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Wang X, Duan C, Lyu J, Han D, Cheng K, Meng Z, Wu X, Chen W, Wang G, Niu Q, Li X, Bian Y, Han D, Guo W, Yang S, Wang X, Zhang T, Bi J, Wu F, Xia S, Tong D, Duan K, Li Z, Wang R, Wang J, Lou X. Impact of the Alberta Stroke Program CT Score subregions on long-term functional outcomes in acute ischemic stroke: Results from two multicenter studies in China. J Transl Int Med 2024; 12:197-208. [PMID: 38779116 PMCID: PMC11107184 DOI: 10.2478/jtim-2022-0057] [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: 11/16/2022] Open
Abstract
Background and Objectives The Alberta Stroke Program CT Score (ASPECTS) is a widely used rating system for assessing infarct extent and location. We aimed to investigate the prognostic value of ASPECTS subregions' involvement in the long-term functional outcomes of acute ischemic stroke (AIS). Materials and Methods Consecutive patients with AIS and anterior circulation large-vessel stenosis and occlusion between January 2019 and December 2020 were included. The ASPECTS score and subregion involvement for each patient was assessed using posttreatment magnetic resonance diffusion-weighted imaging. Univariate and multivariable regression analyses were conducted to identify subregions related to 3-month poor functional outcome (modified Rankin Scale scores, 3-6) in the reperfusion and medical therapy cohorts, respectively. In addition, prognostic efficiency between the region-based ASPECTS and ASPECTS score methods were compared using receiver operating characteristic curves and DeLong's test. Results A total of 365 patients (median age, 64 years; 70% men) were included, of whom 169 had poor outcomes. In the reperfusion therapy cohort, multivariable regression analyses revealed that the involvement of the left M4 cortical region in left-hemisphere stroke (adjusted odds ratio [aOR] 5.39, 95% confidence interval [CI] 1.53-19.02) and the involvement of the right M3 cortical region in right-hemisphere stroke (aOR 4.21, 95% CI 1.05-16.78) were independently associated with poor functional outcomes. In the medical therapy cohort, left-hemisphere stroke with left M5 cortical region (aOR 2.87, 95% CI 1.08-7.59) and caudate nucleus (aOR 3.14, 95% CI 1.00-9.85) involved and right-hemisphere stroke with right M3 cortical region (aOR 4.15, 95% CI 1.29-8.18) and internal capsule (aOR 3.94, 95% CI 1.22-12.78) affected were related to the increased risks of poststroke disability. In addition, region-based ASPECTS significantly improved the prognostic efficiency compared with the conventional ASPECTS score method. Conclusion The involvement of specific ASPECTS subregions depending on the affected hemisphere was associated with worse functional outcomes 3 months after stroke, and the critical subregion distribution varied by clinical management. Therefore, region-based ASPECTS could provide additional value in guiding individual decision making and neurological recovery in patients with AIS.
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Affiliation(s)
- Xinrui Wang
- Department of Radiology, Chinese PLA General Hospital, Beijing100853, China
| | - Caohui Duan
- Department of Radiology, Chinese PLA General Hospital, Beijing100853, China
| | - Jinhao Lyu
- Department of Radiology, Chinese PLA General Hospital, Beijing100853, China
| | - Dongshan Han
- Department of Radiology, Chinese PLA General Hospital, Beijing100853, China
| | - Kun Cheng
- Department of Radiology, Chinese PLA General Hospital, Beijing100853, China
| | - Zhihua Meng
- Department of Radiology, Yuebei People’s Hospital, Shaoguan512000, Guangdong Province, China
| | - Xiaoyan Wu
- Department of Radiology, Anshan Changda Hospital, Anshan114000, Liaoning Province, China
| | - Wen Chen
- Department of Radiology, Shiyan Taihe Hospital, Shiyan442000, Hubei Province, China
| | - Guohua Wang
- Department of Radiology, Qingdao Municipal Hospital, Qingdao University, Qingdao266011, Shandong Province, China
| | - Qingliang Niu
- Department of Radiology, WeiFang Traditional Chinese Hospital, Weifang261053, Shandong Province, China
| | - Xin Li
- Department of Radiology, The Second Hospital of Jilin University, Jilin University, Changchun130014, Jilin Province, China
| | - Yitong Bian
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an710061, Shaanxi Province, China
| | - Dan Han
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming650032, Yunnan Province, China
| | - Weiting Guo
- Department of Radiology, Shanxi Provincial People’s Hospital, Taiyuan030012, Shanxi Province, China
| | - Shuai Yang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha410008, Hunan Province, China
| | - Ximing Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou215006, Jiangsu Province, China
| | - Tijiang Zhang
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi Medical University, Zunyi563000, Guizhou Province, China
| | - Junying Bi
- Department of Radiology, The Third People’s Hospital of Hubei Province, Wuhan430030, Hubei Province, China
| | - Feiyun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing210029, Jiangsu Province, China
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, Nankai University, Tianjin300190, China
| | - Dan Tong
- Department of Radiology, The First Hospital of Jilin University, Jilin University, Changchun130021, Jilin Province, China
| | - Kai Duan
- Department of Radiology, Liangxiang Hospital, Beijing102401, China
