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Cheng B, Forkert ND, Zavaglia M, Hilgetag CC, Golsari A, Siemonsen S, Fiehler J, Pedraza S, Puig J, Cho TH, Alawneh J, Baron JC, Ostergaard L, Gerloff C, Thomalla G. Influence of stroke infarct location on functional outcome measured by the modified rankin scale. Stroke 2014; 45:1695-702. [PMID: 24781084 DOI: 10.1161/strokeaha.114.005152] [Citation(s) in RCA: 165] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE In the early days after ischemic stroke, information on structural brain damage from MRI supports prognosis of functional outcome. It is rated widely by the modified Rankin Scale that correlates only moderately with lesion volume. We therefore aimed to elucidate the influence of lesion location from early MRI (days 2-3) on functional outcome after 1 month using voxel-based lesion symptom mapping. METHODS We analyzed clinical and MRI data of patients from a prospective European multicenter stroke imaging study (I-KNOW). Lesions were delineated on fluid-attenuated inversion recovery images on days 2 to 3 after stroke onset. We generated statistic maps of lesion contribution related to clinical outcome (modified Rankin Scale) after 1 month using voxel-based lesion symptom mapping. RESULTS Lesion maps of 101 patients with middle cerebral artery infarctions were included for analysis (right-sided stroke, 47%). Mean age was 67 years, median admission National Institutes of Health Stroke Scale was 11. Mean infarct volumes were comparable between both sides (left, 37.5 mL; right, 43.7 mL). Voxel-based lesion symptom mapping revealed areas with high influence on higher modified Rankin Scale in regions involving the corona radiata, internal capsule, and insula. In addition, asymmetrically distributed impact patterns were found involving the right inferior temporal gyrus and left superior temporal gyrus. CONCLUSIONS In this group of patients with stroke, characteristic lesion patterns in areas of motor control and areas involved in lateralized brain functions on early MRI were found to influence functional outcome. Our data provide a novel map of the impact of lesion localization on functional stroke outcome as measured by the modified Rankin Scale.
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Affiliation(s)
- Bastian Cheng
- From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.).
| | - Nils Daniel Forkert
- From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.)
| | - Melissa Zavaglia
- From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.)
| | - Claus C Hilgetag
- From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.)
| | - Amir Golsari
- From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.)
| | - Susanne Siemonsen
- From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.)
| | - Jens Fiehler
- From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.)
| | - Salvador Pedraza
- From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.)
| | - Josep Puig
- From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.)
| | - Tae-Hee Cho
- From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.)
| | - Josef Alawneh
- From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.)
| | - Jean-Claude Baron
- From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.)
| | - Leif Ostergaard
- From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.)
| | - Christian Gerloff
- From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.)
| | - Götz Thomalla
- From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.)
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