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Salim H, Lakhani DA, Balar A, Musmar B, Adeeb N, Hoseinyazdi M, Luna L, Deng F, Hyson NZ, Mei J, Dmytriw AA, Guenego A, Faizy TD, Heit JJ, Albers GW, Urrutia VC, Llinas R, Marsh EB, Hillis AE, Nael K, Yedavalli V. Follow-up infarct volume on fluid attenuated inversion recovery (FLAIR) imaging in distal medium vessel occlusions: the role of cerebral blood volume index. J Neurol 2024; 271:3389-3397. [PMID: 38507075 DOI: 10.1007/s00415-024-12279-3] [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: 01/24/2024] [Revised: 02/22/2024] [Accepted: 02/25/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Distal medium vessel occlusions (DMVOs) contribute substantially to the incidence of acute ischemic strokes (AIS) and pose distinct challenges in clinical management and prognosis. Neuroimaging techniques, such as Fluid Attenuation Inversion Recovery (FLAIR) imaging and cerebral blood volume (CBV) index derived from perfusion imaging, have significantly improved our ability to assess the impact of strokes and predict their outcomes. The primary objective of this study was to investigate relationship between follow-up infarct volume (FIV) as assessed by FLAIR imaging in patients with DMVOs. METHODS This prospectively collected, retrospective reviewed cohort study included patients from two comprehensive stroke centers within the Johns Hopkins Medical Enterprise, spanning August 2018-October 2022. The cohort consisted of adults with AIS attributable to DMVO. Detailed imaging analyses were conducted, encompassing non-contrast CT, CT angiography (CTA), CT perfusion (CTP), and FLAIR imaging. Univariable and multivariable linear regression models were employed to assess the association between different factors and FIV. RESULTS The study included 79 patients with DMVO stroke with a median age of 69 years (IQR, 62-77 years), and 57% (n = 45) were female. There was a negative correlation between the CBV index and FIV in a univariable linear regression analysis (Beta = - 16; 95% CI, - 23 to - 8.3; p < 0.001) and a multivariable linear regression model (Beta = - 9.1 per 0.1 change; 95% CI, - 15 to - 2.7; p = 0.006). Diabetes was independently associated with larger FIV (Beta = 46; 95% CI, 16 to 75; p = 0.003). Additionally, a higher baseline ASPECTS was associated with lower FIV (Beta = - 30; 95% CI, - 41 to - 20; p < 0.001). CONCLUSION Our findings underscore the CBV index as an independent association with FIV in DMVOs, which highlights the critical role of collateral circulation in determining stroke outcomes in this patient population. In addition, our study confirms a negative association of ASPECTS with FLAIR FIV and identifies diabetes as independent factor associated with larger FIV. These insights pave the way for further large-scale, prospective studies to corroborate these findings, thereby refining the strategies for stroke prognostication and management.
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Affiliation(s)
- Hamza Salim
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Dhairya A Lakhani
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA
| | - Aneri Balar
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA
| | - Basel Musmar
- Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Baton Rouge, LA, USA
| | - Nimer Adeeb
- Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Baton Rouge, LA, USA
| | - Meisam Hoseinyazdi
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA
| | - Licia Luna
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA
| | - Francis Deng
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA
| | - Nathan Z Hyson
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA
| | - Janet Mei
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Adrien Guenego
- Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
| | - Tobias D Faizy
- Department of Radiology, Neuroendovascular Program, University Medical Center, Münster, Germany
| | - Jeremy J Heit
- Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA
| | - Gregory W Albers
- Department of Neurology, Stanford Medical Center, Palo Alto, CA, USA
| | - Victor C Urrutia
- Department of Neurology, Johns Hopkins Medical Center, Baltimore, MD, USA
| | - Raf Llinas
- Department of Neurology, Johns Hopkins Medical Center, Baltimore, MD, USA
| | - Elisabeth B Marsh
- Department of Neurology, Johns Hopkins Medical Center, Baltimore, MD, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins Medical Center, Baltimore, MD, USA
| | - Kambiz Nael
- University of California San Francisco, San Francisco, CA, USA
| | - Vivek Yedavalli
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
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Zhang JJ, Sánchez Vidaña DI, Chan JNM, Hui ESK, Lau KK, Wang X, Lau BWM, Fong KNK. Biomarkers for prognostic functional recovery poststroke: A narrative review. Front Cell Dev Biol 2023; 10:1062807. [PMID: 36699006 PMCID: PMC9868572 DOI: 10.3389/fcell.2022.1062807] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Background and objective: Prediction of poststroke recovery can be expressed by prognostic biomarkers that are related to the pathophysiology of stroke at the cellular and molecular level as well as to the brain structural and functional reserve after stroke at the systems neuroscience level. This study aimed to review potential biomarkers that can predict poststroke functional recovery. Methods: A narrative review was conducted to qualitatively summarize the current evidence on biomarkers used to predict poststroke functional recovery. Results: Neurophysiological measurements and neuroimaging of the brain and a wide diversity of molecules had been used as prognostic biomarkers to predict stroke recovery. Neurophysiological studies using resting-state electroencephalography (EEG) revealed an interhemispheric asymmetry, driven by an increase in low-frequency oscillation and a decrease in high-frequency oscillation in the ipsilesional hemisphere relative to the contralesional side, which was indicative of individual recovery potential. The magnitude of somatosensory evoked potentials and event-related desynchronization elicited by movement in task-related EEG was positively associated with the quantity of recovery. Besides, transcranial magnetic stimulation (TMS) studies revealed the potential values of using motor-evoked potentials (MEP) and TMS-evoked EEG potentials from the ipsilesional motor cortex as prognostic biomarkers. Brain structures measured using magnetic resonance imaging (MRI) have been implicated in stroke outcome prediction. Specifically, the damage to the corticospinal tract (CST) and anatomical motor connections disrupted by stroke lesion predicted motor recovery. In addition, a wide variety of molecular, genetic, and epigenetic biomarkers, including hemostasis, inflammation, tissue remodeling, apoptosis, oxidative stress, infection, metabolism, brain-derived, neuroendocrine, and cardiac biomarkers, etc., were associated with poor functional outcomes after stroke. However, challenges such as mixed evidence and analytical concerns such as specificity and sensitivity have to be addressed before including molecular biomarkers in routine clinical practice. Conclusion: Potential biomarkers with prognostic values for the prediction of functional recovery after stroke have been identified; however, a multimodal approach of biomarkers for prognostic prediction has rarely been studied in the literature. Future studies may incorporate a combination of multiple biomarkers from big data and develop algorithms using data mining methods to predict the recovery potential of patients after stroke in a more precise way.
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Affiliation(s)
- Jack Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | | | - Jackie Ngai-Man Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Edward S. K. Hui
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Xin Wang
- Department of Rehabilitation Medicine, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Benson W. M. Lau
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Kenneth N. K. Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Kaiser EE, Waters ES, Yang X, Fagan MM, Scheulin KM, Sneed SE, Cheek SR, Jeon JH, Shin SK, Kinder HA, Kumar A, Platt SR, Duberstein KJ, Park HJ, Xie J, West FD. Tanshinone IIA-Loaded Nanoparticle and Neural Stem Cell Therapy Enhances Recovery in a Pig Ischemic Stroke Model. Stem Cells Transl Med 2022; 11:1061-1071. [PMID: 36124817 PMCID: PMC9585947 DOI: 10.1093/stcltm/szac062] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/17/2022] [Indexed: 12/30/2022] Open
Abstract
Induced pluripotent stem cell-derived neural stem cells (iNSCs) are a multimodal stroke therapeutic that possess neuroprotective, regenerative, and cell replacement capabilities post-ischemia. However, long-term engraftment and efficacy of iNSCs is limited by the cytotoxic microenvironment post-stroke. Tanshinone IIA (Tan IIA) is a therapeutic that demonstrates anti-inflammatory and antioxidative effects in rodent ischemic stroke models and stroke patients. Therefore, pretreatment with Tan IIA may create a microenvironment that is more conducive to the long-term survival of iNSCs. In this study, we evaluated the potential of Tan IIA drug-loaded nanoparticles (Tan IIA-NPs) to improve iNSC engraftment and efficacy, thus potentially leading to enhanced cellular, tissue, and functional recovery in a translational pig ischemic stroke model. Twenty-two pigs underwent middle cerebral artery occlusion (MCAO) and were randomly assigned to a PBS + PBS, PBS + iNSC, or Tan IIA-NP + iNSC treatment group. Magnetic resonance imaging (MRI), modified Rankin Scale neurological evaluation, and immunohistochemistry were performed over a 12-week study period. Immunohistochemistry indicated pretreatment with Tan IIA-NPs increased iNSC survivability. Furthermore, Tan IIA-NPs increased iNSC neuronal differentiation and decreased iNSC reactive astrocyte differentiation. Tan IIA-NP + iNSC treatment enhanced endogenous neuroprotective and regenerative activities by decreasing the intracerebral cellular immune response, preserving endogenous neurons, and increasing neuroblast formation. MRI assessments revealed Tan IIA-NP + iNSC treatment reduced lesion volumes and midline shift. Tissue preservation and recovery corresponded with significant improvements in neurological recovery. This study demonstrated pretreatment with Tan IIA-NPs increased iNSC engraftment, enhanced cellular and tissue recovery, and improved neurological function in a translational pig stroke model.
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Affiliation(s)
- Erin E Kaiser
- Regenerative Bioscience Center, Athens, GA, USA
- Biomedical and Health Sciences Institute, Athens, GA, USA
- Animal and Dairy Science Department, College of Agricultural and Environmental Sciences, Athens, GA, USA
| | - Elizabeth S Waters
- Regenerative Bioscience Center, Athens, GA, USA
- Biomedical and Health Sciences Institute, Athens, GA, USA
- Animal and Dairy Science Department, College of Agricultural and Environmental Sciences, Athens, GA, USA
- Environmental Health Science Department, College of Public Health, Athens, GA, USA
| | - Xueyuan Yang
- Chemistry Department, Franklin College of Arts and Sciences, Athens, GA, USA
| | - Madison M Fagan
- Regenerative Bioscience Center, Athens, GA, USA
- Biomedical and Health Sciences Institute, Athens, GA, USA
- Animal and Dairy Science Department, College of Agricultural and Environmental Sciences, Athens, GA, USA
| | - Kelly M Scheulin
- Regenerative Bioscience Center, Athens, GA, USA
- Biomedical and Health Sciences Institute, Athens, GA, USA
- Animal and Dairy Science Department, College of Agricultural and Environmental Sciences, Athens, GA, USA
| | - Sydney E Sneed
- Regenerative Bioscience Center, Athens, GA, USA
- Animal and Dairy Science Department, College of Agricultural and Environmental Sciences, Athens, GA, USA
| | | | - Julie Heejin Jeon
- Nutritional Sciences Department, College of Family and Consumer Sciences, Athens, GA, USA
| | - Soo K Shin
- Regenerative Bioscience Center, Athens, GA, USA
- Animal and Dairy Science Department, College of Agricultural and Environmental Sciences, Athens, GA, USA
- Small Animal Medicine and Surgery Department, College of Veterinary Medicine, Athens, GA, USA
| | - Holly A Kinder
- Regenerative Bioscience Center, Athens, GA, USA
- Biomedical and Health Sciences Institute, Athens, GA, USA
- Animal and Dairy Science Department, College of Agricultural and Environmental Sciences, Athens, GA, USA
| | - Anil Kumar
- Chemistry Department, Franklin College of Arts and Sciences, Athens, GA, USA
| | - Simon R Platt
- Regenerative Bioscience Center, Athens, GA, USA
- Interdisciplinary Toxicology Program, College of Pharmacy, University of Georgia, Athens, GA, USA
| | - Kylee J Duberstein
- Regenerative Bioscience Center, Athens, GA, USA
- Animal and Dairy Science Department, College of Agricultural and Environmental Sciences, Athens, GA, USA
| | - Hea Jin Park
- Nutritional Sciences Department, College of Family and Consumer Sciences, Athens, GA, USA
| | - Jin Xie
- Regenerative Bioscience Center, Athens, GA, USA
- Chemistry Department, Franklin College of Arts and Sciences, Athens, GA, USA
| | - Franklin D West
- Regenerative Bioscience Center, Athens, GA, USA
- Biomedical and Health Sciences Institute, Athens, GA, USA
- Animal and Dairy Science Department, College of Agricultural and Environmental Sciences, Athens, GA, USA
- Small Animal Medicine and Surgery Department, College of Veterinary Medicine, Athens, GA, USA
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Kim Y, Khose S, Zaidat OO, Hassan AE, Fifi JT, Nanda A, Atchie B, Woodward B, Doerfler A, Tomasello A, Yoo AJ, Sheth SA. Duration of Ischemia Affects Outcomes Independent of Infarct Size in Stroke. STROKE (HOBOKEN, N.J.) 2022; 2:e000163. [PMID: 37377482 PMCID: PMC10296784 DOI: 10.1161/svin.121.000163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 02/09/2022] [Indexed: 06/29/2023]
Abstract
BACKGROUND Delays in endovascular reperfusion for patients with large vessel occlusion stroke are known to worsen outcomes, and the mechanism is believed to be time-dependent expansion of the ischemic infarction. In this study, we hypothesize that delays in onset to reperfusion (OTR) assert an effect on outcomes independent of effects of final infarct (FI). METHODS We performed a subgroup analysis from the prospective multicenter COMPLETE (International Acute Ischemic Stroke Registry With the Penumbra System Aspiration Including the 3D Revascularization Device; Penumbra, Inc) registry for 257 patients with anterior circulation large vessel occlusion who underwent endovascular therapy with successful reperfusion (modified treatment in cerebral infarction score 2b/3). FI was measured by Alberta Stroke Program Early CT score and volume on 24- to 48-hour computed tomography or magnetic resonance imaging. The likelihood of 90-day good functional outcome (modified Rankin scale 0-2) was assessed by OTR and absolute risk difference (ARD) was estimated using multivariable logistic regressions adjusting for patient characteristics including FI. RESULTS In univariable analysis, longer OTR was associated with a decreased likelihood of good functional outcome (ARD -3% [95% CI -4.5 to -1.0]/h delay). In multivariable analysis accounting for FI, the association between OTR and functional outcome remained significant (ARD -2% [95% CI -3.5 to -0.4]/h delay) with similar ARD. This finding was maintained in the subset of patients with FI imaging using CT only, using Alberta Stroke Program Early CT Score or volumetric FI measurements, and also in patients with larger versus smaller FIs. CONCLUSIONS The impact of OTR on outcomes appears to be mostly through a mechanism that is independent of FI. Our findings suggest that although the field has moved toward imaging infarct core definitions of eligibility for endovascular treatment, time remains an important predictor of outcome, independent of infarct core.
