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Oesch G, Münger R, Steinlin M. Be aware of childhood stroke: Proceedings from EPNS Webinar. Eur J Paediatr Neurol 2024; 49:82-94. [PMID: 38447504 DOI: 10.1016/j.ejpn.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/11/2023] [Accepted: 02/05/2024] [Indexed: 03/08/2024]
Abstract
Childhood arterial ischaemic stroke (AIS) is a significant health concern with increasing incidence. This review aims to provide an overview of the current understanding of childhood AIS. The incidence of childhood AIS is on the rise especially in developing countries, likely due to improved awareness and diagnostic capabilities. Aetiology of childhood AIS is multifactorial, with both modifiable risk factors and genetic predisposition playing important roles. Identifying and addressing these risk factors, such as infection, sickle cell disease, and congenital heart defects, is essential in prevention and management. Identifying underlying conditions through genetic testing is important for appropriate management and long-term prognosis. Clinically, distinguishing stroke from stroke mimics can be challenging. Awareness of important stroke mimics, including migraines, seizures, and metabolic disorders, is crucial to avoid misdiagnosis and ensure appropriate treatment. The diagnostic approach to childhood AIS involves a comprehensive "chain of care," including initial assessment, neuroimaging, and laboratory investigations. National guidelines play a pivotal role in standardizing and streamlining the diagnostic process, ensuring prompt and accurate management. Early intervention is critical in the management of childhood AIS. Due to the critical time window, the question if mechanical thrombectomy is feasible and beneficial should be addressed as fast as possible. Early initiation of antiplatelet or anticoagulation therapy and, in select cases, thrombolysis can help restore blood flow and minimize long-term neurological damage. Additionally, rehabilitation should start as soon as possible to optimize recovery and improve functional outcomes. In conclusion, childhood AIS is a growing concern. Understanding the increasing incidence, age distribution, risk factors, clinical presentation, diagnostic approach, and management strategies is crucial for optimized management of these patients.
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Affiliation(s)
- Gabriela Oesch
- Division of Neuropaediatrics, Development and Rehabilitation, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Robin Münger
- Division of Neuropaediatrics, Development and Rehabilitation, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Switzerland
| | - Maja Steinlin
- Division of Neuropaediatrics, Development and Rehabilitation, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland.
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Du B, Wu P, Yin S, Cao S, Mo Y, Liu Y, Zhang Y, Qiu B, Wu X, Hu P, Wei L, Wang K, Wei Q. Intracranial Atherosclerotic Stenosis Is Associated with Cognitive Impairment in Patients with Nondisabling Ischemic Stroke: A pCASL-Based Study. Brain Connect 2023; 13:508-518. [PMID: 37128178 DOI: 10.1089/brain.2022.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Background: Intracranial atherosclerotic stenosis (ICAS) is a key risk factor for vascular cognitive impairment. Cerebral blood flow (CBF) and the spatial coefficient of variation (sCoV) of CBF images (based on pseudocontinuous arterial spin labeling) are used to explore abnormal cerebral perfusion. We aimed to probe the mechanisms underlying cognitive impairment in patients with nondisabling anterior circulation macrovascular disease. Methods: This study included 47 patients with ICAS or occlusion and 40 controls. All participants underwent global and individual neuropsychology assessments and magnetic resonance imaging scan. The correlations between cognitive function and abnormal perfusion were explored. Results: The CBF in the ipsilateral middle cerebral artery (MCA) territory of the lesion side decreased significantly, while it increased on the contralateral side. CBF value had a significant correlation with the memory function in the right cerebral artery lesion group. The sCoV in both gray matter (GM) and the ipsilateral MCA territory of the lesion increased significantly. The sCoV value based on the GM territory or MCA territory was significantly correlated with global cognitive function, memory function, and executive function in patients with ICAS. Conclusions: The cognitive function of patients with severe ICAS or occlusion in anterior circulation was significantly impaired. sCoV could be a better indicator of cognitive impairment than CBF. Interventions to relieve vascular stenosis or occlusion and delay cognitive impairment or improve cognitive function should be actively considered.
