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Rangus I, Rios AS, Horn A, Fritsch M, Khalil A, Villringer K, Udke B, Ihrke M, Grittner U, Galinovic I, Al-Fatly B, Endres M, Kufner A, Nolte CH. Fronto-thalamic networks and the left ventral thalamic nuclei play a key role in aphasia after thalamic stroke. Commun Biol 2024; 7:700. [PMID: 38849518 PMCID: PMC11161613 DOI: 10.1038/s42003-024-06399-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 05/29/2024] [Indexed: 06/09/2024] Open
Abstract
Thalamic aphasia results from focal thalamic lesions that cause dysfunction of remote but functionally connected cortical areas due to language network perturbation. However, specific local and network-level neural substrates of thalamic aphasia remain incompletely understood. Using lesion symptom mapping, we demonstrate that lesions in the left ventrolateral and ventral anterior thalamic nucleus are most strongly associated with aphasia in general and with impaired semantic and phonemic fluency and complex comprehension in particular. Lesion network mapping (using a normative connectome based on fMRI data from 1000 healthy individuals) reveals a Thalamic aphasia network encompassing widespread left-hemispheric cerebral connections, with Broca's area showing the strongest associations, followed by the superior and middle frontal gyri, precentral and paracingulate gyri, and globus pallidus. Our results imply the critical involvement of the left ventrolateral and left ventral anterior thalamic nuclei in engaging left frontal cortical areas, especially Broca's area, during language processing.
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Affiliation(s)
- Ida Rangus
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie mit Experimenteller Neurologie, Berlin, Germany.
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin (CSB), Berlin, Germany.
| | - Ana Sofia Rios
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie mit Experimenteller Neurologie, Berlin, Germany
| | - Andreas Horn
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie mit Experimenteller Neurologie, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie mit experimenteller Neurologie, Movement Disorder and Neuromodulation Unit, Berlin, Germany
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Merve Fritsch
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Psychiatrie und Psychotherapie, Berlin, Germany
| | - Ahmed Khalil
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie mit Experimenteller Neurologie, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin (CSB), Berlin, Germany
| | - Kersten Villringer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie mit Experimenteller Neurologie, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin (CSB), Berlin, Germany
| | - Birgit Udke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Audiologie und Phoniatrie, Berlin, Germany
| | - Manuela Ihrke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Audiologie und Phoniatrie, Berlin, Germany
| | - Ulrike Grittner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institut für Biometrie und klinische Epidemiologie, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ivana Galinovic
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie mit Experimenteller Neurologie, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin (CSB), Berlin, Germany
| | - Bassam Al-Fatly
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie mit experimenteller Neurologie, Movement Disorder and Neuromodulation Unit, Berlin, Germany
| | - Matthias Endres
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie mit Experimenteller Neurologie, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin (CSB), Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- German Center for Cardiovascular Research (Deutsches Zentrum für Herz Kreislauferkrankungen, DZHK), Partner Site Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, NeuroCure Cluster of Excellence, NeuroCure Clinical Research Center (NCRC), Berlin, Germany
- German Center for Neurodegenerative Diseases (Deutsches Zentrum für Neurodegenerative Erkrankungen, DZNE), Partner Site Berlin, Berlin, Germany
| | - Anna Kufner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie mit Experimenteller Neurologie, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin (CSB), Berlin, Germany
| | - Christian H Nolte
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie mit Experimenteller Neurologie, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin (CSB), Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- German Center for Cardiovascular Research (Deutsches Zentrum für Herz Kreislauferkrankungen, DZHK), Partner Site Berlin, Berlin, Germany