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Affiliation(s)
- Youngran Kim
- Department of Neurology, UTHealth McGovern Medical School, Houston, TX (Y.K., S.K., S.A.S.); Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Department of Neurology, University of Texas Rio Grande Valley, Harlingen, TX (A.E.H.); Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.T.F.); University of Missouri, Columbia, MO (A.N.); Department of Radiology, Swedish Medical Center, Englewood, CO (B.A.); Vista Radiology, Knoxville, TN (B.W.); Department of Neuroradiology, University of Erlangen-Nuremberg, Germany (A.D.); Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain (A.T.); Texas Stroke Institute, Dallas-Fort Worth, TX (A.J.Y.)
| | - Swapnil Khose
- Department of Neurology, UTHealth McGovern Medical School, Houston, TX (Y.K., S.K., S.A.S.); Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Department of Neurology, University of Texas Rio Grande Valley, Harlingen, TX (A.E.H.); Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.T.F.); University of Missouri, Columbia, MO (A.N.); Department of Radiology, Swedish Medical Center, Englewood, CO (B.A.); Vista Radiology, Knoxville, TN (B.W.); Department of Neuroradiology, University of Erlangen-Nuremberg, Germany (A.D.); Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain (A.T.); Texas Stroke Institute, Dallas-Fort Worth, TX (A.J.Y.)
| | - Osama O Zaidat
- Department of Neurology, UTHealth McGovern Medical School, Houston, TX (Y.K., S.K., S.A.S.); Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Department of Neurology, University of Texas Rio Grande Valley, Harlingen, TX (A.E.H.); Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.T.F.); University of Missouri, Columbia, MO (A.N.); Department of Radiology, Swedish Medical Center, Englewood, CO (B.A.); Vista Radiology, Knoxville, TN (B.W.); Department of Neuroradiology, University of Erlangen-Nuremberg, Germany (A.D.); Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain (A.T.); Texas Stroke Institute, Dallas-Fort Worth, TX (A.J.Y.)
| | - Ameer E Hassan
- Department of Neurology, UTHealth McGovern Medical School, Houston, TX (Y.K., S.K., S.A.S.); Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Department of Neurology, University of Texas Rio Grande Valley, Harlingen, TX (A.E.H.); Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.T.F.); University of Missouri, Columbia, MO (A.N.); Department of Radiology, Swedish Medical Center, Englewood, CO (B.A.); Vista Radiology, Knoxville, TN (B.W.); Department of Neuroradiology, University of Erlangen-Nuremberg, Germany (A.D.); Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain (A.T.); Texas Stroke Institute, Dallas-Fort Worth, TX (A.J.Y.)
| | - Johanna T Fifi
- Department of Neurology, UTHealth McGovern Medical School, Houston, TX (Y.K., S.K., S.A.S.); Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Department of Neurology, University of Texas Rio Grande Valley, Harlingen, TX (A.E.H.); Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.T.F.); University of Missouri, Columbia, MO (A.N.); Department of Radiology, Swedish Medical Center, Englewood, CO (B.A.); Vista Radiology, Knoxville, TN (B.W.); Department of Neuroradiology, University of Erlangen-Nuremberg, Germany (A.D.); Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain (A.T.); Texas Stroke Institute, Dallas-Fort Worth, TX (A.J.Y.)
| | - Ashish Nanda
- Department of Neurology, UTHealth McGovern Medical School, Houston, TX (Y.K., S.K., S.A.S.); Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Department of Neurology, University of Texas Rio Grande Valley, Harlingen, TX (A.E.H.); Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.T.F.); University of Missouri, Columbia, MO (A.N.); Department of Radiology, Swedish Medical Center, Englewood, CO (B.A.); Vista Radiology, Knoxville, TN (B.W.); Department of Neuroradiology, University of Erlangen-Nuremberg, Germany (A.D.); Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain (A.T.); Texas Stroke Institute, Dallas-Fort Worth, TX (A.J.Y.)
| | - Benjamin Atchie
- Department of Neurology, UTHealth McGovern Medical School, Houston, TX (Y.K., S.K., S.A.S.); Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Department of Neurology, University of Texas Rio Grande Valley, Harlingen, TX (A.E.H.); Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.T.F.); University of Missouri, Columbia, MO (A.N.); Department of Radiology, Swedish Medical Center, Englewood, CO (B.A.); Vista Radiology, Knoxville, TN (B.W.); Department of Neuroradiology, University of Erlangen-Nuremberg, Germany (A.D.); Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain (A.T.); Texas Stroke Institute, Dallas-Fort Worth, TX (A.J.Y.)
| | - Britton Woodward
- Department of Neurology, UTHealth McGovern Medical School, Houston, TX (Y.K., S.K., S.A.S.); Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Department of Neurology, University of Texas Rio Grande Valley, Harlingen, TX (A.E.H.); Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.T.F.); University of Missouri, Columbia, MO (A.N.); Department of Radiology, Swedish Medical Center, Englewood, CO (B.A.); Vista Radiology, Knoxville, TN (B.W.); Department of Neuroradiology, University of Erlangen-Nuremberg, Germany (A.D.); Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain (A.T.); Texas Stroke Institute, Dallas-Fort Worth, TX (A.J.Y.)
| | - Arnd Doerfler
- Department of Neurology, UTHealth McGovern Medical School, Houston, TX (Y.K., S.K., S.A.S.); Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Department of Neurology, University of Texas Rio Grande Valley, Harlingen, TX (A.E.H.); Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.T.F.); University of Missouri, Columbia, MO (A.N.); Department of Radiology, Swedish Medical Center, Englewood, CO (B.A.); Vista Radiology, Knoxville, TN (B.W.); Department of Neuroradiology, University of Erlangen-Nuremberg, Germany (A.D.); Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain (A.T.); Texas Stroke Institute, Dallas-Fort Worth, TX (A.J.Y.)
| | - Alejandro Tomasello
- Department of Neurology, UTHealth McGovern Medical School, Houston, TX (Y.K., S.K., S.A.S.); Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Department of Neurology, University of Texas Rio Grande Valley, Harlingen, TX (A.E.H.); Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.T.F.); University of Missouri, Columbia, MO (A.N.); Department of Radiology, Swedish Medical Center, Englewood, CO (B.A.); Vista Radiology, Knoxville, TN (B.W.); Department of Neuroradiology, University of Erlangen-Nuremberg, Germany (A.D.); Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain (A.T.); Texas Stroke Institute, Dallas-Fort Worth, TX (A.J.Y.)
| | - Albert J Yoo
- Department of Neurology, UTHealth McGovern Medical School, Houston, TX (Y.K., S.K., S.A.S.); Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Department of Neurology, University of Texas Rio Grande Valley, Harlingen, TX (A.E.H.); Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.T.F.); University of Missouri, Columbia, MO (A.N.); Department of Radiology, Swedish Medical Center, Englewood, CO (B.A.); Vista Radiology, Knoxville, TN (B.W.); Department of Neuroradiology, University of Erlangen-Nuremberg, Germany (A.D.); Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain (A.T.); Texas Stroke Institute, Dallas-Fort Worth, TX (A.J.Y.)
| | - Sunil A Sheth
- Department of Neurology, UTHealth McGovern Medical School, Houston, TX (Y.K., S.K., S.A.S.); Neuroscience Institute, Mercy Health St. Vincent Medical Center, Toledo, OH (O.O.Z.); Department of Neurology, University of Texas Rio Grande Valley, Harlingen, TX (A.E.H.); Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.T.F.); University of Missouri, Columbia, MO (A.N.); Department of Radiology, Swedish Medical Center, Englewood, CO (B.A.); Vista Radiology, Knoxville, TN (B.W.); Department of Neuroradiology, University of Erlangen-Nuremberg, Germany (A.D.); Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain (A.T.); Texas Stroke Institute, Dallas-Fort Worth, TX (A.J.Y.)
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Imura T, Mitsutake T, Hori T, Tanaka R. Predicting the prognosis of unilateral spatial neglect using magnetic resonance imaging in patients with stroke: A systematic review. Brain Res 2022; 1789:147954. [DOI: 10.1016/j.brainres.2022.147954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 11/24/2022]
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The Comparison and Interpretation of Machine-Learning Models in Post-Stroke Functional Outcome Prediction. Diagnostics (Basel) 2021; 11:diagnostics11101784. [PMID: 34679482 PMCID: PMC8534424 DOI: 10.3390/diagnostics11101784] [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: 08/26/2021] [Revised: 09/18/2021] [Accepted: 09/23/2021] [Indexed: 11/24/2022] Open
Abstract
Prediction of post-stroke functional outcomes is crucial for allocating medical resources. In this study, a total of 577 patients were enrolled in the Post-Acute Care-Cerebrovascular Disease (PAC-CVD) program, and 77 predictors were collected at admission. The outcome was whether a patient could achieve a Barthel Index (BI) score of >60 upon discharge. Eight machine-learning (ML) methods were applied, and their results were integrated by stacking method. The area under the curve (AUC) of the eight ML models ranged from 0.83 to 0.887, with random forest, stacking, logistic regression, and support vector machine demonstrating superior performance. The feature importance analysis indicated that the initial Berg Balance Test (BBS-I), initial BI (BI-I), and initial Concise Chinese Aphasia Test (CCAT-I) were the top three predictors of BI scores at discharge. The partial dependence plot (PDP) and individual conditional expectation (ICE) plot indicated that the predictors’ ability to predict outcomes was the most pronounced within a specific value range (e.g., BBS-I < 40 and BI-I < 60). BI at discharge could be predicted by information collected at admission with the aid of various ML models, and the PDP and ICE plots indicated that the predictors could predict outcomes at a certain value range.
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Troiani Z, Ascanio L, Rossitto CP, Ali M, Mohammadi N, Majidi S, Mocco J, Kellner CP. Prognostic Utility of Serum Biomarkers in Intracerebral Hemorrhage: A Systematic Review. Neurorehabil Neural Repair 2021; 35:946-959. [PMID: 34541960 DOI: 10.1177/15459683211041314] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background. Intracerebral hemorrhage (ICH) accounts for 10-20% of all strokes and is associated with high morbidity and mortality. Recent studies have identified serum biomarkers as a means to improve outcome prognostication in poor grade ICH patients. Poor prognosis of ICH patients and complex pathophysiology of the disease necessitate prognostic serum biomarkers to help guide treatment recommendations. Objective. The objective is to systematically review all biomarkers used to predict long-term functional outcome in patients with spontaneous intracerebral hemorrhage. Results. We identified 36 studies investigating the predictive utility of 50 discrete biomarkers. Data from 4865 ICH patients were reviewed. Inflammatory biomarkers (11/50) were most often studied, followed by oxidative (8/50), then neuron and astrocyte-specific (7/50). S100 calcium binding protein B, white blood cell count, and copeptin were the most often studied individual biomarkers. The prognostic utility of 23 biomarkers was analyzed using receiver operating characteristic curves. Area under the curve (AUC) values for all available biomarkers except neutrophil/lymphocyte ratio were acceptable. Twenty of the 23 biomarkers were characterized by at least one excellent AUC value. Vascular endothelial growth factor, glial fibrillary astrocyte protein, and S100 calcium binding protein B were characterized by outstanding AUC. Conclusions. We identified the inflammatory and neuron and astrocyte-specific biomarker categories as having the greatest number of significant individual biomarker predictors of long-term outcome. Further investigation utilizing cross-validation of prediction models in a second independent group and blinded assessment of outcomes for the predictive utility of biomarkers in patients with ICH is warranted.
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Affiliation(s)
- Zachary Troiani
- Department of Neurosurgery, 5925Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Luis Ascanio
- Department of Neurosurgery, 5925Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Christina P Rossitto
- Department of Neurosurgery, 5925Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Muhammad Ali
- Department of Neurosurgery, 5925Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Nicki Mohammadi
- Department of Neurosurgery, 5925Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Shahram Majidi
- Department of Neurosurgery, 5925Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - J Mocco
- Department of Neurosurgery, 5925Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Christopher P Kellner
- Department of Neurosurgery, 5925Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
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8
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A systematic review of the usefulness of magnetic resonance imaging in predicting the gait ability of stroke patients. Sci Rep 2021; 11:14338. [PMID: 34253774 PMCID: PMC8275756 DOI: 10.1038/s41598-021-93717-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/07/2021] [Indexed: 11/08/2022] Open
Abstract
The usefulness of magnetic resonance imaging (MRI) in predicting gait ability in stroke patients remains unclear. Therefore, MRI evaluations have not yet been standardized in stroke rehabilitation. We performed a systematic review to consolidate evidence regarding the use of MRIs in predicting gait ability of stroke patients. The Medline, Cumulative Index to Nursing and Allied Health Literature, and SCOPUS databases were comprehensively searched. We included all literature published from each source’s earliest date to August 2020. We included 19 studies: 8 were classified as structure- or function-based MRI studies and 11 as neural tract integrity-based MRI studies. Most structure- or function-based MRI studies indicated that damage to motor-related areas (primary motor cortex, corona radiata, internal capsule, and basal ganglia) or insula was related to poor gait recovery. In neural tract integrity-based MRI studies, integrity of the corticospinal tract was related to gait ability. Some studies reported predictive value of the corticoreticular pathway. All included studies had some concerns, at least one, based on the Cochrane risk of bias instrument. This review suggests that MRIs are useful in predicting gait ability of stroke patients. However, we cannot make definitive conclusion regarding the predictive value, due to the lack of quantitative evaluations.