| | - Zhi Li
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming650034, Yunnan Province, China
| | - Rongpin Wang
- Department of Radiology, Guizhou Provincial People’s Hospital, Guiyang550499, Guizhou Province, China
| | - Jinan Wang
- Department of Radiology, Zhongshan Hospital, Xiamen University, Xiamen361004, Fujian Province, China
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital, Beijing100853, China
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Chen H, Xu J, Lv W, Hu Z, Ke Z, Qin R, Chen Y, Xu Y. Altered morphological connectivity mediated white matter hyperintensity-related cognitive impairment. Brain Res Bull 2023; 202:110714. [PMID: 37495024 DOI: 10.1016/j.brainresbull.2023.110714] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/06/2023] [Accepted: 07/22/2023] [Indexed: 07/28/2023]
Abstract
White matter hyperintensities (WMH) are widely observed in older adults and are closely associated with cognitive impairment. However, the underlying neuroimaging mechanisms of WMH-related cognitive dysfunction remain unknown. This study recruited 61 WMH individuals with mild cognitive impairment (WMH-MCI, n = 61), 48 WMH individuals with normal cognition (WMH-NC, n = 48) and 57 healthy control (HC, n = 57) in the final analyses. We constructed morphological networks by applying the Kullback-Leibler divergence to estimate interregional similarity in the distributions of regional gray matter volume. Based on morphological networks, graph theory was applied to explore topological properties, and their relationship to WMH-related cognitive impairment was assessed. There were no differences in small-worldness, global efficiency and local efficiency. The nodal local efficiency, degree centrality and betweenness centrality were altered mainly in the limbic network (LN) and default mode network (DMN). The rich-club analysis revealed that WMH-MCI subjects showed lower average strength of the feeder and local connections than HC (feeder connections: P = 0.034; local connections: P = 0.042). Altered morphological connectivity mediated the relationship between WMH and cognition, including language (total indirect effect: -0.010; 95 % CI: -0.024, -0.002) and executive (total indirect effect: -0.010; 95 % CI: -0.028, -0.002) function. The altered topological organization of morphological networks was mainly located in the DMN and LN and was associated with WMH-related cognitive impairment. The rich-club connection was relatively preserved, while the feeder and local connections declined. The results suggest that single-subject morphological networks may capture neurological dysfunction due to WMH and could be applied to the early imaging diagnostic protocol for WMH-related cognitive impairment.
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Affiliation(s)
- Haifeng Chen
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China; Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China; Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China; Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Jingxian Xu
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Weiping Lv
- Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Nanjing, China
| | - Zheqi Hu
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zhihong Ke
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Ruomeng Qin
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China; Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China; Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Ying Chen
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yun Xu
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China; Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Nanjing, China; Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China; Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China; Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China; Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China.
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Shekari E, Nozari N. A narrative review of the anatomy and function of the white matter tracts in language production and comprehension. Front Hum Neurosci 2023; 17:1139292. [PMID: 37051488 PMCID: PMC10083342 DOI: 10.3389/fnhum.2023.1139292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/24/2023] [Indexed: 03/28/2023] Open
Abstract
Much is known about the role of cortical areas in language processing. The shift towards network approaches in recent years has highlighted the importance of uncovering the role of white matter in connecting these areas. However, despite a large body of research, many of these tracts' functions are not well-understood. We present a comprehensive review of the empirical evidence on the role of eight major tracts that are hypothesized to be involved in language processing (inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, uncinate fasciculus, extreme capsule, middle longitudinal fasciculus, superior longitudinal fasciculus, arcuate fasciculus, and frontal aslant tract). For each tract, we hypothesize its role based on the function of the cortical regions it connects. We then evaluate these hypotheses with data from three sources: studies in neurotypical individuals, neuropsychological data, and intraoperative stimulation studies. Finally, we summarize the conclusions supported by the data and highlight the areas needing further investigation.