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Lee HS, Sohn MK, Lee J, Kim DY, Shin Y, Oh G, Lee Y, Joo MC, Lee SY, Song M, Han J, Ahn J, Kim DH, Kim Y, Chang WH. Long-Term Functional Outcome in Patients With Isolated Thalamic Stroke: The KOSCO Study. J Am Heart Assoc 2024; 13:e032377. [PMID: 38348806 PMCID: PMC11010118 DOI: 10.1161/jaha.123.032377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/12/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Information on the long-term prognosis in patients with isolated thalamic stroke is sparse. We report the functional outcomes of patients with thalamic stroke up to 24 months from the KOSCO (Korean Stroke Cohort for Functioning and Rehabilitation) study. METHODS AND RESULTS Isolated thalamic stroke was defined as the presence of lesions solely in the thalamus, excluding cases with lesions in other brain parenchyma areas apart from the thalamus, as identified by brain magnetic resonance imaging or computed tomography scans. The Fugl-Meyer Assessment, the Functional Ambulatory Category, the Korean Mini-Mental State Examination, the American Speech-Language-Hearing Association National Outcome Measurement System Swallowing Scale, and the short version of the Korean Frenchay Aphasia Screening Test were used to assess physical impairment. The Functional Independence Measure and modified Rankin Scale were used to assess functional outcomes. All measurements were conducted up to 24 months poststroke. A total of 297 patients were included, consisting of 235 with ischemic and 62 with hemorrhagic stroke. Except for the Functional Ambulatory Category and Functional Independence Measure, all physical impairments showed significant improvement up to 3 months poststroke (P<0.001) and reached a plateau. The Functional Ambulatory Category and Functional Independence Measure scores continued to improve up to 12 months poststroke (P<0.05) and reached a plateau. At 7 days poststroke, 47.5% of patients had no disability (modified Rankin Scale score<2), whereas at 24 months poststroke, 76.4% of patients had no significant disability. CONCLUSIONS Patients showed rapid recovery from physical impairment up to 3 months poststroke, with additional improvements in ambulatory function and independence observed up to 12 months poststroke. Additionally, relatively favorable long-term functional prognosis at 24 months after onset was demonstrated. These results could provide insights into the proper management regarding functional outcomes of patients with isolated thalamic stroke.
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Affiliation(s)
- Ho Seok Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, College of MedicineChungnam National UniversityDaejeonRepublic of Korea
| | - Jongmin Lee
- Department of Rehabilitation MedicineKonkuk University School of MedicineSeoulRepublic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | - Yong‐Il Shin
- Department of Rehabilitation MedicinePusan National University School of Medicine, Pusan National University Yangsan HospitalYangsanRepublic of Korea
| | - Gyung‐Jae Oh
- Department of Preventive MedicineWonkwang University, School of MedicineIksanRepublic of Korea
| | - Yang‐Soo Lee
- Department of Rehabilitation Medicine, School of MedicineKyungpook National University, Kyungpook National University HospitalDaeguRepublic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation MedicineWonkwang University School of MedicineIksanRepublic of Korea
| | - So Young Lee
- Department of Rehabilitation MedicineJeju National University Hospital, Jeju National University School of MedicineJeju CityRepublic of Korea
| | - Min‐Keun Song
- Department of Physical and Rehabilitation MedicineChonnam National University Medical SchoolGwangjuRepublic of Korea
| | - Junhee Han
- Department of StatisticsHallym UniversityChuncheonRepublic of Korea
| | - Jeonghoon Ahn
- Department of Health ConvergenceEwha Womans UniversitySeoulRepublic of Korea
| | - Dae Hyun Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Yun‐Hee Kim
- Department of Physical and Rehabilitation MedicineSungkyunkwan University School of MedicineSuwonRepublic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
- Department of Health Science and Technology, Department of Medical Device Management and Research, Department of Digital Healthcare, SAIHSTSungkyunkwan UniversitySeoulRepublic of Korea
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Parker AF, Paterson TSE, Goranson T, Gawryluk JR. The Piano Man: A Case Report of Anterior Thalamic Infarct with Dementia and Preserved Music Ability. Arch Clin Neuropsychol 2024; 39:265-272. [PMID: 37699427 DOI: 10.1093/arclin/acad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVE The thalamus is the integrative hub of the brain with reciprocal connections throughout the cortex. This case report describes a right-handed 81-year-old male patient who experienced sudden onset cognitive impairment following a focal left anterior thalamic infarct. METHODS With consent/assent, the patient was seen for a short neuropsychological assessment 6 weeks post stroke. Neuropsychological assessment included review of medical history, collateral intake, the Toronto Cognitive Assessment, Frontal Systems Behavior Scale-Family Rating Form, the Neuropsychiatric Inventory Questionnaire, and piano performance. RESULTS The assessment revealed impaired performance on measures of orientation, memory, executive function, and language, as well as symptoms including hallucinations, apathy, and hypersomnolence, consistent with thalamic dementia. Remarkably, in this context, the patient maintained an ability to play piano and read music. CONCLUSIONS The case has implications for understanding the complex integrative functions of the thalamus, including how profound impairment can simultaneously present with cognitive strengths that may not be captured by performance on neuropsychological testing. This case also suggests that magnetic resonance imaging may be indicated in cases presenting with vascular risk factors and sudden onset cognitive impairment, given that computed tomography may not be sensitive to small subcortical infarcts.