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9
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Li LH, Chen CT, Chang YC, Chen YJ, Lee IH, How CK. Prognostic role of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune inflammation index in acute ischemic stroke: A STROBE-compliant retrospective study. Medicine (Baltimore) 2021; 100:e26354. [PMID: 34160404 PMCID: PMC8238279 DOI: 10.1097/md.0000000000026354] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 05/28/2021] [Indexed: 01/04/2023] Open
Abstract
The acute ischemic stroke (AIS) is a devastating disease and remains the leading cause of death and disability. This study aims to evaluate the role of hematological inflammatory markers (neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], and systemic immune inflammation index [SII]) in predicting the neurological recovery in acute cerebrovascular events over 1-year follow-up.Adult patients diagnosed with AIS within 3 hours from January 2016 to December 2018 were recruited retrospectively. The modified Rankin Scale (mRS) was recorded upon admission to the emergency department (ED) and 1, 3, 6, and 12 months after a stroke. The primary outcome measure was the neurological recovery. The neurological recovery was defined as an improvement in mRS score ≥ 1 compared with that at the ED admission baseline.A total of 277 consecutive adult patients with AIS within 3 hours were enrolled. The initial average of the National Institute of Health Stroke Scale was 9.2 ± 7.8, and 90.3% of patients had an mRS ≥ 2 at ED admission baseline. The overall neurological recovery rates of 48.7%, 53.7%, 59.2%, and 55.9% were observed at 1, 3, 6, and 12 months follow-up, respectively. The multivariate analysis revealed that the baseline NLR value was a significant predictor of neurological recovery at 3 months after a stroke (adjusted odds ratio = 0.89, 95% confidence interval = 0.80-0.99, P = .035).A low NLR at ED admission could be useful marker for predicting neurological recovery at 3 months after stroke.
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Affiliation(s)
- Li-Hua Li
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital
- Program of Medical Biotechnology, Taipei Medical University
| | - Chung-Ting Chen
- Emergency Department, Taipei Veterans General Hospital
- School of Medicine, National Yang Ming Chiao Tung University
| | | | - Ying-Ju Chen
- Emergency Department, Taipei Veterans General Hospital
- Institute of Environmental and Occupational Health Science, National Yang Ming Chiao Tung University
| | - I-Hui Lee
- School of Medicine, National Yang Ming Chiao Tung University
- Department of Neurology Neurological Institute, Taipei Veterans General Hospital, Taipei
| | - Chorng-Kuang How
- Emergency Department, Taipei Veterans General Hospital
- School of Medicine, National Yang Ming Chiao Tung University
- Kinmen Hospital, Ministry of Health and Welfare, Kinmen, Taiwan
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10
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Park SI, Kang DW, Lim HS. Modeling and simulation to predict the degree of disability over time in acute ischemic stroke patients. Clin Transl Sci 2021; 14:1988-1996. [PMID: 33982427 PMCID: PMC8504832 DOI: 10.1111/cts.13056] [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: 01/13/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 12/01/2022] Open
Abstract
Disability in patients with acute stroke varies over time, with the prediction of outcomes being critical for proper management. This study aimed to develop a model to predict the cumulative probability of each modified Rankin Scale (mRS) score over time with inclusion of significant covariates. Longitudinal data obtained from 193 patients, 1–24 months after onset of acute ischemic stroke, were included for a modeling analysis using nonlinear mixed‐effect modeling (NONMEM). After selecting a model that best described the time course of the probability of different mRS scores, potential covariates were tested. Visual predicted check plots, parameter estimates, and decreases in minimum objective function values were used for model evaluation. The inclusion of disease progression (DP) in the baseline proportional odds cumulative logit model significantly improved the model compared to the baseline model without DP. An inhibitory maximum effect (Emax) model was determined to be the best DP model for describing the probability of specific mRS scores over time. In the final model, DP was multiplied with the baseline cumulative logit probability with a baseline adjustment. In addition to differences in lesion volume (DLV), the final model included comorbid diabetes mellitus (DM) and baseline National Institutes of Health Stroke Scale (NIHSS) scores on Emax as statistically significant covariates. This study developed a model including DLV, NIHSS score, and comorbid DM for predicting the disability time course in patients with acute ischemic stroke. This model may help to predict disease outcomes and to develop more appropriate management plans for patients with acute stroke.
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Affiliation(s)
- Sang-In Park
- Department of Clinical Pharmacology and Therapeutics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Pharmacology, College of Medicine, Kangwon National University, Chuncheon, Korea
| | - Dong-Wha Kang
- Department of Neurology, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Hyeong-Seok Lim
- Department of Clinical Pharmacology and Therapeutics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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11
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Kaiser EE, Poythress J, Scheulin KM, Jurgielewicz BJ, Lazar NA, Park C, Stice SL, Ahn J, West FD. An integrative multivariate approach for predicting functional recovery using magnetic resonance imaging parameters in a translational pig ischemic stroke model. Neural Regen Res 2021; 16:842-850. [PMID: 33229718 PMCID: PMC8178783 DOI: 10.4103/1673-5374.297079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/08/2020] [Accepted: 07/22/2020] [Indexed: 12/11/2022] Open
Abstract
Magnetic resonance imaging (MRI) is a clinically relevant, real-time imaging modality that is frequently utilized to assess stroke type and severity. However, specific MRI biomarkers that can be used to predict long-term functional recovery are still a critical need. Consequently, the present study sought to examine the prognostic value of commonly utilized MRI parameters to predict functional outcomes in a porcine model of ischemic stroke. Stroke was induced via permanent middle cerebral artery occlusion. At 24 hours post-stroke, MRI analysis revealed focal ischemic lesions, decreased diffusivity, hemispheric swelling, and white matter degradation. Functional deficits including behavioral abnormalities in open field and novel object exploration as well as spatiotemporal gait impairments were observed at 4 weeks post-stroke. Gaussian graphical models identified specific MRI outputs and functional recovery variables, including white matter integrity and gait performance, that exhibited strong conditional dependencies. Canonical correlation analysis revealed a prognostic relationship between lesion volume and white matter integrity and novel object exploration and gait performance. Consequently, these analyses may also have the potential of predicting patient recovery at chronic time points as pigs and humans share many anatomical similarities (e.g., white matter composition) that have proven to be critical in ischemic stroke pathophysiology. The study was approved by the University of Georgia (UGA) Institutional Animal Care and Use Committee (IACUC; Protocol Number: A2014-07-021-Y3-A11 and 2018-01-029-Y1-A5) on November 22, 2017.
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Affiliation(s)
- Erin E. Kaiser
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
- Neuroscience, Biomedical and Health Sciences Institute, University of Georgia, Athens, GA, USA
- Department of Animal and Dairy Science, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA, USA
| | - J.C. Poythress
- Department of Statistics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, USA
| | - Kelly M. Scheulin
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
- Neuroscience, Biomedical and Health Sciences Institute, University of Georgia, Athens, GA, USA
- Department of Animal and Dairy Science, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA, USA
| | - Brian J. Jurgielewicz
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
- Neuroscience, Biomedical and Health Sciences Institute, University of Georgia, Athens, GA, USA
- Department of Animal and Dairy Science, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA, USA
| | - Nicole A. Lazar
- Department of Statistics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, USA
| | - Cheolwoo Park
- Department of Statistics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, USA
| | - Steven L. Stice
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
- Neuroscience, Biomedical and Health Sciences Institute, University of Georgia, Athens, GA, USA
- Department of Animal and Dairy Science, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA, USA
| | - Jeongyoun Ahn
- Department of Statistics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, USA
| | - Franklin D. West
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
- Neuroscience, Biomedical and Health Sciences Institute, University of Georgia, Athens, GA, USA
- Department of Animal and Dairy Science, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA, USA
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12
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Reale G, Giovannini S, Iacovelli C, Castiglia SF, Picerno P, Zauli A, Rabuffetti M, Ferrarin M, Maccauro G, Caliandro P. Actigraphic Measurement of the Upper Limbs for the Prediction of Ischemic Stroke Prognosis: An Observational Study. SENSORS 2021; 21:s21072479. [PMID: 33918503 PMCID: PMC8038235 DOI: 10.3390/s21072479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/25/2021] [Accepted: 03/30/2021] [Indexed: 11/29/2022]
Abstract
Background: It is often challenging to formulate a reliable prognosis for patients with acute ischemic stroke. The most accepted prognostic factors may not be sufficient to predict the recovery process. In this view, describing the evolution of motor deficits over time via sensors might be useful for strengthening the prognostic model. Our aim was to assess whether an actigraphic-based parameter (Asymmetry Rate Index for the 24 h period (AR2_24 h)) obtained in the acute stroke phase could be a predictor of a 90 d prognosis. Methods: In this observational study, we recorded and analyzed the 24 h upper limb movement asymmetry of 20 consecutive patients with acute ischemic stroke during their stay in a stroke unit. We recorded the motor activity of both arms using two programmable actigraphic systems positioned on patients’ wrists. We clinically evaluated the stroke patients by NIHSS in the acute phase and then assessed them across 90 days using the modified Rankin Scale (mRS). Results: We found that the AR2_24 h parameter positively correlates with the 90 d mRS (r = 0.69, p < 0.001). Moreover, we found that an AR2_24 h > 32% predicts a poorer outcome (90 d mRS > 2), with sensitivity = 100% and specificity = 89%. Conclusions: Sensor-based parameters might provide useful information for predicting ischemic stroke prognosis in the acute phase.
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Affiliation(s)
- Giuseppe Reale
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore, L. Go F. Vito, 1-00168 Rome, Italy; (G.R.); (A.Z.); (G.M.)
- Unità Operativa Complessa Neuroriabilitazione ad Alta Intensità, Largo A. Gemelli, Fondazione Policlinico Universitario A. Gemelli IRCCS, 8-00168 Rome, Italy
| | - Silvia Giovannini
- Unità Operativa Complessa Medicina Fisica e Riabilitazione, Largo A. Gemelli, Fondazione Policlinico Universitario A. Gemelli IRCCS, 8-00168 Rome, Italy;
- Correspondence: ; Tel.: +39-0630-155-553
| | - Chiara Iacovelli
- Unità Operativa Complessa Medicina Fisica e Riabilitazione, Largo A. Gemelli, Fondazione Policlinico Universitario A. Gemelli IRCCS, 8-00168 Rome, Italy;
| | - Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Viale XXIV Maggio, 7-04100 Latina, Italy;
| | - Pietro Picerno
- SMART Engineering Solutions & Technologies Research Center, Università Telematica “e-Campus”, Via Isimbardi, 10-22060 Novedrate, Italy;
| | - Aurelia Zauli
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore, L. Go F. Vito, 1-00168 Rome, Italy; (G.R.); (A.Z.); (G.M.)
| | - Marco Rabuffetti
- Biomedical Technology Department, IRCCS Fondazione Don Carlo Gnocchi, Via Capecelatro, 66-20148 Milan, Italy; (M.R.); (M.F.)
| | - Maurizio Ferrarin
- Biomedical Technology Department, IRCCS Fondazione Don Carlo Gnocchi, Via Capecelatro, 66-20148 Milan, Italy; (M.R.); (M.F.)
| | - Giulio Maccauro
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore, L. Go F. Vito, 1-00168 Rome, Italy; (G.R.); (A.Z.); (G.M.)
| | - Pietro Caliandro
- Unità Operativa Neurologia, Largo A, Fondazione Policlinico Universitario A. Gemelli IRCCS, Gemelli, 8-00168 Rome, Italy;
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13
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Aswendt M, Pallast N, Wieters F, Baues M, Hoehn M, Fink GR. Lesion Size- and Location-Dependent Recruitment of Contralesional Thalamus and Motor Cortex Facilitates Recovery after Stroke in Mice. Transl Stroke Res 2020; 12:87-97. [PMID: 32166716 PMCID: PMC7803721 DOI: 10.1007/s12975-020-00802-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/06/2020] [Accepted: 03/03/2020] [Indexed: 01/01/2023]
Abstract
Brain lesions caused by cerebral ischemia or hemorrhage lead to a local breakdown of energy homeostasis followed by irreversible cell death and long-term impairment. Importantly, local brain lesions also generate remote functional and structural disturbances, which contribute to the behavioral deficit but also impact the recovery of function. While spontaneous recovery has been associated with endogenous repair mechanisms at the vascular, neural, and immune cell levels, the impact of structural plasticity on sensory-motor dysfunction and recovery thereof remains to be elucidated by longitudinal imaging in a mouse model. Here, we applied behavioral assessments, in vivo fiber tracking, and histological validation in a photothrombotic stroke mouse model. Atlas-based whole-brain structural connectivity analysis and ex vivo histology revealed secondary neurodegeneration in the ipsilesional brain areas, mostly in the dorsal sensorimotor area of the thalamus. Furthermore, we describe for the first time a lesion size-dependent increase in structural connectivity between the contralesional primary motor cortex and thalamus with the ipsilesional cortex. The involvement of the contralesional hemisphere was associated with improved functional recovery relative to lesion size. This study highlights the importance of in vivo fiber tracking and the role of the contralesional hemisphere during spontaneous functional improvement as a potential novel stroke biomarker and therapeutic targets.
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Affiliation(s)
- Markus Aswendt
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Kerpener Strasse, 62 50937, Cologne, Germany. .,Cognitive Neuroscience, Research Center Juelich, Institute of Neuroscience and Medicine (INM-3), Juelich, Germany.
| | - Niklas Pallast
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Kerpener Strasse, 62 50937, Cologne, Germany
| | - Frederique Wieters
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Kerpener Strasse, 62 50937, Cologne, Germany
| | - Mayan Baues
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Kerpener Strasse, 62 50937, Cologne, Germany
| | - Mathias Hoehn
- Cognitive Neuroscience, Research Center Juelich, Institute of Neuroscience and Medicine (INM-3), Juelich, Germany.,Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Kerpener Strasse, 62 50937, Cologne, Germany.,Cognitive Neuroscience, Research Center Juelich, Institute of Neuroscience and Medicine (INM-3), Juelich, Germany
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14
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Chu CL, Chen YP, Chen CCP, Chen CK, Chang HN, Chang CH, Pei YC. Functional Recovery Patterns of Hemorrhagic and Ischemic Stroke Patients Under Post-Acute Care Rehabilitation Program. Neuropsychiatr Dis Treat 2020; 16:1975-1985. [PMID: 32884273 PMCID: PMC7431596 DOI: 10.2147/ndt.s253700] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/13/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Tailored rehabilitation programs for stroke patients cannot be made without knowledge of their recovery potential. The aim of this study is to characterize the functional recovery patterns of ischemic stroke (IS) and intracerebral hemorrhage (ICH) patients under post-acute care stroke rehabilitation. METHODS This retrospective study analyzed the data of patients enrolled in the Post-Acute Care-Cerebrovascular Disease (PAC-CVD) rehabilitation program, which provides an individualized 1- to 3-hour intensive physical, occupational, and speech and language therapy for post-acute stroke patients in Taoyuan Chang Gung Memorial hospital in Taiwan. Our primary endpoint measure was Barthel Index (BI), and secondary endpoint measures included other 12 functional measures. RESULTS A total of 489 patients were included for analysis. Patients with stroke history had less BI improvement than those who suffered their first-ever stroke. In first-ever stroke patients who had completed 6 to 12 weeks of PAC-CVD program, subcortical ICH patients had greater BI, quality of life, sensation, and balance improvements, and had greater late-phase recovery than their IS counterparts. In IS patients, those with age >75 had less BI improvement; those with National Institute of Health Stroke Scale (NIHSS) score 1-5 had greater Motor Activity Log quality of use (MAL-quality) improvement than those with NIHSS score >5; those with Mini-Mental State Examination (MMSE) score ≥24 had greater BI and instrumental activities of daily living (IADL) improvement. Using the general linear model, previous stroke (ß: -6.148, p=0.01) and subcortical ICH (ß: 5.04, p=0.03) were factors associated with BI improvement. CONCLUSION Subcortical ICH patients have greater functional improvement and greater late-phase recovery than their IS counterparts following PAC rehabilitation. More studies are needed to validate our findings and unravel the underlying mechanisms of stroke recovery to optimize the treatment strategy following a stroke.