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Affiliation(s)
- Baogen Du
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Pan Wu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Shanshan Yin
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Shanshan Cao
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Yuting Mo
- Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Yuanyuan Liu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Ying Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Bensheng Qiu
- Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, China
| | - Xingqi Wu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Anhui, China
| | - Panpan Hu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Anhui, China
| | - Ling Wei
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Anhui, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Anhui, China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Qiang Wei
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Anhui, China
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Li CX, Tong F, Kempf D, Howell L, Zhang X. Longitudinal evaluation of the functional connectivity changes in the secondary somatosensory cortex (S2) of the monkey brain during acute stroke. CURRENT RESEARCH IN NEUROBIOLOGY 2023; 5:100097. [PMID: 37404949 PMCID: PMC10315998 DOI: 10.1016/j.crneur.2023.100097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 05/29/2023] [Accepted: 06/09/2023] [Indexed: 07/06/2023] Open
Abstract
Background Somatosensory deficits are frequently seen in acute stroke patients and may recover over time and affect functional outcome. However, the underlying mechanism of function recovery remains poorly understood. In the present study, progressive function alteration of the secondary somatosensory cortex (S2) and its relationship with regional perfusion and neurological outcome were examined using a monkey model of stroke. Methods and materials Rhesus monkeys (n = 4) were induced with permanent middle cerebral artery occlusion (pMCAo). Resting-state functional MRI, dynamic susceptibility contrast perfusion MRI, diffusion-weighted, T1 and T2 weighted images were collected before surgery and at 4-6, 48, and 96 h post stroke on a 3T scanner. Progressive changes of relative functional connectivity (FC), cerebral blood flow (CBF), and CBF/Tmax (Time to Maximum) of affected S2 regions were evaluated. Neurological deficits were assessed using the Spetzler approach. Results Ischemic lesion was evidently seen in the MCA territory including S2 in each monkey. Relative FC of injured S2 regions decreased substantially following stroke. Spetzler scores dropped substantially at 24 h post stroke but slightly recovered from Day 2 to Day 4. Relative FC progressively increased from 6 to 48 and 96 h post stroke and correlated significantly with relative CBFand CBF/Tmax changes. Conclusion The present study revealed the progressive alteration of function connectivity in S2 during acute stroke. The preliminary results suggested the function recovery might start couple days post occlusion and collateral circulation might play a key role in the recovery of somatosensory function after stroke insult. The relative function connectivity in S2 may provide additional information for prediction of functional outcome in stroke patients.
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Affiliation(s)
- Chun-Xia Li
- Emory National Primate Research Center, Emory University, Atlanta, 30329, Georgia
| | - Frank Tong
- Department of Radiology, Emory University School of Medicine, Atlanta, 30322, Georgia
| | - Doty Kempf
- Emory National Primate Research Center, Emory University, Atlanta, 30329, Georgia
| | - Leonard Howell
- Emory National Primate Research Center, Emory University, Atlanta, 30329, Georgia
| | - Xiaodong Zhang
- Emory National Primate Research Center, Emory University, Atlanta, 30329, Georgia
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Bhattarai S, Subedi U, Manikandan S, Sharma S, Sharma P, Miller C, Bhuiyan MS, Kidambi S, Aidinis V, Sun H, Miriyala S, Panchatcharam M. Endothelial Specific Deletion of Autotaxin Improves Stroke Outcomes. Cells 2023; 12:511. [PMID: 36766854 PMCID: PMC9914107 DOI: 10.3390/cells12030511] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/20/2023] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
Autotaxin (ATX) is an extracellular secretory enzyme (lysophospholipase D) that catalyzes the hydrolysis of lysophosphatidyl choline to lysophosphatidic acid (LPA). The ATX-LPA axis is a well-known pathological mediator of liver fibrosis, metastasis in cancer, pulmonary fibrosis, atherosclerosis, and neurodegenerative diseases. Additionally, it is believed that LPA may cause vascular permeability. In ischemic stroke, vascular permeability leading to hemorrhagic transformation is a major limitation for therapies and an obstacle to stroke management. Therefore, in this study, we generated an endothelial-specific ATX deletion in mice (ERT2 ATX-/-) to observe stroke outcomes in a mouse stroke model to analyze the role of endothelial ATX. The AR2 probe and Evans Blue staining were used to perform the ATX activity and vascular permeability assays, respectively. Laser speckle imaging was used to observe the cerebral blood flow following stroke. In this study, we observed that stroke outcomes were alleviated with the endothelial deletion of ATX. Permeability and infarct volume were reduced in ERT2 ATX-/- mice compared to ischemia-reperfusion (I/R)-only mice. In addition, the cerebral blood flow was retained in ERT2 ATX-/- compared to I/R mice. The outcomes in the stroke model are alleviated due to the limited LPA concentration, reduced ATX concentration, and ATX activity in ERT2 ATX-/- mice. This study suggests that endothelial-specific ATX leads to increased LPA in the brain vasculature following ischemic-reperfusion and ultimately disrupts vascular permeability, resulting in adverse stroke outcomes.
