M.); and Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Germany (F.A.W., M.D.)
| | - Wieland H. Sommer
- From the Department of Radiology (P.R., K.M.T., M.P.F., W.H.S., W.G.K.) and Department of Neuroradiology (F.D.), University Hospital, LMU Munich, Germany; Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Germany (K.M.T., F.G.M.); and Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Germany (F.A.W., M.D.)
| | - Felix G. Meinel
- From the Department of Radiology (P.R., K.M.T., M.P.F., W.H.S., W.G.K.) and Department of Neuroradiology (F.D.), University Hospital, LMU Munich, Germany; Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Germany (K.M.T., F.G.M.); and Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Germany (F.A.W., M.D.)
| | - Franziska Dorn
- From the Department of Radiology (P.R., K.M.T., M.P.F., W.H.S., W.G.K.) and Department of Neuroradiology (F.D.), University Hospital, LMU Munich, Germany; Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Germany (K.M.T., F.G.M.); and Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Germany (F.A.W., M.D.)
| | - Frank A. Wollenweber
- From the Department of Radiology (P.R., K.M.T., M.P.F., W.H.S., W.G.K.) and Department of Neuroradiology (F.D.), University Hospital, LMU Munich, Germany; Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Germany (K.M.T., F.G.M.); and Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Germany (F.A.W., M.D.)
| | - Marco Duering
- From the Department of Radiology (P.R., K.M.T., M.P.F., W.H.S., W.G.K.) and Department of Neuroradiology (F.D.), University Hospital, LMU Munich, Germany; Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Germany (K.M.T., F.G.M.); and Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Germany (F.A.W., M.D.)
| | - Wolfgang G. Kunz
- From the Department of Radiology (P.R., K.M.T., M.P.F., W.H.S., W.G.K.) and Department of Neuroradiology (F.D.), University Hospital, LMU Munich, Germany; Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Germany (K.M.T., F.G.M.); and Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Germany (F.A.W., M.D.)
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14
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Yanev P, Seevinck PR, Rudrapatna US, Bouts MJ, van der Toorn A, Gertz K, Kronenberg G, Endres M, van Tilborg GA, Dijkhuizen RM. Magnetic resonance imaging of local and remote vascular remodelling after experimental stroke. J Cereb Blood Flow Metab 2017; 37:2768-2779. [PMID: 27798270 PMCID: PMC5536787 DOI: 10.1177/0271678x16674737] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The pattern of vascular remodelling in relation to recovery after stroke remains largely unclear. We used steady-state contrast-enhanced magnetic resonance imaging to assess the development of cerebral blood volume and microvascular density in perilesional and exofocal areas from (sub)acutely to chronically after transient stroke in rats. Microvascular density was verified histologically after infusion with Evans Blue dye. At day 1, microvascular cerebral blood volume and microvascular density were reduced in and around the ischemic lesion (intralesional borderzone: microvascular cerebral blood volume = 72 ± 8%; microvascular density = 76 ± 8%) (P < 0.05), while total cerebral blood volume remained relatively unchanged. Perilesional microvascular cerebral blood volume and microvascular density subsequently normalized (day 7) and remained relatively stable (day 70). In remote ipsilateral areas in the thalamus and substantia nigra - not part of the ischemic lesion - microvascular density gradually increased between days 1 and 70 (thalamic ventral posterior nucleus: microvascular density = 119 ± 9%; substantia nigra: microvascular density = 122 ± 8% (P < 0.05)), which was confirmed histologically. Our data indicate that initial microvascular collapse, with maintained collateral flow in larger vessels, is followed by dynamic revascularization in perilesional tissue. Furthermore, progressive neovascularization in non-ischemic connected areas may offset secondary neuronal degeneration and/or contribute to non-neuronal tissue remodelling. The complex spatiotemporal pattern of vascular remodelling, involving regions outside the lesion territory, may be a critical endogenous process to promote post-stroke brain reorganization.