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Affiliation(s)
- Chan-Lin Chu
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yueh-Peng Chen
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Carl C P Chen
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chih-Kuang Chen
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Hsiang-Ning Chang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chien-Hung Chang
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Electrical Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Cheng Pei
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Center of Vascularized Tissue Allograft, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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15
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Spellicy SE, Kaiser EE, Bowler MM, Jurgielewicz BJ, Webb RL, West FD, Stice SL. Neural Stem Cell Extracellular Vesicles Disrupt Midline Shift Predictive Outcomes in Porcine Ischemic Stroke Model. Transl Stroke Res 2019; 11:776-788. [PMID: 31811639 PMCID: PMC7340639 DOI: 10.1007/s12975-019-00753-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 12/11/2022]
Abstract
Magnetic resonance imaging (MRI) is a clinically relevant non-invasive imaging tool commonly utilized to assess stroke progression in real time. This study investigated the utility of MRI as a predictive measure of clinical and functional outcomes when a stroke intervention is withheld or provided, in order to identify biomarkers for stroke functional outcome under these conditions. Fifteen MRI and ninety functional parameters were measured in a middle cerebral artery occlusion (MCAO) porcine ischemic stroke model. Multiparametric analysis of correlations between MRI measurements and functional outcome was conducted. Acute axial and coronal midline shift (MLS) at 24 h post-stroke were associated with decreased survival and recovery measured by modified Rankin scale (mRS) and were significantly correlated with 52 measured acute (day 1 post) and chronic (day 84 post) gait and behavior impairments in non-treated stroked animals. These results suggest that MLS may be an important non-invasive biomarker that can be used to predict patient outcomes and prognosis as well as guide therapeutic intervention and rehabilitation in non-treated animals and potentially human patients that do not receive interventional treatments. Neural stem cell–derived extracellular vesicle (NSC EV) was a disruptive therapy because NSC EV administration post-stroke disrupted MLS correlations observed in non-treated stroked animals. MLS was not associated with survival and functional outcomes in NSC EV–treated animals. In contrast to untreated animals, NSC EVs improved stroked animal outcomes regardless of MLS severity.
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Affiliation(s)
- Samantha E Spellicy
- Regenerative Bioscience Center, University of Georgia, Athens, GA, 30602, USA
- Department of Animal and Dairy Science, University of Georgia, Athens, GA, 30602, USA
| | - Erin E Kaiser
- Regenerative Bioscience Center, University of Georgia, Athens, GA, 30602, USA
- Department of Animal and Dairy Science, University of Georgia, Athens, GA, 30602, USA
| | - Michael M Bowler
- Regenerative Bioscience Center, University of Georgia, Athens, GA, 30602, USA
| | - Brian J Jurgielewicz
- Regenerative Bioscience Center, University of Georgia, Athens, GA, 30602, USA
- Department of Animal and Dairy Science, University of Georgia, Athens, GA, 30602, USA
| | | | - Franklin D West
- Regenerative Bioscience Center, University of Georgia, Athens, GA, 30602, USA
- Department of Animal and Dairy Science, University of Georgia, Athens, GA, 30602, USA
| | - Steven L Stice
- Regenerative Bioscience Center, University of Georgia, Athens, GA, 30602, USA.
- Department of Animal and Dairy Science, University of Georgia, Athens, GA, 30602, USA.
- ArunA Biomedical, Athens, GA, 30602, USA.
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16
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Wake-up stroke: thrombolysis reduces ischemic lesion volume and neurological deficit. J Neurol 2019; 267:666-673. [PMID: 31720820 DOI: 10.1007/s00415-019-09603-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUNDS Wake-Up Stroke (WUS) patients are generally excluded from thrombolytic therapy (rTPA) due to the unknown time of stroke onset. This study aimed to investigate the effects of rTPA in WUS patients during every day clinical scenarios, by measuring ischemic lesion volume and functional outcomes compared to non-treated WUS patients. METHODS We retrospectively analyzed clinical and imaging data of 149 (75 rTPA; 74 non-rTPA) patients with acute ischemic WUS. Ischemic volume was calculated on follow-up CT and functional outcomes were the NIHSS and mRS comparing rTPA and non-rTPA WUS. Patients were selected using ASPECTS > 6 on CT and/or ischemic penumbra > 50% of hypoperfused tissue on CTP. RESULTS A reduced volume was measured on the follow-up CT for rTPA (1 mL, 0-8) compared to the non-rTPA patients (10 mL, 0-40; p = 0.000). NIHSS at 7 days from admission was significantly lower in the rTPA (1, 0-4) compared to non-rTPA group (3, 1-9; p = 0.015), as was the percentage of improvement (ΔNIHSS) (70% vs 50%; p = 0.002). A higher prevalence of mRS 0-2 was observed in the rTPA compared to the non-rTPA (54% vs 39%; p = 0.060). Multivariate analysis showed that NIHSS at baseline and rTPA treatment are significant predictors of good outcome both in terms of NIHSS at 7 days and ischemic lesion volume on follow-up CT (p < 0.05). CONCLUSIONS rTPA in WUS patients selected with CT and/or CTP resulted in reduced ischemic infarct volume on follow-up CT and better functional outcome without increment of intracranial hemorrhages and in-hospital mortality.
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17
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Hawe RL, Findlater SE, Kenzie JM, Hill MD, Scott SH, Dukelow SP. Differential Impact of Acute Lesions Versus White Matter Hyperintensities on Stroke Recovery. J Am Heart Assoc 2019; 7:e009360. [PMID: 30371192 PMCID: PMC6222954 DOI: 10.1161/jaha.118.009360] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Understanding how the size of acute lesions and white matter hyperintensities (WMH) impact stroke recovery can improve our ability to predict outcomes and tailor treatments. The aim of this exploratory study was to investigate the role of acute lesion volume and WMH volume on longitudinal recovery of specific sensory, motor, and cognitive impairments after stroke using robotic and clinical measures. Methods and Results Eighty‐two individuals were assessed at 1, 6, 12, and 26 weeks poststroke with robotic tasks and commonly used clinical measures. The volumes of acute lesions and WMH were measured on fluid‐attenuated inversion recovery images. Linear mixed models were used to investigate the role of acute lesions and WMH on parameters derived from the robotic tasks and clinical measures. Regression analysis determined the added value of acute lesion and WMH volumes along with measures of initial performance to predict outcomes at 6 months. Acute lesion volume has widespread effects on sensory, motor, and overall functional recovery poststroke. The impact of WMH was specific to cognitive impairments. Apart from the robotic position sense task, neither lesion volume nor WMH measure had significant ability to predict outcomes at 6 months over using initial impairment as measured by robotic assessments alone. Conclusions While acute lesion volume and WMH may impact different impairments poststroke, their clinical utility in predicting outcomes at 6 months poststroke is limited.
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Affiliation(s)
- Rachel L Hawe
- 1 Department of Clinical Neurosciences Hotchkiss Brain Institute University of Calgary Alberta Canada
| | - Sonja E Findlater
- 1 Department of Clinical Neurosciences Hotchkiss Brain Institute University of Calgary Alberta Canada
| | - Jeffrey M Kenzie
- 1 Department of Clinical Neurosciences Hotchkiss Brain Institute University of Calgary Alberta Canada
| | - Michael D Hill
- 1 Department of Clinical Neurosciences Hotchkiss Brain Institute University of Calgary Alberta Canada
| | - Stephen H Scott
- 2 Department of Biomedical and Molecular Sciences Queen's University Kingston Ontario Canada
| | - Sean P Dukelow
- 1 Department of Clinical Neurosciences Hotchkiss Brain Institute University of Calgary Alberta Canada
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18
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Kozyolkin O, Kuznietsov A, Novikova L. Prediction of the Lethal Outcome of Acute Recurrent Cerebral Ischemic Hemispheric Stroke. MEDICINA-LITHUANIA 2019; 55:medicina55060311. [PMID: 31242700 PMCID: PMC6631068 DOI: 10.3390/medicina55060311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 01/04/2023]
Abstract
Background and objectives. Stroke-induced mortality is the third most common cause of death in developed countries. Intense interest has focused on the recurrent ischemic stroke, which rate makes up 30% during first 5 years after first-ever stroke. This work aims to develop criteria for the prediction of acute recurrent cerebral ischemic hemispheric stroke (RCIHS) outcome on the basis of comprehensive baseline clinical, laboratory, and neuroimaging examinations. Materials and Methods. One hundred thirty-six patients (71 males and 65 females, median age 74 (65; 78)) with acute RCIHS were enrolled in the study. All patients underwent a detailed clinical and neurological examination using National Institutes of Health Stroke Scale (NIHSS), computed tomography of the brain, hematological, and biochemical investigations. In order to detect the dependent and independent risk factors of the lethal outcome of the acute period of RCIHS, univariable and multivariable regression analysis were conducted. A receiver operating characteristic (ROC) analysis with the calculation of sensitivity and specificity was performed to determine the prediction variables. Results. Twenty-five patients died. The independent predictors of the lethal outcome of acute RCIHS were: Baseline NIHSS score (OR 95% CІ 1.33 (1.08-1.64), p = 0.0003), septum pellucidum displacement (OR 95% CI 1.53 (1.17-2.00), p = 0.0021), glucose serum level (OR 95% CI 1.28 (1.09-1.50), p = 0.0022), neutrophil-to-lymphocyte ratio (OR 95% CI 1.11 (1.00-1.21), p = 0.0303). The mathematical model, which included these variables was developed and it could determine the prognosis of lethal outcome of the acute RCIHS with an accuracy of 86.8% (AUC = 0.88 ± 0.04 (0.88-0.93), p < 0.0001).
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Affiliation(s)
- Olexandr Kozyolkin
- Department of Nervous Disease Zaporizhzhia State Medical University, 69035 Zaporizhzhia, Ukraine.
| | - Anton Kuznietsov
- Department of Nervous Disease Zaporizhzhia State Medical University, 69035 Zaporizhzhia, Ukraine.
| | - Liubov Novikova
- Department of Nervous Disease Zaporizhzhia State Medical University, 69035 Zaporizhzhia, Ukraine.
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19
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Kumral E, Bayam FE, Köken B, Erdoğan CE. Clinical and neuroimaging determinants of minimally conscious and persistent vegetative states after acute stroke. JOURNAL OF NEUROCRITICAL CARE 2019. [DOI: 10.18700/jnc.190080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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20
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Jiang C, Yi L, Cai S, Zhang L. Ischemic Stroke in Pontine and Corona Radiata: Location Specific Impairment of Neural Network Investigated With Resting State fMRI. Front Neurol 2019; 10:575. [PMID: 31214111 PMCID: PMC6554416 DOI: 10.3389/fneur.2019.00575] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/15/2019] [Indexed: 12/25/2022] Open
Abstract
Objective: This study aims to investigate location-specific functional remodeling following ischemic stroke in pons and corona radiata. Methods: This study was approved by the local Institutional Review Board. Written consent was obtained from each of the participants prior to the MRI examination. Thirty six subjects with first ever acute ischemic stroke in pons (PS, n = 15, aged 62.8 ± 11.01 years) or corona radiata (CRS, n = 21, aged 59.33 ± 13.84 years) as well as 30 age and sex matched healthy controls (HC, n = 30, aged 60 ± 6.43 years) were examined with resting state functional magnetic resonance imaging (rs-fMRI). Regional homogeneity (ReHo) and degree centrality (DC) were calculated using a voxel-based approach. Intergroup differences in ReHo and DC were explored using a permutation test with a threshold-free cluster enhancement (PT TFCE, number of permutations = 1,000, family-wise error rate (FWER) < 0.05). Results: ReHo and DC alterations were identified in distributed anatomies for both PS and CRS groups. DC mainly increased in the bilateral anterior and posterior cingulate cortex, the inferior frontal-orbital gyrus, and decreased in the bilateral cuneus, calcarine, and the precuneus, while ReHo mainly decreased in the precentral and the postcentral gyri, inferior parietal lobules, precuneus, posterior cingulate cortex, and the superior occipital gyrus. PS and CRS groups were not significantly different in ReHo or DC (FWER > 0.05). Conclusions: Focal ischemic stroke in pons or corona radiata leads to extensive alterations in the functional network centrality. IS-induced network remodeling is more anatomy-specific than pathway-specific, which may underpin the clinicotopographical profiles during the disease dynamic. Approaches targeting neural pathway and functional connectivity may shed light on a better characterization and management innovation of ischemic stroke.
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Affiliation(s)
- Chunxiang Jiang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Li Yi
- Department of Neurology Peking University Shenzhen Hospital, Shenzhen, China
| | - Siqi Cai
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Lijuan Zhang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
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21
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Abstract
Stroke remains a leading cause of disability and death worldwide despite significant scientific and therapeutic advances. Therefore, there is a critical need to improve stroke prevention and treatment. In this review, we describe several examples that leverage nucleic acid therapeutics to improve stroke care through prevention, acute treatment, and recovery. Aptamer systems are under development to increase the safety and efficacy of antithrombotic and thrombolytic treatment, which represent the mainstay of medical stroke therapy. Antisense oligonucleotide therapy has shown some promise in treating stroke causes that are genetically determined and resistant to classic prevention approaches such as elevated lipoprotein (a) and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Targeting microRNAs may be attractive because they regulate factors involved in neuronal cell death and reperfusion-associated injury, as well as neurorestorative pathways. Lastly, microRNAs may aid reliable etiologic classification of stroke subtypes, which is important for effective secondary stroke prevention.