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Affiliation(s)
- Ehsan Shekari
- Department of Neuroscience, Iran University of Medical Sciences, Tehran, Iran
| | - Nazbanou Nozari
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, United States
- Center for the Neural Basis of Cognition (CNBC), Pittsburgh, PA, United States
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Elmongui A, AbdelRazek A, Abou-Elsaad T, Belal T, Ibrahim N, Alnaghy E. Diffusion tensor imaging of dorsal stream language areas in patients with post-stroke aphasia. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-021-00690-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Aphasia complicating stroke occurs due to language deficits that decrease communication abilities and functional independence. Our study aims to assess fractional anisotropy (FA) and mean diffusivity (MD) parameters of diffusion tensor imaging (DTI) of the dorsal stream language areas in patients with post-stroke aphasia. It was conducted on 27 patients with post-stroke aphasia and 27 age- and sex-matched controls who underwent DTI of the brain. FA and MD values of Broca's area (BA), Wernick's area (WA), superior longitudinal fasciculus (SLF), and arcuate fasciculus (AF), and number of tract fibers (TF) of AF and SLF were calculated. Results were correlated with National Institutes of Health Stroke Scale (NIHSS), Arabic version of Comprehensive Aphasia Test (Arabic CAT), and Mansoura Arabic Screening Aphasia Test (MASAT).
Results
FA of AF and SLF in patients was significantly lower (P = 0.001) than controls. MD of AF and SLF in patients was significantly higher (P = 0.001) than controls. The mean volume TF of AF and SLF in patients was significantly (P = 0.001) lower than the mean volume in controls for AF and SLF. FA cutoff for AF was 0.34 and for SLF, it was 0.35 with sensitivity, specificity, and accuracy (85.2%, 62.1%, 73.2%) for AF, (74.1%, 69%, 71.4%) for SLF, respectively. MD cutoff value for AF was 0.87, and 0.84 for SLF with sensitivity, specificity, and accuracy (63%, 72.4%, 67.8%) for AF, (81.5%, 79.3%, 80.4%) for SLF, respectively. Cutoff TF of AF was 1728 and for SLF it was 601 with sensitivity, specificity, and accuracy (88.9%, 72.4%, 80.4%) for AF and (85.2%, 85.2%, 78.6%) for SLF, respectively.
Conclusions
DTI is a non-invasive promising method that can be used to assess language areas in patients with post-stroke aphasia.
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Structural Integrity and Functional Neural Activity Associated with Oral Language Function after Stroke. J Clin Med 2022; 11:jcm11113028. [PMID: 35683416 PMCID: PMC9180994 DOI: 10.3390/jcm11113028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: The impairment of language function after a stroke is common. It is unclear how the brain reorganizes for language function after cerebral infarction. The aim of this observational study is to investigate the association of structural integrity and functional neural activity with language function in aphasic patients with middle cerebral artery infarction. (2) Methods: Magnetic resonance images and scores from the Western Aphasia Battery on 20 patients were retrieved from medical records. A Voxel-wise linear regression analysis was performed using fractional anisotropy maps or the fractional amplitude of low-frequency fluctuation maps as dependent variables and scores of oral language function as independent variables while controlling for age and time elapsed after stroke. (3) Results: Spontaneous speech was positively associated with fractional anisotropy in the left dorsal stream and the right posterior corpus callosum and with the fractional amplitude of the low-frequency fluctuation of cranial nuclei in the pontomedullary junction. Comprehension was positively associated with the left ventral stream. Naming was positively associated with the left ventral stream and the bilateral occipitofrontal fasciculus, as well as with the fractional amplitude of low-frequency fluctuation of the supramarginal gyrus in the left hemisphere. (4) Conclusions: The dorsal and ventral streams are important for articulation and meaning after the reorganization of neural circuits following stroke. Subdomains of oral language function with a visual component are dependent on the visual association areas located in the right hemisphere.
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Changes in Bihemispheric Structural Connectivity Following Middle Cerebral Artery Infarction. J Pers Med 2022; 12:jpm12010081. [PMID: 35055396 PMCID: PMC8781463 DOI: 10.3390/jpm12010081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/11/2021] [Accepted: 12/15/2021] [Indexed: 02/01/2023] Open
Abstract
This study investigated the changes in the structural connectivity of the bilateral hemispheres over time following a middle cerebral artery infarction. Eighteen patients in the subacute group and nine patients in the chronic group with mild upper extremity motor impairment (Fugl-Meyer motor assessment score for the upper limb > 43) following middle cerebral artery infarction were retrospectively evaluated in this study. All the patients underwent T1-weighted and diffusion tensor imaging. Tract-based statistical analyses of fractional anisotropy were used to compare the changes in the bilateral structural connectivity with those of age-matched normal controls. The corticospinal tract pathway of the affected hemisphere, corpus callosum, and corona radiata of the unaffected hemisphere had decreased structural connectivity in the subacute group, while the motor association area and anterior corpus callosum in the bilateral frontal lobes had increased structural connectivity in the chronic group. The bilateral hemispheres were influenced even in patients with mild motor impairment following middle cerebral artery infarction, and the structural connectivity of the bilateral hemispheres changed according to the time following the stroke.