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Affiliation(s)
- Pavel Yanev
- 1 Biomedical MR Imaging and Spectroscopy Group, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter R Seevinck
- 1 Biomedical MR Imaging and Spectroscopy Group, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Umesh S Rudrapatna
- 1 Biomedical MR Imaging and Spectroscopy Group, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mark Jrj Bouts
- 1 Biomedical MR Imaging and Spectroscopy Group, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annette van der Toorn
- 1 Biomedical MR Imaging and Spectroscopy Group, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karen Gertz
- 2 Department of Neurology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.,3 Center for Stroke Research Berlin, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Golo Kronenberg
- 2 Department of Neurology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.,4 German Center for Cardiovascular Research (DZHK), Universitaetsmedizin Berlin, Berlin, Germany
| | - Matthias Endres
- 2 Department of Neurology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.,3 Center for Stroke Research Berlin, Charité - Universitaetsmedizin Berlin, Berlin, Germany.,4 German Center for Cardiovascular Research (DZHK), Universitaetsmedizin Berlin, Berlin, Germany.,5 German Center for Neurodegenerative Diseases (DZNE), Universitaetsmedizin Berlin, Berlin, Germany.,6 Berlin Institute of Health (BIH), Berlin, Germany
| | - Geralda A van Tilborg
- 1 Biomedical MR Imaging and Spectroscopy Group, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rick M Dijkhuizen
- 1 Biomedical MR Imaging and Spectroscopy Group, University Medical Center Utrecht, Utrecht, The Netherlands
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15
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Sommer WH, Bollwein C, Thierfelder KM, Baumann A, Janssen H, Ertl-Wagner B, Reiser MF, Plate A, Straube A, von Baumgarten L. Crossed cerebellar diaschisis in patients with acute middle cerebral artery infarction: Occurrence and perfusion characteristics. J Cereb Blood Flow Metab 2016; 36:743-54. [PMID: 26661242 PMCID: PMC4821023 DOI: 10.1177/0271678x15617953] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 10/12/2015] [Indexed: 01/22/2023]
Abstract
We aimed to investigate the overall prevalence and possible factors influencing the occurrence of crossed cerebellar diaschisis after acute middle cerebral artery infarction using whole-brain CT perfusion. A total of 156 patients with unilateral hypoperfusion of the middle cerebral artery territory formed the study cohort; 352 patients without hypoperfusion served as controls. We performed blinded reading of different perfusion maps for the presence of crossed cerebellar diaschisis and determined the relative supratentorial and cerebellar perfusion reduction. Moreover, imaging patterns (location and volume of hypoperfusion) and clinical factors (age, sex, time from symptom onset) resulting in crossed cerebellar diaschisis were analysed. Crossed cerebellar diaschisis was detected in 35.3% of the patients with middle cerebral artery infarction. Crossed cerebellar diaschisis was significantly associated with hypoperfusion involving the left hemisphere, the frontal lobe and the thalamus. The degree of the relative supratentorial perfusion reduction was significantly more pronounced in crossed cerebellar diaschisis-positive patients but did not correlate with the relative cerebellar perfusion reduction. Our data suggest that (i) crossed cerebellar diaschisis is a common feature after middle cerebral artery infarction which can robustly be detected using whole-brain CT perfusion, (ii) its occurrence is influenced by location and degree of the supratentorial perfusion reduction rather than infarct volume (iii) other clinical factors (age, sex and time from symptom onset) did not affect the occurrence of crossed cerebellar diaschisis.
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Affiliation(s)
- Wieland H Sommer
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Christine Bollwein
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Kolja M Thierfelder
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Alena Baumann
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Hendrik Janssen
- Department of Neuroradiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Birgit Ertl-Wagner
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Maximilian F Reiser
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Annika Plate
- Department of Neurology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Andreas Straube
- Department of Neurology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Louisa von Baumgarten
- Department of Neurology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
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16
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Hervé D, Molko N, Pappata S, Buffon F, LeBihan D, Bousser MG, Chabriat H. Longitudinal thalamic diffusion changes after middle cerebral artery infarcts. J Neurol Neurosurg Psychiatry 2005; 76:200-5. [PMID: 15654032 PMCID: PMC1739509 DOI: 10.1136/jnnp.2004.041012] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Cerebral infarcts are responsible for functional alterations and microscopic tissue damage at distance from the ischaemic area. Such remote effects have been involved in stroke recovery. Thalamic hypometabolism is related to motor recovery in middle cerebral artery (MCA) infarcts but little is known concerning the tissue changes underlying these metabolic changes. Diffusion tensor imaging (DTI) is highly sensitive to microstructural tissue alterations and can be used to quantify in vivo the longitudinal microscopic tissue changes occurring in the thalamus after MCA infarcts in humans. METHODS Nine patients underwent DTI after an isolated MCA infarct. Mean diffusivity (MD), fractional anisotropy (FA), and thalamic region volume were measured from the first week to the sixth month after stroke onset in these patients and in 10 age matched controls. RESULTS MD significantly increased in the ipsilateral thalamus between the first and the sixth month (0.766 x 10(-3) mm(2)/s first month; 0.792 x 10(-3) mm(2)/s third month; 0.806 x 10(-3) mm(2)/s sixth month). No significant modification of FA was detected. In six patients, the ipsilateral/contralateral index of MD was higher than the upper limit of the 95% CI calculated in 10 age matched controls. An early decrease of MD preceded the increase of ipsilateral thalamic diffusion in one patient at the first week and in two other patients at the first month. CONCLUSION After MCA infarcts, an increase in diffusion is observed with DTI in the ipsilateral thalamus later than 1 month after the stroke onset. This is presumably because of the progressive loss of neurons and/or glial cells. In some patients, this increase is preceded by a transient decrease in diffusion possibly related to an early swelling of these cells or to microglial activation. Further studies in larger series are needed to assess the clinical correlates of these findings.