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Affiliation(s)
- Nils Henninger
- Department of Neurology, University of Massachusetts Medical School, 55 Lake Ave, North, Worcester, MA, 01655, USA.
- Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Ave, North, Worcester, MA, 01655, USA.
| | - Yunis Mayasi
- Division of Neurocritical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
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22
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Landman T, Schoon Y, Warlé M, De Leeuw FE, Thijssen D. The effect of repeated remote ischemic postconditioning on infarct size in patients with an ischemic stroke (REPOST): study protocol for a randomized clinical trial. Trials 2019; 20:167. [PMID: 30876432 PMCID: PMC6419836 DOI: 10.1186/s13063-019-3264-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 02/27/2019] [Indexed: 01/28/2023] Open
Abstract
Background Remote ischemic postconditioning (rIPostC) refers to the observation that repeated, short periods of ischemia protect remote areas against tissue damage during and after prolonged ischemia. Based on previous observations of a potential neuroprotective effect of rIPostC, the aim of this study is to evaluate whether repeated rIPostC after an ischemic stroke can reduce infarct size, which could be translated to an improvement in clinical outcomes. Methods/design We will enroll 200 ischemic stroke patients to daily rIPostC or sham conditioning during hospitalization into a randomized single-blind placebo-controlled trial. The intervention consists of twice daily exposure to four cycles of 5-min cuff inflation around the upper arm to > 20 mmHg above systolic blood pressure (i.e., rIPostC) or 50 mmHg (i.e., control), followed by 5 minutes of deflation. The primary outcome is infarct size, measured using an MRI diffusion-weighted image at the end of hospitalization. Secondary outcomes include the Modified Rankin Scale, National Institutes of Health Stroke Scale, quality of life, and cardiovascular and cerebrovascular morbidity and mortality. To explore possible underlying mechanisms of rIPostC, venous blood will be sampled to assess biomarkers of inflammation and vascular health. Discussion Previous studies in animals and humans, using a single bout of remote ischemic conditioning, report a potential effect of rIPostC in attenuating neural damage. Although repeated rIPostC has been investigated for cardiovascular disease patients and preclinical stroke models, no previous study has explored the potential physiological and clinical effects of repeatedly applying rIPostC during the hospitalization phase after a stroke. Trial registration Netherlands Trial Register, NTR6880. Registered on 8 December 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3264-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thijs Landman
- Department of Physiology, Radboud University Medical Centre, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, Gelderland, Netherlands.
| | - Yvonne Schoon
- Department of Geriatric Medicine, Radboud University Medical Centre, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, Gelderland, Netherlands
| | - Michiel Warlé
- Department of Surgery, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, Gelderland, Netherlands
| | - Frank-Erik De Leeuw
- Centre for Cognitive Neuroscience, Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, Gelderland, Netherlands
| | - Dick Thijssen
- Department of Physiology, Radboud University Medical Centre, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, Gelderland, Netherlands
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23
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Shea-Shumsky NB, Schoeneberger S, Grigsby J. Executive functioning as a predictor of stroke rehabilitation outcomes. Clin Neuropsychol 2019; 33:854-872. [DOI: 10.1080/13854046.2018.1546905] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
| | | | - Jim Grigsby
- Departments of Psychology and Medicine, University of Colorado Denver, Denver, CO, USA
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24
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Ramirez-Garcia G, Harrison KA, Fernandez-Ruiz J, Nashed JY, Cook DJ. Stroke Longitudinal Volumetric Measures Correlate with the Behavioral Score in Non-Human Primates. Neuroscience 2018; 397:41-55. [PMID: 30481566 DOI: 10.1016/j.neuroscience.2018.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/14/2018] [Accepted: 11/16/2018] [Indexed: 12/26/2022]
Abstract
Stroke is the second leading cause of death worldwide. Brain imaging data from experimental rodent stroke models suggest that size and location of the ischemic lesion relate to behavioral outcome. However, such a relationship between these two variables has not been established in Non-Human Primate (NHP) models. Thus, we aimed to evaluate whether size, location, and severity of stroke following controlled Middle Cerebral Artery Occlusion (MCAO) in NHP model correlated to neurological outcome. Forty cynomolgus macaques underwent MCAO, after four mortalities, thirty-six subjects were followed up during the longitudinal study. Structural T2 scans were obtained by magnetic resonance imaging (MRI) prior to, 48 h, and 30 days post-MCAO. Neurological function was assessed with the Non-human Primate Stroke Scale (NHPSS). T2 whole lesion volume was calculated per subject. At chronic stages, remaining brain volume was computed, and the affected hemisphere parceled into 50 regions of interest (ROIs). Whole and parceled volumetric measures were analyzed in relation to the NHPSS score. The longitudinal lesion volume evaluation showed a positive correlation with the NHPSS score, whereas the remaining brain volume negatively correlated with the NHPSS. Following ROI parcellation, NHPSS outcome correlated with frontal, temporal, occipital, and middle white matter, as well as the internal capsule, and the superior temporal and middle temporal gyri, and the caudate nucleus. These results represent an important step in stroke translational research by demonstrating close similarities between the NHP stroke model and the clinical characteristics following a human stroke and illustrating significant areas that could represent targets for novel neuroprotective strategies.
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Affiliation(s)
- Gabriel Ramirez-Garcia
- Unidad Periférica de Neurociencias, Facultad de Medicina, Universidad Nacional Autónoma de México en Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suarez", Ciudad de México, Mexico
| | | | - Juan Fernandez-Ruiz
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Joseph Y Nashed
- Centre for Neuroscience studies, Queen's University, Kingston, Canada
| | - Douglas J Cook
- Centre for Neuroscience studies, Queen's University, Kingston, Canada; Translational Stroke Research Lab, Department of Surgery, Faculty of Health Sciences, Queen's University, Kingston, Canada.
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25
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Mole JA, Demeyere N. The relationship between early post-stroke cognition and longer term activities and participation: A systematic review. Neuropsychol Rehabil 2018; 30:346-370. [DOI: 10.1080/09602011.2018.1464934] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Joseph A. Mole
- Oxford Institute of Clinical Psychology Training, University of Oxford, Oxford, UK
- Cognitive Neuropsychology Centre, Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Nele Demeyere
- Cognitive Neuropsychology Centre, Department of Experimental Psychology, University of Oxford, Oxford, UK
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26
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Webb RL, Kaiser EE, Jurgielewicz BJ, Spellicy S, Scoville SL, Thompson TA, Swetenburg RL, Hess DC, West FD, Stice SL. Human Neural Stem Cell Extracellular Vesicles Improve Recovery in a Porcine Model of Ischemic Stroke. Stroke 2018; 49:1248-1256. [PMID: 29650593 PMCID: PMC5916046 DOI: 10.1161/strokeaha.117.020353] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/28/2018] [Accepted: 03/12/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Recent work from our group suggests that human neural stem cell-derived extracellular vesicle (NSC EV) treatment improves both tissue and sensorimotor function in a preclinical thromboembolic mouse model of stroke. In this study, NSC EVs were evaluated in a pig ischemic stroke model, where clinically relevant end points were used to assess recovery in a more translational large animal model. METHODS Ischemic stroke was induced by permanent middle cerebral artery occlusion (MCAO), and either NSC EV or PBS treatment was administered intravenously at 2, 14, and 24 hours post-MCAO. NSC EV effects on tissue level recovery were evaluated via magnetic resonance imaging at 1 and 84 days post-MCAO. Effects on functional recovery were also assessed through longitudinal behavior and gait analysis testing. RESULTS NSC EV treatment was neuroprotective and led to significant improvements at the tissue and functional levels in stroked pigs. NSC EV treatment eliminated intracranial hemorrhage in ischemic lesions in NSC EV pigs (0 of 7) versus control pigs (7 of 8). NSC EV-treated pigs exhibited a significant decrease in cerebral lesion volume and decreased brain swelling relative to control pigs 1-day post-MCAO. NSC EVs significantly reduced edema in treated pigs relative to control pigs, as assessed by improved diffusivity through apparent diffusion coefficient maps. NSC EVs preserved white matter integrity with increased corpus callosum fractional anisotropy values 84 days post-MCAO. Behavior and mobility improvements paralleled structural changes as NSC EV-treated pigs exhibited improved outcomes, including increased exploratory behavior and faster restoration of spatiotemporal gait parameters. CONCLUSIONS This study demonstrated for the first time that in a large animal model novel NSC EVs significantly improved neural tissue preservation and functional levels post-MCAO, suggesting NSC EVs may be a paradigm changing stroke therapeutic.
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Affiliation(s)
- Robin L Webb
- From the ArunA Biomedical, Athens, GA (R.L.W., S.L. Scoville, T.A.T., R.L.S).,Regenerative Bioscience Center (R.L.W., E.E.K., B.J.J., S.S., F.D.W., S.L. Stice)
| | - Erin E Kaiser
- Regenerative Bioscience Center (R.L.W., E.E.K., B.J.J., S.S., F.D.W., S.L. Stice).,Department of Animal and Dairy Science, College of Agricultural and Environmental Sciences (E.E.K., F.D.W.)
| | - Brian J Jurgielewicz
- Regenerative Bioscience Center (R.L.W., E.E.K., B.J.J., S.S., F.D.W., S.L. Stice)
| | - Samantha Spellicy
- Regenerative Bioscience Center (R.L.W., E.E.K., B.J.J., S.S., F.D.W., S.L. Stice)
| | - Shelley L Scoville
- From the ArunA Biomedical, Athens, GA (R.L.W., S.L. Scoville, T.A.T., R.L.S)
| | - Tyler A Thompson
- From the ArunA Biomedical, Athens, GA (R.L.W., S.L. Scoville, T.A.T., R.L.S)
| | | | - David C Hess
- University of Georgia, Rhodes Center for Animal and Dairy Science, Athens; and Department of Neurology, Augusta University, GA (D.C.H.)
| | - Franklin D West
- Regenerative Bioscience Center (R.L.W., E.E.K., B.J.J., S.S., F.D.W., S.L. Stice).,Department of Animal and Dairy Science, College of Agricultural and Environmental Sciences (E.E.K., F.D.W.)
| | - Steven L Stice
- Regenerative Bioscience Center (R.L.W., E.E.K., B.J.J., S.S., F.D.W., S.L. Stice)
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27
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Halai AD, Woollams AM, Lambon Ralph MA. Predicting the pattern and severity of chronic post-stroke language deficits from functionally-partitioned structural lesions. NEUROIMAGE-CLINICAL 2018; 19:1-13. [PMID: 30038893 PMCID: PMC6051318 DOI: 10.1016/j.nicl.2018.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 02/28/2018] [Accepted: 03/13/2018] [Indexed: 11/25/2022]
Abstract
There is an ever-increasing wealth of knowledge arising from basic cognitive and clinical neuroscience on how speech and language capabilities are organised in the brain. It is, therefore, timely to use this accumulated knowledge and expertise to address critical research challenges, including the ability to predict the pattern and level of language deficits found in aphasic patients (a third of all stroke cases). Previous studies have mainly focused on discriminating between broad aphasia dichotomies from purely anatomically-defined lesion information. In the current study, we developed and assessed a novel approach in which core language areas were mapped using principal component analysis in combination with correlational lesion mapping and the resultant ‘functionally-partitioned’ lesion maps were used to predict a battery of 21 individual test scores as well as aphasia subtype for 70 patients with chronic post-stroke aphasia. Specifically, we used lesion information to predict behavioural scores in regression models (cross-validated using 5-folds). The winning model was identified through the adjusted R2 (model fit to data) and performance in predicting holdout folds (generalisation to new cases). We also used logistic regression to predict fluent/non-fluent status and aphasia subtype. Functionally-partitioned models generally outperformed other models at predicting individual tests, fluency status and aphasia subtype. Predict the pattern and level of language deficits found in chronic aphasic patients Use principal component analysis to identify functional lesion maps Functionally-partitioned lesion maps used as predictor variables instead of lesion volume Functionally-partitioned lesion model plus age produced the best regression model Model can successfully predict fluent/non-fluent types and aphasia classification
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Affiliation(s)
- Ajay D Halai
- Neuroscience and Aphasia Research Unit, Division of Neuroscience & Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, UK.
| | - Anna M Woollams
- Neuroscience and Aphasia Research Unit, Division of Neuroscience & Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Matthew A Lambon Ralph
- Neuroscience and Aphasia Research Unit, Division of Neuroscience & Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, UK.