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Zhang J, Zheng W, Shang D, Chen Y, Zhong S, Ye J, Li L, Yu Y, Zhang L, Cheng R, He F, Wu D, Ye X, Luo B. Fixel-based evidence of microstructural damage in crossing pathways improves language mapping in Post-stroke aphasia. NEUROIMAGE-CLINICAL 2021; 31:102774. [PMID: 34371239 PMCID: PMC8358698 DOI: 10.1016/j.nicl.2021.102774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/16/2021] [Accepted: 07/22/2021] [Indexed: 12/28/2022]
Abstract
FBA shows greater specificity in mapping injured fibers in post-stroke aphasia. Intra-axonal volume of axons in dual streams is reduced in post-stroke aphasia. FBA could locate more precise segments associated with language defects. FBA could attribute language subdomain scores to fiber density of distinct tracts.
Background The complex crossing-fiber characteristics in the dual-stream system have been ignored by traditional diffusion tensor models regarding disconnections in post-stroke aphasia. It is valuable to identify microstructural damage of crossing-fiber pathways and reveal accurate fiber-specific language mapping in patients with aphasia. Methods This cross-sectional study collected magnetic resonance imaging data from 29 participants with post-stroke aphasia in the subacute stage and from 33 age- and sex-matched healthy controls. Fixel-based analysis was performed to examine microstructural fiber density (FD) and bundle cross-section alterations of specific fiber populations in crossing-fiber regions. Group comparisons were performed, and relationships with language scores were assessed. Results The aphasic group exhibited significant fixel-wise FD reductions in the dual-stream tracts, including the left inferior fronto-occipital fasciculus (IFOF), arcuate fasciculus, and superior longitudinal fasciculus (SLF) III (family-wise-error-corrected p < 0.05). Voxel- and fixel-wise comparisons revealed mismatched distributions in regions with crossing-fiber nexuses. Fixel-wise correlation analyses revealed significant associations between comprehension impairment and reduced FD in the temporal and frontal segments of the left IFOF, and also mapped naming ability to the IFOF. Average features along the whole course of dominant tracts assessed with tract-wise analyses attributed word-level comprehension to the IFOF (r = 0.723, p < 0.001) and revealed a trend-level correlation between sentence-level comprehension and FD of the SLF III (r = 0.451, p = 0.021). The mean FD of the uncinate fasciculus (UF) and IFOF correlated with total and picture naming scores, and the IFOF also correlated with responsive naming subdomains (Bonferroni corrected p < 0.05). Conclusions FD reductions of dual streams suggest that intra-axonal volume reduction constitutes the microstructural damage of white matter integrity in post-stroke aphasia. Fixel-based analysis provides a complementary method of language mapping that identifies fiber-specific tracts in the left hemisphere language network with greater specificity than voxel-based analysis. It precisely locates the precise segments of the IFOF for comprehension, yields fiber-specific evidence for the debated UF-naming association, and reveals dissociative subdomain associations with distinct tracts.
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Affiliation(s)
- Jie Zhang
- Department of Neurology & Brain Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Rehabilitation Medicine Center & Rehabilitation Research Institute of Zhejiang Province, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Weihao Zheng
- School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Desheng Shang
- Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yating Chen
- Rehabilitation Medicine Center & Rehabilitation Research Institute of Zhejiang Province, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Shuchang Zhong
- Rehabilitation Medicine Center & Rehabilitation Research Institute of Zhejiang Province, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Jing Ye
- Rehabilitation Medicine Center & Rehabilitation Research Institute of Zhejiang Province, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Lingling Li
- Department of Neurology & Brain Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yamei Yu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Li Zhang
- Rehabilitation Medicine Center & Rehabilitation Research Institute of Zhejiang Province, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Ruidong Cheng
- Rehabilitation Medicine Center & Rehabilitation Research Institute of Zhejiang Province, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Fangping He
- Department of Neurology & Brain Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dan Wu
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Xiangming Ye
- Rehabilitation Medicine Center & Rehabilitation Research Institute of Zhejiang Province, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Benyan Luo
- Department of Neurology & Brain Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Collaborative Innovation Center for Brain Science, Zhejiang University School of Medicine, China.