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Affiliation(s)
- Ashleigh F Parker
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
| | - Theone S E Paterson
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
- Baycrest Health Sciences Centre, Toronto, Ontario, Canada
| | - Tamara Goranson
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
- Centre for Wellbeing, Victoria, British Columbia, Canada
| | - Jodie R Gawryluk
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
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Ye C, Kwapong WR, Tang B, Liu J, Tao W, Lu K, Pan R, Wang A, Liao L, Yang T, Cao L, Wang Y, Jiang S, Zhang X, Liu M, Wu B. Association between functional network connectivity, retina structure and microvasculature, and visual performance in patients after thalamic stroke: An exploratory multi-modality study. Brain Behav 2024; 14:e3385. [PMID: 38376035 PMCID: PMC10794127 DOI: 10.1002/brb3.3385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/06/2023] [Accepted: 12/21/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Neuro-ophthalmologic symptoms and retinal changes have been increasingly observed following thalamic stroke, and there is mounting evidence indicating distinct alterations occurring in the vision-related functional network. However, the intrinsic correlations between these changes are not yet fully understood. Our objective was to explore the altered patterns of functional network connectivity and retina parameters, and their correlations with visual performance in patients with thalamic stroke. METHODS We utilized resting-state functional MRI to obtain multi-modular functional connectivity (FC), and optical coherence tomography-angiography to measure various retina parameters, such as the retinal nerve fiber layer (RNFL), ganglion cell-inner plexiform layer (GCIPL), superficial vascular complex (SVC), and deep vascular complex. Visual acuity (VA) was used as a metric for visual performance. RESULTS We included 46 patients with first-ever unilateral thalamic stroke (mean age 59.74 ± 10.02 years, 33 males). Significant associations were found between FC of attention-to-default mode and SVC, RNFL, and GCIPL, as well as between FC of attention-to-visual and RNFL (p < .05). Both RNFL and GCIPL exhibited significant associations with FC of visual-to-visual (p < .05). Only GCIPL showed an association with VA (p = .038). Stratified analysis based on a disease duration of 6 months revealed distinct and significant linking patterns in multi-modular FC and specific retina parameters, with varying correlations with VA in each subgroup. CONCLUSION These findings provide valuable insight into the neural basis of the associations between brain network dysfunction and impaired visual performance in patients with thalamic stroke. Our novel findings have the potential to inform future targeted and individualized therapies. However, further comprehensive studies are necessary to validate our results.