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28
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Peters DM, Fridriksson J, Stewart JC, Richardson JD, Rorden C, Bonilha L, Middleton A, Gleichgerrcht E, Fritz SL. Cortical disconnection of the ipsilesional primary motor cortex is associated with gait speed and upper extremity motor impairment in chronic left hemispheric stroke. Hum Brain Mapp 2017; 39:120-132. [PMID: 28980355 DOI: 10.1002/hbm.23829] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 12/11/2022] Open
Abstract
Advances in neuroimaging have enabled the mapping of white matter connections across the entire brain, allowing for a more thorough examination of the extent of white matter disconnection after stroke. To assess how cortical disconnection contributes to motor impairments, we examined the relationship between structural brain connectivity and upper and lower extremity motor function in individuals with chronic stroke. Forty-three participants [mean age: 59.7 (±11.2) years; time poststroke: 64.4 (±58.8) months] underwent clinical motor assessments and MRI scanning. Nonparametric correlation analyses were performed to examine the relationship between structural connectivity amid a subsection of the motor network and upper/lower extremity motor function. Standard multiple linear regression analyses were performed to examine the relationship between cortical necrosis and disconnection of three main cortical areas of motor control [primary motor cortex (M1), premotor cortex (PMC), and supplementary motor area (SMA)] and motor function. Anatomical connectivity between ipsilesional M1/SMA and the (1) cerebral peduncle, (2) thalamus, and (3) red nucleus were significantly correlated with upper and lower extremity motor performance (P ≤ 0.003). M1-M1 interhemispheric connectivity was also significantly correlated with gross manual dexterity of the affected upper extremity (P = 0.001). Regression models with M1 lesion load and M1 disconnection (adjusted for time poststroke) explained a significant amount of variance in upper extremity motor performance (R2 = 0.36-0.46) and gait speed (R2 = 0.46), with M1 disconnection an independent predictor of motor performance. Cortical disconnection, especially of ipsilesional M1, could significantly contribute to variability seen in locomotor and upper extremity motor function and recovery in chronic stroke. Hum Brain Mapp 39:120-132, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Denise M Peters
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, 921 Assembly Street, Columbia, South Carolina
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, 915 Greene Street, Columbia, South Carolina
| | - Jill C Stewart
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, 921 Assembly Street, Columbia, South Carolina
| | - Jessica D Richardson
- Department of Communication Sciences and Disorders, University of South Carolina, 915 Greene Street, Columbia, South Carolina
| | - Chris Rorden
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Columbia, South Carolina
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, South Carolina
| | - Addie Middleton
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, 921 Assembly Street, Columbia, South Carolina
| | - Ezequiel Gleichgerrcht
- Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, South Carolina
| | - Stacy L Fritz
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, 921 Assembly Street, Columbia, South Carolina
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Heiss WD. Contribution of Neuro-Imaging for Prediction of Functional Recovery after Ischemic Stroke. Cerebrovasc Dis 2017; 44:266-276. [PMID: 28869961 DOI: 10.1159/000479594] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 07/18/2017] [Indexed: 12/23/2022] Open
Abstract
Prediction measures of recovery and outcome after stroke perform with only modest levels of accuracy if based only on clinical data. Prediction scores can be improved by including morphologic imaging data, where size, location, and development of the ischemic lesion is best documented by magnetic resonance imaging. In addition to the primary lesion, the involvement of fiber tracts contributes to prognosis, and consequently the use of diffusion tensor imaging (DTI) to assess primary and secondary pathways improves the prediction of outcome and of therapeutic effects. The recovery of ischemic tissue and the progression of damage are dependent on the quality of blood supply. Therefore, the status of the supplying arteries and of the collateral flow is not only crucial for determining eligibility for acute interventions, but also has an impact on the potential to integrate areas surrounding the lesion that are not typically part of a functional network into the recovery process. The changes in these functional networks after a localized lesion are assessed by functional imaging methods, which additionally show altered pathways and activated secondary centers related to residual functions and demonstrate changes in activation patterns within these networks with improved performance. These strategies in some instances record activation in secondary centers of a network, for example, also in homolog contralateral areas, which might be inhibitory to the recovery of primary centers. Such findings might have therapeutic consequences, for example, image-guided inhibitory stimulation of these areas. In the future, a combination of morphological imaging including DTI of fiber tracts and activation studies during specific tasks might yield the best information on residual function, reserve capacity, and prospects for recovery after ischemic stroke.
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Lin C, Lee J, Chatterjee N, Corado C, Carroll T, Naidech A, Prabhakaran S. Predicting Domain-Specific Health-Related Quality of Life Using Acute Infarct Volume. Stroke 2017; 48:1925-1931. [PMID: 28536175 DOI: 10.1161/strokeaha.117.017094] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 04/20/2017] [Accepted: 04/25/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Limited data exist on the relationship between acute infarct volume and health-related quality of life (HRQOL) measures after ischemic stroke. We evaluated whether acute infarct volume predicts domain-specific Neuro-Quality of Life scores at 3 months after stroke. METHODS Between 2012 and 2014, we prospectively enrolled consecutive patients with ischemic stroke and calculated infarct volume. Outcome scores at 3 months included modified Rankin Scale and Neuro-Quality of Life T scores. We evaluated whether volume organized by quartiles predicted modified Rankin Scale and HRQOL scores at 3 months using logistic and linear regression as appropriate, adjusting for relevant covariates. We calculated variance accounted for (R2) overall and by volume for each domain of HRQOL. RESULTS Among 490 patients (mean age 64.2±15.86 years; 51.2% male; 63.3% White) included for analysis, 58 (11.8%) were disabled (modified Rankin Scale score of >2) at 3 months. In unadjusted analysis, the highest volume quartile remained a significant predictor of 1 HRQOL domain, applied cognition-general concerns (R2=0.06; P<0.001). Our fully adjusted prediction model explained 32% to 51% of the variance in HRQOL: upper extremity (R2=0.32), lower extremity (R2=0.51), executive function (R2=0.45), and general concerns (R2=0.34). CONCLUSIONS Acute infarct volume is a poor predictor of HRQOL domains after ischemic stroke, with the exception of the cognitive domain. Overall, clinical and imaging variables explained <50% of the variance in HRQOL outcomes at 3 months. Our data imply that a broad range of factors, some known and others undiscovered, may better predict poststroke HRQOL than what is currently available.
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Affiliation(s)
- Chen Lin
- From the Northwestern University, Chicago, IL (C.L., J.L., N.C., C.C., A.N., S.P.); and University of Chicago, IL (T.C.).
| | - Jungwha Lee
- From the Northwestern University, Chicago, IL (C.L., J.L., N.C., C.C., A.N., S.P.); and University of Chicago, IL (T.C.)
| | - Neil Chatterjee
- From the Northwestern University, Chicago, IL (C.L., J.L., N.C., C.C., A.N., S.P.); and University of Chicago, IL (T.C.)
| | - Carlos Corado
- From the Northwestern University, Chicago, IL (C.L., J.L., N.C., C.C., A.N., S.P.); and University of Chicago, IL (T.C.)
| | - Timothy Carroll
- From the Northwestern University, Chicago, IL (C.L., J.L., N.C., C.C., A.N., S.P.); and University of Chicago, IL (T.C.)
| | - Andrew Naidech
- From the Northwestern University, Chicago, IL (C.L., J.L., N.C., C.C., A.N., S.P.); and University of Chicago, IL (T.C.)
| | - Shyam Prabhakaran
- From the Northwestern University, Chicago, IL (C.L., J.L., N.C., C.C., A.N., S.P.); and University of Chicago, IL (T.C.)
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Haller S, Barkhof F. Interaction of Vascular Damage and Alzheimer Dementia: Focal Damage and Disconnection. Radiology 2017; 282:311-313. [PMID: 28099102 DOI: 10.1148/radiol.2016161564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sven Haller
- From the Affidea Centre de Diagnostic Radiologique de Carouge (CDRC), Geneva, Switzerland (S.H.); Department of Surgical Sciences, Division of Radiology, Uppsala University, Uppsala, Sweden (S.H.); Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany (S.H.); Faculty of Medicine of the University of Geneva, Geneva, Switzerland (S.H.); Department of Radiology & Nuclear Medicine and PET Research, VU University Medical Centre, Amsterdam, the Netherlands (F.B.); and Institutes of Neurology and Healthcare Engineering, University College London, London, England (F.B.)
| | - Frederik Barkhof
- From the Affidea Centre de Diagnostic Radiologique de Carouge (CDRC), Geneva, Switzerland (S.H.); Department of Surgical Sciences, Division of Radiology, Uppsala University, Uppsala, Sweden (S.H.); Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany (S.H.); Faculty of Medicine of the University of Geneva, Geneva, Switzerland (S.H.); Department of Radiology & Nuclear Medicine and PET Research, VU University Medical Centre, Amsterdam, the Netherlands (F.B.); and Institutes of Neurology and Healthcare Engineering, University College London, London, England (F.B.)
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Ram R, Kaul S, Alladi S, Afshan JS, Prabha TS, Kohat A, Tandra S, Rani JY. Risk Factors, Vascular Lesion Distribution, Outcome and Recurrence of Strokes Due to Intracranial Atherosclerosis: One Year Data from Hyderabad Stroke Registry. Ann Indian Acad Neurol 2017; 20:387-392. [PMID: 29184342 PMCID: PMC5682743 DOI: 10.4103/aian.aian_227_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Intracranial atherosclerotic stenosis (ICAS) is a common cause of ischemic stroke in Asian countries and probably in India. Aim: The aim of this study was to describe the risk factors, distribution of vascular lesions, recurrence and outcome of stroke due to ICAS. Methodology: A total of 100 consecutive patients of ischemic stroke due to ICAS were enrolled prospectively from January 1, 2015, to December 31, 2015, and followed for 1 year for treatment compliance and recurrence. The details about demographics, risk factors, and vascular lesions were noted. Results: There were 68 males and 32 females. Hypertension (HTN), diabetes, alcohol, smoking, hyperlipidemia, and hyperhomocysteinemia was present in 82%, 52%, 34%, 33%, 28%, and 23%, respectively. The number of arteries involved were middle cerebral artery, 53 (37.3%); posterior cerebral artery, 24 (16.9%); internal cerebral artery, 21 (14.8%); vertebral artery, 18 (12.7%); basilar artery, 6 (4.2%); and anterior cerebral artery, 6 (4.2%). Seventeen (17%) patients had a recurrent stroke during 1 year follow-up. The presence of uncontrolled HTN and diabetes mellitus after discharge were significantly associated with stroke recurrence (P < 0.05). The use of dual antiplatelet agents and statins was found to have a significant effect in the prevention of recurrent stroke (P < 0.05). Severe stroke at presentation and presence of hemiparesis were the predictors for unfavorable outcome at 3 months (P < 0.05). Conclusion: Risk factors, distribution of vascular lesions and high recurrence of stroke due to ICAS in this study is similar to that reported from other Asian countries. Aggressive medical management and risk factor control remains the best strategy for preventing recurrence.
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Affiliation(s)
- Raghu Ram
- Department of Neurology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Subhash Kaul
- Department of Neurology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Suvarna Alladi
- Department of Neurology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Jabeen S Afshan
- Department of Neurology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - T Surya Prabha
- Department of Neurology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Abhijeet Kohat
- Department of Neurology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Swetha Tandra
- Department of Neurology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Jyotsna Y Rani
- Department of Radiology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
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Wei XE, Zhou J, Li WB, Zhao YW, Li MH, Li YH. MRI based thrombolysis for FLAIR-negative stroke patients within 4.5-6h after symptom onset. J Neurol Sci 2016; 372:421-427. [PMID: 27839719 DOI: 10.1016/j.jns.2016.11.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 11/06/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Abstract
To investigate the feasibility of DWI-FLAIR mismatch in identifying patients who might benefit from thrombolytic therapy within 4.5-6h, we analyzed the data of 105 ischemic stroke patients with known time of symptom onset who underwent MRI within 6h of stroke and thrombolysis between December 2006 and December 2013. They were divided into three groups: symptom onset within 4.5h (n=66); 4.5-6h and FLAIR images negative (n=9); and 4.5-6h and FLAIR images positive (n=30). Outcome of thrombolysis was assessed for each group by recanalization rate, National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores. The results showed that mismatch between positive DWI and negative FLAIR images identified patients within 4.5h of symptom onset with sensitivity, specificity, positive predictive value and negative predictive value of 40.9%, 76.9%, and 75% and 43.5%. Recanalization rate, NIHSS score and mRS score were all better in both the 0-4.5h and 4.5-6h FLAIR-negative groups than in the 4.5-6h FLAIR-positive group (p<0.05). These data demonstrate that within 4.5-6h of symptom onset, patients with negative FLAIR images may benefit from thrombolysis therapy.
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Affiliation(s)
- Xiao-Er Wei
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai 200233, China
| | - Jia Zhou
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai 200233, China
| | - Wen-Bin Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai 200233, China
| | - Yu-Wu Zhao
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai 200233, China
| | - Ming-Hua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai 200233, China
| | - Yue-Hua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai 200233, China.
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Meng D, Hosseini AA, Simpson RJ, Shaikh Q, Tench CR, Dineen RA, Auer DP. Lesion Topography and Microscopic White Matter Tract Damage Contribute to Cognitive Impairment in Symptomatic Carotid Artery Disease. Radiology 2016; 282:502-515. [PMID: 27598537 PMCID: PMC5283872 DOI: 10.1148/radiol.2016152685] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Subcortical disconnection of cognitive neural networks is a key mechanism of cognitive impairment in patients with probable vascular cognitive disorder. Purpose To investigate associations between neuroimaging markers of cerebrovascular disease, including lesion topography and extent and severity of strategic and global cerebral tissue injury, and cognition in carotid artery disease (CAD). Materials and Methods All participants gave written informed consent to undergo brain magnetic resonance imaging and the Addenbrooke’s Cognitive Examination–Revised. One hundred eight patients with symptomatic CAD but no dementia were included, and a score less than 82 represented cognitive impairment. Group comparison and interrelations between global cognitive and fluency performance, lesion topography, and ultrastructural damage were assessed with voxel-based statistics. Associations between cognition, medial temporal lobe atrophy (MTA), lesion volumes, and global white matter ultrastructural damage indexed as increased mean diffusivity were tested with regression analysis by controlling for age. Diagnostic accuracy of imaging markers selected from a multivariate prediction model was tested with receiver operating characteristic analysis. Results Cognitively impaired patients (n = 53 [49.1%], classified as having probable vascular cognitive disorder) were older than nonimpaired patients (P = .027) and had more frequent MTA (P < .001), more cortical infarctions (P = .016), and larger volumes of acute (P = .028) and chronic (P = .009) subcortical ischemic lesions. Lesion volumes did not correlate with global cognitive performance (lacunar infarctions, P = .060; acute lesions, P = .088; chronic subcortical ischemic lesions, P = .085). In contrast, cognitive performance correlated with presence of chronic ischemic lesions within the interhemispheric tracts and thalamic radiation (P < .05, false discovery rate corrected). Skeleton mean diffusivity showed the closest correlation with cognition (R2 = 0.311, P < .001) and promising diagnostic accuracy for vascular cognitive disorder (area under the curve, 0.82 [95% confidence interval: 0.75, 0.90]). Findings were confirmed in subjects with a low risk of preclinical Alzheimer disease indexed by the absence of MTA (n = 85). Conclusion Subcortical white matter ischemic lesion locations and severity of ultrastructural tract damage contribute to cognitive impairment in symptomatic CAD, which suggests that subcortical disconnection within large-scale cognitive neural networks is a key mechanism of vascular cognitive disorder. Online supplemental material is available for this article.