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Lee HA, Kim DH. Brain Connectivity Affecting Gait Function After Unilateral Supratentorial Stroke. Brain Sci 2021; 11:brainsci11070870. [PMID: 34210030 PMCID: PMC8301903 DOI: 10.3390/brainsci11070870] [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: 06/09/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022] Open
Abstract
Gait dysfunction is a leading cause of long-term disability after stroke. The mechanisms underlying recovery of gait function are unknown. We retrospectively evaluated the association between structural connectivity and gait function in 127 patients with unilateral supratentorial stroke (>1 month after stroke). All patients underwent T1-weighted, diffusion tensor imaging and functional ambulation categorization. Voxel-wise linear regression analyses of the images were conducted using fractional anisotropy, mean diffusivity, and mode of anisotropy mapping as dependent variables, while the functional ambulation category was used as an independent variable with age and days after stroke as covariates. The functional ambulation category was positively associated with increased fractional anisotropy in the lesioned cortico-ponto-cerebellar system, corona radiata of the non-lesioned corticospinal tract pathway, bilateral medial lemniscus in the brainstem, and the corpus callosum. The functional ambulation category was also positively associated with increased mode of anisotropy in the lesioned posterior corpus callosum. In conclusion, structural connectivity associated with motor coordination and feedback affects gait function after stroke. Diffusion tensor imaging for evaluating structural connectivity can help to predict gait recovery and target rehabilitation goals after stroke.
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Affiliation(s)
- Hyun-Ah Lee
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul 05368, Korea;
| | - Dae-Hyun Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
- Correspondence: ; Tel.: +82-2-2228-3724
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Kim DH, Kang CS, Kyeong S. Robot-assisted gait training promotes brain reorganization after stroke: A randomized controlled pilot study. NeuroRehabilitation 2020; 46:483-489. [DOI: 10.3233/nre-203054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Dae Hyun Kim
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea
| | - Chang Soon Kang
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea
| | - Sohyun Kyeong
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea
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Hara S, Seida M, Kumagai K, Yamamoto T. Beneficial Effect of Carotid Artery Stenting on Cerebral Hemodynamic Impairment and Cognitive Function. Neurol Med Chir (Tokyo) 2019; 60:66-74. [PMID: 31748442 PMCID: PMC7040432 DOI: 10.2176/nmc.oa.2019-0147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to evaluate the effects of the carotid artery stenting (CAS) procedure on cerebral hemodynamics and cognitive performance in patients with internal carotid artery stenosis. In this prospective observational study, 16 consecutive patients in a single institute were treated with CAS from 2010 to 2011 (71.7 ± 7.3 years old, 12 males, and six left-sided procedures). Before and after the CAS procedure, all patients were evaluated with single photon emission computed tomography using 123
I-iodoamphetamine and acetazolamide as well as the Weschler Adult Intelligent Scale (WAIS) to assess three intelligent quotients and four indexes. Patients with decreased preprocedural cerebral blood flow (CBF) and cerebrovascular reserve (CVR) experienced significant increases in CBF and CVR (P = 0.01 and 0.03). Twelve (75%) patients experienced a significant increase in one or more WAIS scores, while two (13%) showed a significant decrease. The most frequently improved scores were the Working Memory Index and Processing Speed Index (seven patients/44%). Preprocedural CBF was significantly correlated with the Full-scale and Performance Intelligent Quotients (r = 0.51–0.56, P = 0.02–0.04), and patients who experienced a significant increase in these scores had larger increases in CVR than patients with unchanged scores (P = 0.0097–0.019). These results indicate that the CAS procedure improved impaired cerebral hemodynamics and might benefit the cognitive function of patients with internal carotid artery stenosis related to impaired cerebral hemodynamics.
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Affiliation(s)
- Shoko Hara
- Department of Neurosurgery, Toshima Hospital, Tokyo Metropolitan Health and Hospitals Corporation
| | - Mitsuru Seida
- Department of Neurosurgery, Toshima Hospital, Tokyo Metropolitan Health and Hospitals Corporation
| | - Kotaro Kumagai
- Department of Neurosurgery, Toshima Hospital, Tokyo Metropolitan Health and Hospitals Corporation
| | - Takahiro Yamamoto
- Department of Neurosurgery, Toshima Hospital, Tokyo Metropolitan Health and Hospitals Corporation
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