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Affiliation(s)
- Chen Ye
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - William Robert Kwapong
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Biqiu Tang
- Department of Radiology, Huaxi MR Research Center (HMRRC)West China Hospital, Sichuan UniversityChengduChina
| | - Junfeng Liu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Wendan Tao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Kun Lu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Ruosu Pan
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Anmo Wang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Lanhua Liao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Tang Yang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Le Cao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Youjie Wang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Shuai Jiang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Xuening Zhang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Ming Liu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Bo Wu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
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Onofrj M, Russo M, Delli Pizzi S, De Gregorio D, Inserra A, Gobbi G, Sensi SL. The central role of the Thalamus in psychosis, lessons from neurodegenerative diseases and psychedelics. Transl Psychiatry 2023; 13:384. [PMID: 38092757 PMCID: PMC10719401 DOI: 10.1038/s41398-023-02691-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/06/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023] Open
Abstract
The PD-DLB psychosis complex found in Parkinson's disease (PD) and Dementia with Lewy Bodies (DLB) includes hallucinations, Somatic Symptom/Functional Disorders, and delusions. These disorders exhibit similar presentation patterns and progression. Mechanisms at the root of these symptoms also share similarities with processes promoting altered states of consciousness found in Rapid Eye Movement sleep, psychiatric disorders, or the intake of psychedelic compounds. We propose that these mechanisms find a crucial driver and trigger in the dysregulated activity of high-order thalamic nuclei set in motion by ThalamoCortical Dysrhythmia (TCD). TCD generates the loss of finely tuned cortico-cortical modulations promoted by the thalamus and unleashes the aberrant activity of the Default Mode Network (DMN). TCD moves in parallel with altered thalamic filtering of external and internal information. The process produces an input overload to the cortex, thereby exacerbating DMN decoupling from task-positive networks. These phenomena alter the brain metastability, creating dreamlike, dissociative, or altered states of consciousness. In support of this hypothesis, mind-altering psychedelic drugs also modulate thalamic-cortical pathways. Understanding the pathophysiological background of these conditions provides a conceptual bridge between neurology and psychiatry, thereby helping to generate a promising and converging area of investigation and therapeutic efforts.
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Affiliation(s)
- Marco Onofrj
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology - CAST, Institute for Advanced Biomedical Technology-ITAB University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
| | - Mirella Russo
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology - CAST, Institute for Advanced Biomedical Technology-ITAB University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Stefano Delli Pizzi
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology - CAST, Institute for Advanced Biomedical Technology-ITAB University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Danilo De Gregorio
- Division of Neuroscience, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Inserra
- Neurobiological Psychiatry Unit, McGill University, Montreal, QC, Canada
| | - Gabriella Gobbi
- Neurobiological Psychiatry Unit, McGill University, Montreal, QC, Canada
| | - Stefano L Sensi
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology - CAST, Institute for Advanced Biomedical Technology-ITAB University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
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Zhang J, Li L, Ji R, Shang D, Wen X, Hu J, Wang Y, Wu D, Zhang L, He F, Ye X, Luo B. NODDI Identifies Cognitive Associations with In Vivo Microstructural Changes in Remote Cortical Regions and Thalamocortical Pathways in Thalamic Stroke. Transl Stroke Res 2023:10.1007/s12975-023-01221-w. [PMID: 38049671 DOI: 10.1007/s12975-023-01221-w] [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: 10/26/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/06/2023]
Abstract
The roles of cerebral structures distal to isolated thalamic infarcts in cognitive deficits remain unclear. We aimed to identify the in vivo microstructural characteristics of remote gray matter (GM) and thalamic pathways and elucidate their roles across cognitive domains. Patients with isolated ischemic thalamic stroke and healthy controls underwent neuropsychological assessment and magnetic resonance imaging. Neurite orientation dispersion and density imaging (NODDI) was modeled to derive the intracellular volume fraction (VFic) and orientation dispersion index. Fiber density (FD) was determined by constrained spherical deconvolution, and tensor-derived fractional anisotropy (FA) was calculated. Voxel-wise GM analysis and thalamic pathway tractography were performed. Twenty-six patients and 26 healthy controls were included. Patients exhibited reduced VFic in remote GM regions, including ipsilesional insular and temporal subregions. The microstructural metrics VFic, FD, and FA within ipsilesional thalamic pathways decreased (false discovery rate [FDR]-p < 0.05). Noteworthy associations emerged as VFic within insular cortices (ρ = -0.791 to -0.630; FDR-p < 0.05) and FD in tracts connecting the thalamus and insula (ρ = 0.830 to 0.971; FDR-p < 0.001) were closely associated with executive function. The VFic in Brodmann area 52 (ρ = -0.839; FDR-p = 0.005) and FA within its thalamic pathway (ρ = -0.799; FDR-p = 0.003) correlated with total auditory memory scores. In conclusion, NODDI revealed neurite loss in remote normal-appearing GM regions and ipsilesional thalamic pathways in thalamic stroke. Reduced cortical dendritic density and axonal density of thalamocortical tracts in specific subregions were associated with improved cognitive functions. Subacute microstructural alterations beyond focal thalamic infarcts might reflect beneficial remodeling indicating post-stroke plasticity.