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Affiliation(s)
- Dewen Meng
- From the Department of Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, England (D.M., A.A.H., R.J.S., Q.S., R.A.D., D.P.A.); Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, England (D.M., R.J.S., R.A.D., D.P.A.); Department of Vascular Surgery, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, England (R.J.S.); and Department of Clinical Neurology, Division of Clinical Neurosciences, University of Nottingham, Queen's Medical Centre, Nottingham, England (C.R.T.)
| | - Akram A Hosseini
- From the Department of Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, England (D.M., A.A.H., R.J.S., Q.S., R.A.D., D.P.A.); Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, England (D.M., R.J.S., R.A.D., D.P.A.); Department of Vascular Surgery, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, England (R.J.S.); and Department of Clinical Neurology, Division of Clinical Neurosciences, University of Nottingham, Queen's Medical Centre, Nottingham, England (C.R.T.)
| | - Richard J Simpson
- From the Department of Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, England (D.M., A.A.H., R.J.S., Q.S., R.A.D., D.P.A.); Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, England (D.M., R.J.S., R.A.D., D.P.A.); Department of Vascular Surgery, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, England (R.J.S.); and Department of Clinical Neurology, Division of Clinical Neurosciences, University of Nottingham, Queen's Medical Centre, Nottingham, England (C.R.T.)
| | - Quratulain Shaikh
- From the Department of Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, England (D.M., A.A.H., R.J.S., Q.S., R.A.D., D.P.A.); Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, England (D.M., R.J.S., R.A.D., D.P.A.); Department of Vascular Surgery, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, England (R.J.S.); and Department of Clinical Neurology, Division of Clinical Neurosciences, University of Nottingham, Queen's Medical Centre, Nottingham, England (C.R.T.)
| | - Christopher R Tench
- From the Department of Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, England (D.M., A.A.H., R.J.S., Q.S., R.A.D., D.P.A.); Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, England (D.M., R.J.S., R.A.D., D.P.A.); Department of Vascular Surgery, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, England (R.J.S.); and Department of Clinical Neurology, Division of Clinical Neurosciences, University of Nottingham, Queen's Medical Centre, Nottingham, England (C.R.T.)
| | - Robert A Dineen
- From the Department of Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, England (D.M., A.A.H., R.J.S., Q.S., R.A.D., D.P.A.); Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, England (D.M., R.J.S., R.A.D., D.P.A.); Department of Vascular Surgery, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, England (R.J.S.); and Department of Clinical Neurology, Division of Clinical Neurosciences, University of Nottingham, Queen's Medical Centre, Nottingham, England (C.R.T.)
| | - Dorothee P Auer
- From the Department of Radiological Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, England (D.M., A.A.H., R.J.S., Q.S., R.A.D., D.P.A.); Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, England (D.M., R.J.S., R.A.D., D.P.A.); Department of Vascular Surgery, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, England (R.J.S.); and Department of Clinical Neurology, Division of Clinical Neurosciences, University of Nottingham, Queen's Medical Centre, Nottingham, England (C.R.T.)
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Kim B, Winstein C. Can Neurological Biomarkers of Brain Impairment Be Used to Predict Poststroke Motor Recovery? A Systematic Review. Neurorehabil Neural Repair 2016; 31:3-24. [PMID: 27503908 DOI: 10.1177/1545968316662708] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background There is growing interest to establish recovery biomarkers, especially neurological biomarkers, in order to develop new therapies and prediction models for the promotion of stroke rehabilitation and recovery. However, there is no consensus among the neurorehabilitation community about which biomarker(s) have the highest predictive value for motor recovery. Objective To review the evidence and determine which neurological biomarker(s) meet the high evidence quality criteria for use in predicting motor recovery. Methods We searched databases for prognostic neuroimaging/neurophysiological studies. Methodological quality of each study was assessed using a previously employed comprehensive 15-item rating system. Furthermore, we used the GRADE approach and ranked the overall evidence quality for each category of neurologic biomarker. Results Seventy-one articles met our inclusion criteria; 5 categories of neurologic biomarkers were identified: diffusion tensor imaging (DTI), transcranial magnetic stimulation (TMS), functional magnetic resonance imaging (fMRI), conventional structural MRI (sMRI), and a combination of these biomarkers. Most studies were conducted with individuals after ischemic stroke in the acute and/or subacute stage (~70%). Less than one-third of the studies (21/71) were assessed with satisfactory methodological quality (80% or more of total quality score). Conventional structural MRI and the combination biomarker categories ranked "high" in overall evidence quality. Conclusions There were 3 prevalent methodological limitations: (a) lack of cross-validation, (b) lack of minimal clinically important difference (MCID) for motor outcomes, and (c) small sample size. More high-quality studies are needed to establish which neurological biomarkers are the best predictors of motor recovery after stroke. Finally, the quarter-century old methodological quality tool used here should be updated by inclusion of more contemporary methods and statistical approaches.
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Affiliation(s)
- Bokkyu Kim
- University of Southern California, Los Angeles, CA, USA
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Rehme AK, Volz LJ, Feis DL, Eickhoff SB, Fink GR, Grefkes C. Individual prediction of chronic motor outcome in the acute post-stroke stage: Behavioral parameters versus functional imaging. Hum Brain Mapp 2015; 36:4553-65. [PMID: 26381168 DOI: 10.1002/hbm.22936] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 07/15/2015] [Accepted: 08/03/2015] [Indexed: 12/22/2022] Open
Abstract
Several neurobiological factors have been found to correlate with functional recovery after brain lesions. However, predicting the individual potential of recovery remains difficult. Here we used multivariate support vector machine (SVM) classification to explore the prognostic value of functional magnetic resonance imaging (fMRI) to predict individual motor outcome at 4-6 months post-stroke. To this end, 21 first-ever stroke patients with hand motor deficits participated in an fMRI hand motor task in the first few days post-stroke. Motor impairment was quantified assessing grip force and the Action Research Arm Test. Linear SVM classifiers were trained to predict good versus poor motor outcome of unseen new patients. We found that fMRI activity acquired in the first week post-stroke correctly predicted the outcome for 86% of all patients. In contrast, the concurrent assessment of motor function provided 76% accuracy with low sensitivity (<60%). Furthermore, the outcome of patients with initially moderate impairment and high outcome variability could not be predicted based on motor tests. In contrast, fMRI provided 87.5% prediction accuracy in these patients. Classifications were driven by activity in ipsilesional motor areas and contralesional cerebellum. The accuracy of subacute fMRI data (two weeks post-stroke), age, time post-stroke, lesion volume, and location were at 50%-chance-level. In conclusion, multivariate decoding of fMRI data with SVM early after stroke enables a robust prediction of motor recovery. The potential for recovery is influenced by the initial dysfunction of the active motor system, particularly in those patients whose outcome cannot be predicted by behavioral tests.
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Affiliation(s)
- Anne K Rehme
- Department of Neurology, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-1, INM-3), Research Centre Jülich, Jülich, Germany
| | - Lukas J Volz
- Department of Neurology, University of Cologne, Cologne, Germany.,Department of Psychological and Brain Sciences, University of California, Santa Barbara, USA
| | - Delia-Lisa Feis
- Max Planck Institute for Metabolism Research, Cologne, Germany
| | - Simon B Eickhoff
- Institute of Neuroscience and Medicine (INM-1, INM-3), Research Centre Jülich, Jülich, Germany.,Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University, Düsseldorf, Germany
| | - Gereon R Fink
- Department of Neurology, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-1, INM-3), Research Centre Jülich, Jülich, Germany
| | - Christian Grefkes
- Department of Neurology, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-1, INM-3), Research Centre Jülich, Jülich, Germany
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Forkert ND, Verleger T, Cheng B, Thomalla G, Hilgetag CC, Fiehler J. Multiclass Support Vector Machine-Based Lesion Mapping Predicts Functional Outcome in Ischemic Stroke Patients. PLoS One 2015; 10:e0129569. [PMID: 26098418 PMCID: PMC4476759 DOI: 10.1371/journal.pone.0129569] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 05/11/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The aim of this study was to investigate if ischemic stroke final infarction volume and location can be used to predict the associated functional outcome using a multi-class support vector machine (SVM). MATERIAL AND METHODS Sixty-eight follow-up MR FLAIR datasets of ischemic stroke patients with known modified Rankin Scale (mRS) functional outcome after 30 days were used. The infarct regions were segmented and used to calculate the percentage of lesioned voxels in the predefined MNI, Harvard-Oxford cortical and subcortical atlas regions as well as using four problem-specific VOIs, which were identified from the database using voxel-based lesion symptom mapping. An overall of 12 SVM classification models for predicting the corresponding mRS score were generated using the lesion overlap values from the different brain region definitions, stroke laterality information, and the optional parameters infarct volume, admission NIHSS, and patient age. RESULTS Leave-one-out cross validations revealed that including information about the stroke location in terms of lesion overlap measurements led to improved mRS prediction results compared to classification models not utilizing the stroke location information. Furthermore, integration of the optional features led to improved mRS prediction results in all cases tested. The problem-specific brain regions and additional integration of the optional features led to the best mRS predictions with a precise multi-value mRS prediction accuracy of 56%, sliding window multi-value mRS prediction accuracy (mRS±1) of 82%, and binary mRS (0-2 vs. 3-5) prediction accuracy of 85%. CONCLUSION Therefore, a graded SVM-based functional stroke outcome prediction using the problem-specific brain regions for lesion overlap quantification leads to promising results but needs to be further validated using an independent database to rule out a potential methodical bias and overfitting effects. The prediction of the graded mRS functional outcome could be a valuable tool if combined with voxel-wise tissue outcome predictions based on multi-parametric datasets acquired at the acute phase.
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Affiliation(s)
- Nils Daniel Forkert
- Department of Radiology and Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
- * E-mail:
| | - Tobias Verleger
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Claus C. Hilgetag
- Department of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Department of Health Sciences, Boston University, 635 Commonwealth Ave, Boston, MA, 02215, United States of America
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Krishnan P, Saposnik G, Ovbiagele B, Zhang L, Symons S, Aviv R. Contribution and additional impact of imaging to the SPAN-100 score. AJNR Am J Neuroradiol 2015; 36:646-52. [PMID: 25572947 DOI: 10.3174/ajnr.a4195] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 10/16/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Stroke Prognostication by Using Age and NIHSS score (SPAN-100 index) facilitates stroke outcomes. We assessed imaging markers associated with the SPAN-100 index and their additional impact on outcome determination. MATERIALS AND METHODS Of 273 consecutive patients with acute ischemic stroke (<4.5 hours), 55 were characterized as SPAN-100-positive (age +NIHSS score ≥ 100). A comprehensive imaging review evaluated differences, using the presence of the hyperattenuated vessel sign, ASPECTS, clot burden score, collateral score, CBV, CBF, and MTT. The primary outcome assessed was favorable outcome (mRS ≤ 2). Secondary outcomes included recanalization, lack of neurologic improvement, and hemorrhagic transformation. Uni- and multivariate analyses assessed factors associated with favorable outcome. Area under the curve evaluated predictors of favorable clinical outcome. RESULTS Compared with the SPAN-100-negative group, the SPAN-100-positive group (55/273; 20%) demonstrated larger CBVs (<0.001), poorer collaterals (P < .001), and increased hemorrhagic transformation rates (56.0% versus 36%, P = .02) despite earlier time to rtPA (P = .03). Favorable outcome was less common among patients with SPAN-100-positive compared with SPAN-100-negative (10.9% versus 42.2%; P < .001). Multivariate regression revealed poorer outcome for SPAN-100-positive (OR = 0.17; 95% CI, 0.06-0.38; P = .001), clot burden score (OR = 1.14; 95% CI, 1.05-1.25; P < .001), and CBV (OR = 0.58; 95% CI, 0.46-0.72; P = .001). The addition of the clot burden score and CBV improved the predictive value of SPAN-100 alone for favorable outcome from 60% to 68% and 74%, respectively. CONCLUSIONS SPAN-100-positivity predicts a lower likelihood of favorable outcome and increased hemorrhagic transformation. CBV and clot burden score contribute to poorer outcomes among high-risk patients and improve stroke-outcome prediction.
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Affiliation(s)
- P Krishnan
- From the Division of Neuroradiology (P.K., S.S., R.A.), Department of Medical Imaging, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - G Saposnik
- Stroke Outcome Reach Center (G.S.), Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - B Ovbiagele
- Department of Neurosciences (B.O.), Medical University of South Carolina, Charleston, South Carolina
| | - L Zhang
- Biostatistician (L.Z.), Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - S Symons
- From the Division of Neuroradiology (P.K., S.S., R.A.), Department of Medical Imaging, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - R Aviv
- From the Division of Neuroradiology (P.K., S.S., R.A.), Department of Medical Imaging, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Ghosh N, Sun Y, Bhanu B, Ashwal S, Obenaus A. Automated detection of brain abnormalities in neonatal hypoxia ischemic injury from MR images. Med Image Anal 2014; 18:1059-69. [PMID: 25000294 DOI: 10.1016/j.media.2014.05.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 04/23/2014] [Accepted: 05/10/2014] [Indexed: 11/30/2022]
Abstract
We compared the efficacy of three automated brain injury detection methods, namely symmetry-integrated region growing (SIRG), hierarchical region splitting (HRS) and modified watershed segmentation (MWS) in human and animal magnetic resonance imaging (MRI) datasets for the detection of hypoxic ischemic injuries (HIIs). Diffusion weighted imaging (DWI, 1.5T) data from neonatal arterial ischemic stroke (AIS) patients, as well as T2-weighted imaging (T2WI, 11.7T, 4.7T) at seven different time-points (1, 4, 7, 10, 17, 24 and 31 days post HII) in rat-pup model of hypoxic ischemic injury were used to assess the temporal efficacy of our computational approaches. Sensitivity, specificity, and similarity were used as performance metrics based on manual ('gold standard') injury detection to quantify comparisons. When compared to the manual gold standard, automated injury location results from SIRG performed the best in 62% of the data, while 29% for HRS and 9% for MWS. Injury severity detection revealed that SIRG performed the best in 67% cases while 33% for HRS. Prior information is required by HRS and MWS, but not by SIRG. However, SIRG is sensitive to parameter-tuning, while HRS and MWS are not. Among these methods, SIRG performs the best in detecting lesion volumes; HRS is the most robust, while MWS lags behind in both respects.