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Affiliation(s)
- Susmita Bhattarai
- Department of Cellular Biology and Anatomy, Louisiana State University Health Sciences, Shreveport, LA 71103, USA
| | - Utsab Subedi
- Department of Cellular Biology and Anatomy, Louisiana State University Health Sciences, Shreveport, LA 71103, USA
| | - Shrivats Manikandan
- Department of Cellular Biology and Anatomy, Louisiana State University Health Sciences, Shreveport, LA 71103, USA
| | - Sudha Sharma
- Department of Cellular Biology and Anatomy, Louisiana State University Health Sciences, Shreveport, LA 71103, USA
| | - Papori Sharma
- Department of Cellular Biology and Anatomy, Louisiana State University Health Sciences, Shreveport, LA 71103, USA
| | - Chloe Miller
- Department of Cellular Biology and Anatomy, Louisiana State University Health Sciences, Shreveport, LA 71103, USA
| | - Md Shenuarin Bhuiyan
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences, Shreveport, LA 71103, USA
| | - Srivatsan Kidambi
- Department of Chemical and Biomolecular Engineering, University of Nebraska, Lincoln, NB 68588, USA
| | - Vassilis Aidinis
- Biomedical Sciences Research Center Alexander Fleming, 16672 Athens, Greece
| | - Hong Sun
- Department of Cellular Biology and Anatomy, Louisiana State University Health Sciences, Shreveport, LA 71103, USA
| | - Sumitra Miriyala
- Department of Cellular Biology and Anatomy, Louisiana State University Health Sciences, Shreveport, LA 71103, USA
| | - Manikandan Panchatcharam
- Department of Cellular Biology and Anatomy, Louisiana State University Health Sciences, Shreveport, LA 71103, USA
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Wu YF, Jin KY, Wang DP, Lin Q, Sun J, Su SH, Hai J. VEGF loaded nanofiber membranes inhibit chronic cerebral hypoperfusion-induced cognitive dysfunction by promoting HIF-1a/VEGF mediated angiogenesis. NANOMEDICINE : NANOTECHNOLOGY, BIOLOGY, AND MEDICINE 2023; 48:102639. [PMID: 36549557 DOI: 10.1016/j.nano.2022.102639] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/09/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
We investigated the potential effects and mechanisms of vascular endothelial growth factor (VEGF)-nanofiber membranes (NFMs) treatment in a rat model of chronic cerebral hypoperfusion (CCH). VEGF-NFMs treatment promoted angiogenesis in surgical temporal cortex and hippocampus, alleviating decreased CBF in these two cerebral regions. VEGF-NFMs application improved reduced NAA/Cr ratio, preventing neuronal loss. VEGF-NFMs sticking decreased the number of TUNEL-positive cells in surgical temporal cortex, ameliorated impaired synaptic plasticity, and inhibited the release of pro-inflammatory cytokines and the activation of microglia and astrocytes in surgical temporal cortex and hippocampus. Furthermore, BDNF-TrkB/PI3K/AKT, BDNF-TrkB/ERK and HIF-1a/VEGF/ERK pathways were involved in the treatment of VEGF-NFMs against CCH-induced neuronal injury. These results showed the neuroprotective effects of VEGF-NFMs sticking may initiate from neurovascular repairing followed by inhibition of neuronal apoptosis and neuronal and synaptic damage, eventually leading to the suppression of cognitive dysfunction, which provided theoretical foundation for further clinical transformation of VEGF-NFMs.
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Affiliation(s)
- Yi-Fang Wu
- Department of Neurosurgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Kai-Yan Jin
- Department of Neurosurgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Da-Peng Wang
- Department of Neurosurgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Qi Lin
- Department of Pharmacy, Institutes of Medical Sciences, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Jun Sun
- Department of Neurosurgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Shao-Hua Su
- Department of Neurosurgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China.
| | - Jian Hai
- Department of Neurosurgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China.
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Lesion size and long-term cognitive outcome after pediatric stroke: A comparison between two techniques to assess lesion size. Eur J Paediatr Neurol 2023; 42:126-132. [PMID: 36641854 DOI: 10.1016/j.ejpn.2023.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 11/25/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is little consensus on how lesion size impacts long-term cognitive outcome after pediatric arterial ischemic stroke (AIS). This study, therefore, compared two techniques to assessed lesion size in the chronic phase after AIS and determined their measurement agreement in relation to cognitive functions in patients after pediatric stroke. METHODS Twenty-five patients after pediatric AIS were examined in the chronic phase (>2 years after stroke) in respect to intelligence, memory, executive functions, visuo-motor functions, motor abilities, and disease-specific outcome. Lesion size was measured using the ABC/2 formula and segmentation technique (3D Slicer). Correlation analysis determined the association between volumetry techniques and outcome measures in respect to long-term cognitive outcome. RESULTS The measurements from the ABC/2 and segmentation technique were strongly correlated (r = 0.878, p < .001) and displayed agreement in particular for small lesions. Lesion size from both techniques was significantly correlated with disease-specific outcome (p < .001) and processing speed (p < .005) after controlling for age at stroke and multiple comparison. CONCLUSION The two techniques showed convergent validity and were both significantly correlated with long-term outcome after pediatric AIS. Compared to the time-consuming segmentation technique, ABC/2 facilitates clinical and research work as it requires relatively little time and is easy to apply.