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Affiliation(s)
- Jie Zhang
- Department of Neurology, Brain Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310003, Hangzhou, China
- Center for Rehabilitation Medicine, Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, 310014, China
| | - Lingling Li
- Department of Neurology, Dongyang People's Hospital, Wenzhou Medical University, Dongyang, 322109, China
| | - Renjie Ji
- Department of Neurology, Brain Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310003, Hangzhou, China
| | - Desheng Shang
- Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Xinrui Wen
- Department of Neurology, Brain Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310003, Hangzhou, China
| | - Jun Hu
- Department of Neurology, Brain Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310003, Hangzhou, China
| | - Yingqiao Wang
- Center for Rehabilitation Medicine, Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, 310014, China
| | - Dan Wu
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, 310027, China
| | - Li Zhang
- Department of Neurology, Brain Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310003, Hangzhou, China
- Center for Rehabilitation Medicine, Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, 310014, China
| | - Fangping He
- Department of Neurology, Brain Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310003, Hangzhou, China
| | - Xiangming Ye
- Center for Rehabilitation Medicine, Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, 310014, China
| | - Benyan Luo
- Department of Neurology, Brain Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310003, Hangzhou, China.
- MOE Frontier Science Center for Brain Science & Brain-Machine Integration, Zhejiang University, Hangzhou, 310003, China.
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7
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Polito G, Russo M, Santilli M, Cantarella C, D'Aurizio C, Sensi SL. Role of neurorehabilitation in the recovery of bilateral thalamic stroke related to the artery of Percheron anatomical variant. BMJ Case Rep 2023; 16:e254872. [PMID: 37714557 PMCID: PMC10510918 DOI: 10.1136/bcr-2023-254872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
Bilateral thalamic stroke is a rare condition, mostly related to the presence of the artery of Percheron (AoP) variant. The clinical presentation of AoP-related strokes is remarkably heterogeneous and often includes cognitive and behavioural alterations. Our report describes the clinical course of an AoP-related bilateral thalamic stroke and highlights the pivotal role of a tailored rehabilitation programme plays in enhancing recovery. A man in his 40s was admitted to the neurology ward due to the abrupt onset of mental status alterations and weakness in his left limbs. The first brain CT scan and subsequent MRI exam revealed a bilateral thalamic stroke and the presence of an AoP anatomical variant. After the first critical phase, the patient's condition became stable, but he still suffered from severe attention, memory and speech deficits. The patient was then transferred to the rehabilitation unit and was subjected to a tailored neurorehabilitation programme that allowed a complete recovery of the symptoms. Neurorehabilitation plays a pivotal role in the patient's recovery and should always be pursued to minimise the residual deficits and, most importantly, to prevent permanent cognitive deficits.