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Affiliation(s)
- Nirmalya Ghosh
- Department of Pediatrics, Loma Linda University, School of Medicine, Loma Linda, CA 92354, USA
| | - Yu Sun
- Center for Research in Intelligent Systems (CRIS), University of California, Riverside, CA 92521, USA
| | - Bir Bhanu
- Center for Research in Intelligent Systems (CRIS), University of California, Riverside, CA 92521, USA
| | - Stephen Ashwal
- Department of Pediatrics, Loma Linda University, School of Medicine, Loma Linda, CA 92354, USA
| | - Andre Obenaus
- Department of Pediatrics, Loma Linda University, School of Medicine, Loma Linda, CA 92354, USA; Cell, Molecular and Developmental Biology Program and Department of Neuroscience, University of California, 1140 Bachelor Hall, Riverside, CA 92521, USA.
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Burke E, Dodakian L, See J, McKenzie A, Riley JD, Le V, Cramer SC. A multimodal approach to understanding motor impairment and disability after stroke. J Neurol 2014; 261:1178-86. [PMID: 24728337 DOI: 10.1007/s00415-014-7341-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/01/2014] [Accepted: 04/02/2014] [Indexed: 01/20/2023]
Abstract
Many different measures have been found to be related to behavioral outcome after stroke. Preclinical studies emphasize the importance of brain injury and neural function. However, the measures most important to human outcomes remain uncertain, in part because studies often examine one measure at a time or enroll only mildly impaired patients. The current study addressed this by performing multimodal evaluation in a heterogeneous population. Patients (n = 36) with stable arm paresis 3-6 months post-stroke were assessed across 6 categories of measures related to stroke outcome: demographics/medical history, cognitive/mood status, genetics, neurophysiology, brain injury, and cortical function. Multivariate modeling identified measures independently related to an impairment-based outcome (arm Fugl-Meyer motor score). Analyses were repeated (1) identifying measures related to disability (modified Rankin Scale score), describing independence in daily functions and (2) using only patients with mild deficits. Across patients, greater impairment was related to measures of injury (reduced corticospinal tract integrity) and neurophysiology (absence of motor evoked potential). In contrast, (1) greater disability was related to greater injury and poorer cognitive status (MMSE score) and (2) among patients with mild deficits, greater impairment was related to cortical function (greater contralesional motor/premotor cortex activation). Impairment after stroke is most related to injury and neurophysiology, consistent with preclinical studies. These relationships vary according to the patient subgroup or the behavioral endpoint studied. One potential implication of these results is that choice of biomarker or stratifying variable in a clinical stroke study might vary according to patient characteristics.
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Affiliation(s)
- Erin Burke
- Department of Anatomy and Neurobiology, University of California, Irvine, CA, 92697, USA,
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Grefkes C, Fink GR. Connectivity-based approaches in stroke and recovery of function. Lancet Neurol 2014; 13:206-16. [PMID: 24457190 DOI: 10.1016/s1474-4422(13)70264-3] [Citation(s) in RCA: 349] [Impact Index Per Article: 34.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
After focal damage, cerebral networks reorganise their structural and functional anatomy to compensate for both the lesion itself and remote effects. Novel developments in the analysis of functional neuroimaging data enable us to assess in vivo the specific contributions of individual brain areas to recovery of function and the effect of treatment on cortical reorganisation. Connectivity analyses can be used to investigate the effect of stroke on cerebral networks, and help us to understand why some patients make a better recovery than others. This systems-level view also provides insights into how neuromodulatory interventions might target pathological network configurations associated with incomplete recovery. In the future, such analyses of connectivity could help to optimise treatment regimens based on the individual network pathology underlying a particular neurological deficit, thereby opening the way for stratification of patients based on the possible response to an intervention.
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Affiliation(s)
- Christian Grefkes
- Department of Neurology, University Hospital Cologne, Köln, Germany; Neuromodulation and Neurorehabilitation, Max Planck Institute for Neurological Research, Köln, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany.
| | - Gereon R Fink
- Department of Neurology, University Hospital Cologne, Köln, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
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Heiss WD, Kidwell CS. Imaging for prediction of functional outcome and assessment of recovery in ischemic stroke. Stroke 2014; 45:1195-201. [PMID: 24595589 DOI: 10.1161/strokeaha.113.003611] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Wolf-Dieter Heiss
- From the Max Planck Institute for Neurological Research, Cologne, Germany (W.-D.H.); and Departments of Neurology and Medical Imaging, University of Arizona, Tucson (C.S.K.)
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Henninger N, Khan MA, Zhang J, Moonis M, Goddeau RP. Leukoaraiosis predicts cortical infarct volume after distal middle cerebral artery occlusion. Stroke 2014; 45:689-95. [PMID: 24523039 DOI: 10.1161/strokeaha.113.002855] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Leukoaraiosis (LA) predominantly affects the subcortical white matter, but mounting evidence suggests an association with cortical microvascular dysfunction and potentially decreased cortical ischemic tolerance. Thus, we sought to assess whether preexisting LA is predictive of the cortical infarct volume after middle cerebral artery branch occlusion and whether it relates to a worse outcome. METHODS We analyzed data from 117 consecutive patients with middle cerebral artery branch occlusion as documented by admission computed tomography angiography. Baseline clinical, laboratory, and outcome data, as well as final cortical infarct volumes, were retrospectively analyzed from a prospectively collected database. LA severity was assessed on admission computed tomography using the van Swieten scale grading the supratentorial white matter hypoattenuation. Infarct volume predicting a favorable 90-day outcome (modified Rankin Scale score≤2) was determined by receiver operating characteristic curves. Multivariable linear and logistic regression analyses were used to identify independent predictors of the final infarct volume and outcome. RESULTS Receiver operating characteristic curve analyses indicated that a final infarct volume of ≤27 mL best predicted a favorable 90-day outcome. Severe LA (odds ratio, 11.231; 95% confidence interval, 2.526-49.926; P=0.001) was independently associated with infarct volume>27 mL. Severe LA (odds ratio, 3.074; 95% confidence interval, 1.055-8.961; P=0.040) and infarct volume>27 mL (odds ratio, 9.156; 95% confidence interval, 3.191-26.270; P<0.001) were independent predictors of a poor 90-day outcome (modified Rankin Scale, 3-6). CONCLUSIONS The presence of severe, subcortical LA contributes to larger cortical infarct volumes and worse functional outcomes adding to the notion that the brain is negatively affected beyond LA's macroscopic boundaries.
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Affiliation(s)
- Nils Henninger
- From the Departments of Neurology (N.H., M.A.K., J.Z., M.M., R.P.G.) and Psychiatry (N.H.), University of Massachusetts Medical School, Worcester
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Ibatullin MM, Kalinin MN, Kurado AT, Valeeva AA, Khasanova DR. [Multimodal imaging protocols and their predictive role in acute stroke functional outcome]. Zh Nevrol Psikhiatr Im S S Korsakova 2014; 114:9-15. [PMID: 25726796 DOI: 10.17116/jnevro20141141229-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Brain imaging plays a central role in the assessment of patients with acute ischemic stroke. Within a few minutes, modern multimodal imaging protocols can provide one with comprehensive information about prognosis, management, and outcome of the disease, and may detect changes in the intracranial structures reflecting severity of the ischemic injury depicted by four Ps: parenchyma (of the brain), pipes (i.e., the cerebral blood vessels), penumbra, and permeability (of the blood brain barrier). In this article, we have reviewed neuroradiological predictors of stroke functional outcome in the light of the aforementioned four Ps.
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Affiliation(s)
- M M Ibatullin
- GBOU VPO "Kazanskiĭ gosudarstvennyĭ meditsinskiĭ universitet"
| | - M N Kalinin
- GBOU VPO "Kazanskiĭ gosudarstvennyĭ meditsinskiĭ universitet"
| | - A T Kurado
- GAUZ "Mezhregional'nyĭ kliniko-diagnosticheskiĭ tsentr", Kazan'
| | - A A Valeeva
- GBOU VPO "Kazanskiĭ gosudarstvennyĭ meditsinskiĭ universitet"
| | - D R Khasanova
- GBOU VPO "Kazanskiĭ gosudarstvennyĭ meditsinskiĭ universitet"
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Artzi M, Aizenstein O, Jonas-Kimchi T, Myers V, Hallevi H, Ben Bashat D. FLAIR lesion segmentation: Application in patients with brain tumors and acute ischemic stroke. Eur J Radiol 2013; 82:1512-8. [DOI: 10.1016/j.ejrad.2013.05.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 02/09/2012] [Accepted: 02/25/2012] [Indexed: 11/26/2022]
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Abstract
Neuroimaging plays an important role In acute stroke diagnosis and management, but It Is not routinely used In rehabilitation settings. Incorporating Imaging Information In rehabilitation planning may eventually translate to better outcomes after stroke. Here we review the prediction of outcomes after stroke using magnetic resonance imaging. There are clear and specific relationships between the anatomy of the stroke lesion and impairments at the time of scanning, and at later time points in recovery. However, most studies demonstrate these relationships in groups of patients at the chronic stage. In order to be useful for rehabilitation, neuroimaging needs to provide prognostic information for individual patients at a much earlier stage. Recent studies have used diffusion tensor imaging and functional neuroimaging to address this, with promising results. Combining neuroimaging with clinical and neurophysiological assessments may also be useful. Future work in this area may support the tailoring of rehabilitation for individual patients based on their capacity for neural reorganization and recovery.
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Affiliation(s)
- Cathy M. Stinear
- Department of Medicine, The University of Auckland, Auckland, New Zealand
- Centre for Brain Research, The University of Auckland, Auckland, New Zealand
| | - Nick S. Ward
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, UK
- The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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48
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Abstract
Knowledge about factors that determine the final outcome after stroke is important for early stroke management, rehabilitation goals, and discharge planning. This narrative review provides an overview of current knowledge about the prediction of activities after stroke. We reviewed the pattern of stroke recovery for functions and activities, the impact of spontaneous recovery on activities, and the measurement of improvement in general. We explored the activities profiles during the chronic phase and predictors for activities of daily living independence after stroke, and finally, we discussed where to from here? Mathematical regularities explain the nonlinear patterns of recovery, making the outcome of activities of daily living highly predictable. Initial severity of disability and extent of improvement observed within the first weeks poststroke are important indicators of the outcome at six-months. The sequence of progress in activities is almost fixed in time. Studies showed that most motor recovery is almost completed within 10 weeks poststroke. On average, stroke recovery plateaus three- to six-months after onset. Strong evidence was found that age and scores on scales assessing severity of neurological deficits in the early poststroke phase are strongly associated with the final basic activities of daily living outcome after three-months poststroke. The validated prediction models using simple algorithms, such as National Institutes of Health Stroke Scale or Barthel Index, need to be implemented in rehabilitation services and used for stratifying stroke patients in trials. Future studies should investigate the accuracy of dynamic models that includes time poststroke to optimize the application of prediction rules in individuals with stroke.
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Affiliation(s)
- G. Kwakkel
- Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Center (VUmc), Amsterdam. The Netherlands
- Centre of Excellence for Rehabilitation Medicine, Rehabilitation Centre ‘De Hoogstraaf, Utrecht, The Netherlands
- Department of Rehabilitation and Sports Medicine, Rudolf Magnus Institute of Neuroscience, UMC, Utrecht, The Netherlands
| | - B. J. Kollen
- Department of General Practice, University Medical Centre Groningen, University of Groningen, The Netherlands
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Qureshi AI, Chaudhry SA, Sivagnanam K, Rodriguez GJ, Suri MFK, Lakshminarayan K, Ezzeddine MA. Clinical-radiological severity mismatch phenomenon: patients with severe neurological deficits without matching infarction on computed tomographic scan. J Neuroimaging 2012; 23:21-7. [PMID: 23228033 DOI: 10.1111/j.1552-6569.2012.00737.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE The objective was to determine the long-term outcome of patients with severe persistent neurological deficits without a large infarction on computed tomographic (CT) scan. METHODS We analyzed the prospectively collected data as part of the randomized, placebo controlled trial in patients with ischemic stroke presenting within 3 hours of symptom onset. Volume of infarction was measured from CT scan acquired at 3 months. Favorable outcome defined by no significant or slight disability on a modified Rankin scale at 12 months. We determined the outcome of patients with National Institutes of Health Stroke Scale score (NIHSS score) ≥ 10 at 24 hours. RESULTS Of the 277 patients with NIHSS score ≥ 10 at 24 hours, 88 (32%) met the criteria of clinical-radiological severity mismatch. Compared with patients with NIHSS score ≥ 10 with infarct volume ≥ 20 cc, the patients with NIHSS score ≥ 10 and infarct volume <20 cc were older but there were no differences in the gender, race or vascular risk factors. Patients with clinical-radiological severity mismatch were more likely to have a favorable outcome at 12 months compared with those without mismatch (odd ratio 4.3, 95% confidence interval 1.5-12.6, P = .0063) after adjusting for potential confounders. CONCLUSIONS We observed that approximately one-fourth of patients with severe neurological deficits have clinical-radiological severity mismatch. Such patients appear to have a high rate of favorable outcomes at 1 year.
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Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, Minneapolis, MN 55455, USA.
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Abstract
Neonatal hypoxic-ischemic brain injury (HII) and arterial ischemic stroke (AIS) result in irreversibly injured (core) and salvageable (penumbral) tissue regions. Identification and reliable quantification of salvageable tissue is pivotal to any effective and safe intervention. Magnetic resonance imaging (MRI) is the current standard to distinguish core from penumbra using diffusion-perfusion mismatch (DPM). However, subtle MR signal variations between core-penumbral regions make their visual delineation difficult. We hypothesized that computational analysis of MRI data provides a more accurate assessment of core and penumbral tissue evolution in HII/AIS. We used two neonatal rat-pup models of HII/AIS (unilateral and global hypoxic-ischemia) and clinical data sets from neonates with AIS to test our noninvasive, automated computational approach, Hierarchical Region Splitting (HRS), to detect and quantify ischemic core-penumbra using only a single MRI modality (T2- or diffusion-weighted imaging, T2WI/DWI). We also validated our approach by comparing core-penumbral images (from HRS) to DPM with immunohistochemical validation of HII tissues. Our translational and clinical data results showed that HRS could accurately and reliably distinguish the ischemic core from penumbra and their spatiotemporal evolution, which may aid in the vetting and execution of effective therapeutic interventions as well as patient selection.
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