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Mrakotsky C, Williams TS, Shapiro KA, Westmacott R. Rehabilitation in Pediatric Stroke: Cognition and Behavior. Semin Pediatr Neurol 2022; 44:100998. [PMID: 36456041 DOI: 10.1016/j.spen.2022.100998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
Abstract
Pediatric stroke is associated with a range of maladaptive cognitive and behavioral outcomes that often require targeted intervention. Despite increasing research on neuropsychological outcomes over the past decade, evidence for effective therapies and interventions for the most commonly reported cognitive and behavioral challenges is still limited. The most widely prescribed interventions address more overt deficits in sensorimotor and speech/language functions, yet interventions for higher-order cognitive, linguistic and behavioral deficits are notably less defined. Moreover, concepts of rehabilitation in adult stroke cannot be easily translated directly to pediatric populations because the effect of stroke and recovery in the developing brain takes a very different course than in the mature brain. In pediatric stroke, neuropsychological deficits often emerge gradually over time necessitating a long-term approach to intervention. Furthermore, family and school context often play a much larger role. The goal of this review is to describe cognitive and behavioral interventions for perinatal and childhood stroke, as motor rehabilitation is covered elsewhere in this issue. We also discuss cognitive aspects of current rehabilitative therapies and technology. Acknowledging the current limited state of stroke-specific rehabilitation research in children, findings from pediatric acquired brain injury intervention and use of transdiagnostic approaches lend important insights. Because there is limited support for single domain (cognitive) trainings and translation of research rehabilitation programs to clinical practice can be challenging, the value of holistic multidisciplinary approaches to improve everyday function in children and adolescents following stroke is emphasized.
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Affiliation(s)
- Christine Mrakotsky
- Departments of Neurology & Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA.
| | - Tricia S Williams
- Department of Psychology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Kevin A Shapiro
- Cortica Healthcare, Department of Neurology, Children's Hospital Los Angeles, Los Angeles, CA
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Pretzel P, Dhollander T, Chabrier S, Al-Harrach M, Hertz-Pannier L, Dinomais M, Groeschel S. Structural brain connectivity in children after neonatal stroke: A whole-brain fixel-based analysis. Neuroimage Clin 2022; 34:103035. [PMID: 35561553 PMCID: PMC9112015 DOI: 10.1016/j.nicl.2022.103035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/16/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022]
Abstract
Neonatal arterial ischemic stroke affects white matter distant from the lesion. Alterations are located ipsilesionally and in interhemispheric connections. Manual dexterity correlates with these structural impairments. The disseminated effects are therefore functionally relevant. Neonatal arterial ischemic stroke is a developmental network injury.
Introduction Neonatal arterial ischemic stroke (NAIS) has been shown to affect white matter (WM) microstructure beyond the lesion. Here, we employed fixel-based analysis, a technique which allows to model and interpret WM alterations in complex arrangements such as crossing fibers, to further characterize the long-term effects of NAIS on the entire WM outside the primary infarct area. Materials and methods 32 children (mean age 7.3 years (SD 0.4), 19 male) with middle cerebral artery NAIS (18 left hemisphere, 14 right hemisphere) and 31 healthy controls (mean age 7.7 years (SD 0.6), 16 male) underwent diffusion MRI scans and clinical examination for manual dexterity. Microstructural and macrostructural properties of the WM were investigated in a fixel-based whole-brain analysis, which allows to detect fiber-specific effects. Additionally, tract-averaged fixel metrics in interhemispheric tracts, and their correlation with manual dexterity, were examined. Results Significantly reduced microstructural properties were identified, located within the parietal and temporal WM of the affected hemisphere, as well as within their interhemispheric connecting tracts. Tract-averaged fixel metrics showed moderate, significant correlation with manual dexterity of the affected hand. No increased fixel metrics or contralesional alterations were observed. Discussion Our results show that NAIS leads to long-term alterations in WM microstructure distant from the lesion site, both within the parietal and temporal lobes as well as in their interhemispheric connections. The functional significance of these findings is demonstrated by the correlations with manual dexterity. The localization of alterations in structures highly connected to the lesioned areas shift our perception of NAIS from a focal towards a developmental network injury.
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Affiliation(s)
- Pablo Pretzel
- Department of Child Neurology, Paediatric Neuroimaging, University Hospital, Tübingen, Germany.
| | - Thijs Dhollander
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia
| | | | | | - Lucie Hertz-Pannier
- UNIACT/Neurospin/JOLIOT/DRF/CEA-Saclay, and U1141 NeuroDiderot/Inserm, CEA, Paris University, France
| | - Mickael Dinomais
- Department of Physical and Rehabilitation Medicine, University Hospital, CHU Angers, France
| | - Samuel Groeschel
- Department of Child Neurology, Paediatric Neuroimaging, University Hospital, Tübingen, Germany
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