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Affiliation(s)
- Gaetano Polito
- Department of Neuroscience, Imaging and Clinical Science, Università degli Studi Gabriele d'Annunzio Chieti Pescara, Chieti, Italy
| | - Mirella Russo
- Department of Neurosciences, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Matteo Santilli
- Department of Neuroscience, Imaging and Clinical Science, Università degli Studi Gabriele d'Annunzio Chieti Pescara, Chieti, Italy
| | | | | | - Stefano L Sensi
- CeSI-MeT, Center for Excellence on Aging and Translational Medicine, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
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Scharf AC, Gronewold J, Eilers A, Todica O, Moenninghoff C, Doeppner TR, de Haan B, Bassetti CL, Hermann DM. Depression and anxiety in acute ischemic stroke involving the anterior but not paramedian or inferolateral thalamus. Front Psychol 2023; 14:1218526. [PMID: 37701875 PMCID: PMC10493383 DOI: 10.3389/fpsyg.2023.1218526] [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: 05/07/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Abstract
Background and objectives Emotional and cognitive deficits are prevalent in strokes involving the thalamus. In contrast to cognitive deficits, emotional deficits have not been studied prospectively in isolated thalamic stroke. Methods In 37 ischemic thalamic stroke patients (57.0 [50.0; 69.5] years [median (Q1; Q3)], 21 males, 5 anterior, 12 paramedian, 20 inferolateral vascular territory), and 37 non-stroke control patients matched for age and sex, we prospectively examined depression, anxiety, activities of daily living, and quality of life at 1, 6, 12, and 24 months post-stroke using the Hospital-Anxiety-and-Depression Scale (HADS), Nürnberger-Alters-Alltagsaktivitäten scale (NAA), and Short Form-36 (SF36) questionnaire. Voxel-based lesion-symptom mapping (VLSM) and lesion-subtraction analyzes were performed to determine associations between questionnaire scores and thalamic stroke topography. Results At 1 month post-stroke, anterior thalamic stroke patients had higher depression scores [8.0 (7.5; 10.5)] than paramedian [4.5 (1.0; 5.8)] and inferolateral [4.0 (1.0; 7.0)] thalamic stroke patients. Furthermore, anterior thalamic stroke patients had higher anxiety scores [11.0 (8.0; 14.5)] than their matched controls [2.5 (2.0; 2.5)], paramedian [4.5 (1.0; 5.8)] and inferior [4.0 (1.0; 7.0)] thalamic stroke patients. Depression and anxiety scores in anterior thalamic stroke patients remained high across the follow-up [depression: 9.0 (3.5; 13,8); anxiety:10.05 (2.8, 14.5)].Physical health assessed by SF36 was intact in anterior [1 month post-stroke: T-score = 55.9 (37.0; 57.6)] but reduced in inferolateral [44.5(32.4; 53.1)] thalamic stroke, whereas mental health was reduced in anterior thalamic stroke [32.0 (29.8; 47.3)].VLSM confirmed that voxels in the anterior thalamus around Montreal Neurological Institute (MNI) coordinates X = -8, Y = -12, Z = 2 were more often affected by the stroke in depressed (HADS-score ≥ 8) than non-depressed (HADS-score < 8) patients and voxels around coordinates X = -10, Y = -12, Z = 2 were more often affected in anxious (HADS-score ≥ 8) than non-anxious (HADS-score < 8) patients. Conclusion Anterior, but not paramedian or inferolateral thalamic stroke was associated with depression and anxiety. Even though our results are mostly significant in the left thalamus, this observation on stroke laterality might be confounded by the fact that the right hemisphere was underrepresented in our study.
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Affiliation(s)
- Anne-Carina Scharf
- Department of Neurology, Institute of Vascular Neurology, Dementia and Ageing Research, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Janine Gronewold
- Department of Neurology, Institute of Vascular Neurology, Dementia and Ageing Research, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andres Eilers
- Department of Neurology, Institute of Vascular Neurology, Dementia and Ageing Research, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Olga Todica
- Department of Neurology, Institute of Vascular Neurology, Dementia and Ageing Research, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christoph Moenninghoff
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Thorsten R. Doeppner
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
| | - Bianca de Haan
- Division of Psychology, Department of Life Sciences, Centre for Cognitive Neuroscience, Brunel University, London, United Kingdom
| | | | - Dirk M. Hermann
- Department of Neurology, Institute of Vascular Neurology, Dementia and Ageing Research, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Gronewold J, Jokisch M, Schramm S, Himpfen H, Ginster T, Tenhagen I, Doeppner TR, Jockwitz C, Miller T, Lehmann N, Moebus S, Jöckel KH, Erbel R, Caspers S, Hermann DM. Association of regional white matter hyperintensities with hypertension and cognition in the population-based 1000BRAINS study. Eur J Neurol 2023; 30:1174-1190. [PMID: 36702775 DOI: 10.1111/ene.15716] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/05/2023] [Indexed: 01/28/2023]
Abstract