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Affiliation(s)
- D Hervé
- The Department of Neurology, CHU Lariboisière, Paris, France
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17
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Zappoli R, Zappoli F, Picchiecchio A, Chiaramonti R, Grazia Arneodo M, Zappoli Thyrion GD, Zerauschek V. Frontal and parieto-temporal cortical ablations and diaschisis-like effects on auditory neurocognitive potentials evocable from apparently intact ipsilateral association areas in humans: five case reports. Int J Psychophysiol 2002; 44:117-42. [PMID: 11909646 DOI: 10.1016/s0167-8760(01)00197-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to investigate the effects of disruption on the warning auditory S1-elicited ERP and CNV complexes recordable on the site and on remote ipsilateral apparently normal anatomo-functionally interconnected brain regions. These effects in some cases showed aspects of a probable diaschisis-like phenomenon, due to resections of extensive frontal association cortex or of primary and secondary sensory parieto-temporal areas damaged by differing pathological processes. Using a standard CNV paradigm, 21/19 EEG electrodes connected with three different references, and scalp-topographic bidimensional mapping analysis, the S1 auditory binaural/monaural clicks N1a,b,c, P2, N2, P3 and CNV waves were recorded in 10 normal subjects and 11 patients. Nine of the latter had been submitted to unilateral frontal dorsolateral cortex ablation, one to bihemispheric dorsomedial cortex ablation, and one to unilateral ablation of sensory parieto-temporal cortex and underlying white matter, verified through CT/MRI examinations. No true S1ERP/CNV components were recordable over the ablated cortical areas, whereas normal ERP/CNV complexes were observable on the intact hemispheres. In five patients, four of whom with frontocortical ablations, the S1 ERP/CNV complexes appeared severely diminished or disrupted, in two cases in a slow, partially-reversible manner, also in the neuroradiologically normal ipsilateral functionally-connected post-rolandic sensory and association areas. Similar deactivation of some ERP components was observed in reverse on the unilateral dorsolateral frontocortical region in the fifth patient with parieto-temporal cortex ablation. Even when they are partially reversible, these ipsilateral remote ERP changes in apparently intact brain regions, due to ablations of functionally-interconnected cortical formations, probably reflect cortical deactivation or simply dysfacilitation deriving from functional unilateral diaschisis. If these changes are instead irreversible they may probably be interpreted as transneuronal degeneration phenomena, though they are not at present easy to document either neuroradiologically or electroclinically.
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Affiliation(s)
- Roberto Zappoli
- Department of Neurological and Psychiatric Sciences, University of Florence, Viale G.B., 85, 50134, Morgagni, Italy.
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18
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Serteser M, Ozben T, Gümüşlü S, Balkan S, Balkan E. Biochemical evidence of crossed cerebellar diaschisis in terms of nitric oxide indicators and lipid peroxidation products in rats during focal cerebral ischemia. Acta Neurol Scand 2001; 103:43-8. [PMID: 11153887 DOI: 10.1034/j.1600-0404.2001.00142.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Cerebral hypoperfusion in the contralateral cerebellar hemisphere after stroke is interpreted as a functional and metabolic depression, possibly caused by a loss of excitatory afferent inputs on the corticopontocerebellar pathway terminating in the cerebellar gray matter. This phenomenon is defined as crossed cerebellar diaschisis and can be diagnosed clinically by positron emission tomography, single-photon emission computed tomography, brain magnetic resonance imaging and electroencephalography in terms of regional cerebral blood flow or metabolic rate of oxygen measurements. MATERIALS AND METHODS In the present study, nitric oxide indicators (nitrite and cyclic guanosine monophosphate) and lipid peroxidation products (malondialdehyde and conjugated dienes) were measured in rat cerebral cortices and cerebella after permanent right middle cerebral artery occlusion in order to assess the crossed cerebellar diaschisis. RESULTS Nitrite values in ipsilateral cortex were significantly higher than those in contralateral cortex at 10 (P < 0.001) and 60 (P < 0.05) min of ischemia but no significant changes were observed in both cerebellum compared to the 0 min values. In both cerebral cortex and cerebellum cGMP levels at 10 and 60 min were significantly increased (P < 0.001). This increase was marked in ipsilateral cortex and contralateral cerebellum when compared with opposite cortex and cerebellum (P < 0.001). MDA values in ipsilateral cortex were significantly higher than those in contralateral cortex at 60 min of ischemia (P < 0.05). Contralateral cerebellar MDA values were found significantly higher than those in ipsilateral cerebellum at 0 (P<0.001) and 60 (P < 0.05) min of ischemia. In ipsilateral cortex, conjugated diene values at 0, 10, 60 min of ischemia were higher than those in contralateral cortex. On the other hand 0, 10, 60 min conjugated diene levels in contralateral cerebellum were significantly higher than those in ipsilateral cerebellum (P < 0.001). CONCLUSION These findings support the interruption of the corticopontocerebellar tract as the mechanism of the crossed cerebellar diaschisis.
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Affiliation(s)
- M Serteser
- Afyon Kocatepe University, School of Medicine, Department of Biochemistry, Turkey.
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19
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Witte OW, Bidmon HJ, Schiene K, Redecker C, Hagemann G. Functional differentiation of multiple perilesional zones after focal cerebral ischemia. J Cereb Blood Flow Metab 2000; 20:1149-65. [PMID: 10950376 DOI: 10.1097/00004647-200008000-00001] [Citation(s) in RCA: 191] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Transient and permanent focal cerebral ischemia results in a series of typical pathophysiologic events. These consequences evolve in time and space and are not limited to the lesion itself, but they can be observed in perilesional (penumbra) and widespread ipsi- and sometimes contralateral remote areas (diaschisis). The extent of these areas is variable depending on factors such as the type of ischemia, the model, and the functional modality investigated. This review describes some typical alterations attributable to focal cerebral ischemia using the following classification scheme to separate different lesioned and perilesional areas: (1) The lesion core is the brain area with irreversible ischemic damage. (2) The penumbra is a brain region that suffers from ischemia, but in which the ischemic damage is potentially, or at least partially, reversible. (3) Remote brain areas are brain areas that are not directly affected by ischemia. With respect to the etiology, several broad categories of remote changes may be differentiated: (3a) remote changes caused by brain edema; (3b) remote changes caused by waves of spreading depression; (3c) remote changes in projection areas; and (3d) remote changes because of reactive plasticity and systemic effects. The various perilesional areas are not necessarily homogeneous; but a broad differentiation of separate topographic perilesional areas according to their functional state and sequelae allows segregation into several signaling cascades, and may help to understand the functional consequences and adaptive processes after focal brain ischemia.
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Affiliation(s)
- O W Witte
- Department of Neurology, Heinrich Heine University, Düsseldorf, Germany
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Karussis D, Leker RR, Abramsky O. Cognitive dysfunction following thalamic stroke: a study of 16 cases and review of the literature. J Neurol Sci 2000; 172:25-9. [PMID: 10620656 DOI: 10.1016/s0022-510x(99)00267-1] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The thalamus is a relay center for afferent sensory pathways that regulates and transmits peripheral stimulation to various representative areas of the cortex. Aphasia, neglect and anosognosia were also reported to occur after thalamic lesions, in the absence of cortical pathology. However, considerable controversy exists as to the pathogenetic mechanisms, and incidence of cognitive abnormalities following thalamic lesions. We present a series of sixteen consecutive stroke patients with thalamic stroke (n=12) or hemorrhage (n=4), admitted to a university based neurology department. Dysphasia was observed in seven of eight patients with left thalamic strokes (five in the territory of the tuberothalamic artery, two inferior-lateral thalamic lesions and one in the area supplied by the anterior choroidal artery). Neglect and anosognosia appeared in five of eight patients with right side thalamic insults (two each in the territories of the tuberothalamic and thalamogeniculate arteries and one in the area supplied by the posterior choroidal artery). These findings reconfirm those found in previous studies and suggest that the thalamus is part of an integral neuronal network concerned with cognitive functions.
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Affiliation(s)
- D Karussis
- Department of Neurology, Hadassah University Hospital, P.O. Box 12000, Jerusalem, Israel.
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21
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Taber K, Wen C, Khan A, Hurley R, Hayman L. Imaging Anatomy of the Human Thalamus, Part I: Memory, Emotion, and Arousal. Neuroimage 1998. [DOI: 10.1016/s1053-8119(18)31546-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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