BACKGROUND White matter hyperintensities of presumed vascular origin (WMH) are frequent in cerebral magnetic resonance imaging of older people. They are promoted by vascular risk factors, especially hypertension, and are associated with cognitive deficits at the group level. It has been suggested that not only the severity, but also the location, of lesions might critically influence cognitive deficits and represent different pathologies. METHODS In 560 participants (65.2 ± 7.5 years, 51.4% males) of the population-based 1000BRAINS study, we analyzed the association of regional WMH using Fazekas scoring separately for cerebral lobes, with hypertension and cognition. RESULTS WMH most often affected the frontal lobe (83.7% score >0), followed by the parietal (75.8%), temporal (32.7%), and occipital lobe (7.3%). Higher Fazekas scores in the frontal, parietal, and temporal lobe were associated with higher blood pressure and antihypertensive treatment in unadjusted ordinal regression models and in models adjusted for age, sex, and vascular risk factors (e.g., age- and sex-adjusted odds ratio = 1.14, 95% confidence interval = 1.03-1.25 for the association of frontal lobe WMH Fazekas score with systolic blood pressure [SBP] [per 10 mm Hg]; 1.13 [1.02-1.23] for the association of parietal lobe score with SBP; 1.72 [1.19-2.48] for the association of temporal lobe score with antihypertensive medications). In linear regressions, higher frontal lobe scores were associated with lower performance in executive function and non-verbal memory, and higher parietal lobe scores were associated with lower performance in executive function, verbal-, and non-verbal memory. CONCLUSIONS Hypertension promotes WMH in the frontal, parietal, and temporal lobe. WMH in the frontal and parietal lobe are associated with reduced executive function and memory.
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Affiliation(s)
- Janine Gronewold
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Martha Jokisch
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Heiko Himpfen
- Department of Cardiology, Gastroenterology and Intensive-Care Medicine, Alfried Krupp Krankenhaus Essen, Essen, Germany
| | - Theresa Ginster
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Isabell Tenhagen
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | | | - Christiane Jockwitz
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany.,Institute for Anatomy I, Medical Faculty & University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Tatiana Miller
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany.,Institute for Anatomy I, Medical Faculty & University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Nils Lehmann
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Susanne Moebus
- Centre for Urban Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Raimund Erbel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Svenja Caspers
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany.,Institute for Anatomy I, Medical Faculty & University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Dirk M Hermann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
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Tahmi M, Kane VA, Pavol MA, Naqvi IA. Neuroimaging biomarkers of cognitive recovery after ischemic stroke. Front Neurol 2022; 13:923942. [PMID: 36588894 PMCID: PMC9796574 DOI: 10.3389/fneur.2022.923942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 11/23/2022] [Indexed: 12/15/2022] Open
Abstract
Post-stroke cognitive impairment affects more than one-third of patients after an ischemic stroke (IS). Identifying markers of potential cognitive recovery after ischemic stroke can guide patients' selection for treatments, enrollment in clinical trials, and cognitive rehabilitation methods to restore cognitive abilities in post-stroke patients. Despite the burden of post-stroke cognitive impairment, biomarkers of cognitive recovery are an understudied area of research. This narrative review summarizes and critically reviews the current literature on the use and utility of neuroimaging as a predictive biomarker of cognitive recovery after IS. Most studies included in this review utilized structural Magnetic Resonance Imaging (MRI) to predict cognitive recovery after IS; these studies highlighted baseline markers of cerebral small vessel disease and cortical atrophy as predictors of cognitive recovery. Functional Magnetic Resonance Imaging (fMRI) using resting-state functional connectivity and Diffusion Imaging are potential biomarkers of cognitive recovery after IS, although more precise predictive tools are needed. Comparison of these studies is limited by heterogeneity in cognitive assessments. For all modalities, current findings need replication in larger samples. Although no neuroimaging tool is ready for use as a biomarker at this stage, these studies suggest a clinically meaningful role for neuroimaging in predicting post-stroke cognitive recovery.
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Affiliation(s)
- Mouna Tahmi
- Department of Neurology, State University of New York Downstate Health Sciences University, New York, NY, United States
| | - Veronica A. Kane
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States
| | - Marykay A. Pavol
- Department of Neurology and Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, United States
| | - Imama A. Naqvi
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Columbia University, New York, NY, United States,*Correspondence: Imama A. Naqvi
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