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Frase S, Steddin J, Paschen E, Lenz M, Conforti P, Haas CA, Vlachos A, Schachtrup C, Hosp JA. Dense dopaminergic innervation of the peri-infarct cortex despite dopaminergic cell loss after a pure motor-cortical stroke in rats. J Neurochem 2023; 167:427-440. [PMID: 37735852 DOI: 10.1111/jnc.15970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Abstract
After ischemic stroke, the cortex directly adjacent to the ischemic core (i.e., the peri-infarct cortex, PIC) undergoes plastic changes that facilitate motor recovery. Dopaminergic signaling is thought to support this process. However, ischemic stroke also leads to the remote degeneration of dopaminergic midbrain neurons, possibly interfering with this beneficial effect. In this study, we assessed the reorganization of dopaminergic innervation of the PIC in a rat model of focal cortical stroke. Adult Sprague-Dawley rats either received a photothrombotic stroke (PTS) in the primary motor cortex (M1) or a sham operation. 30 days after PTS or sham procedure, the retrograde tracer Micro Ruby (MR) was injected into the PIC of stroke animals or into homotopic cortical areas of matched sham rats. Thus, dopaminergic midbrain neurons projecting into the PIC were identified based on MR signal and immunoreactivity against tyrosine hydroxylase (TH), a marker for dopaminergic neurons. The density of dopaminergic innervation within the PIC was assessed by quantification of dopaminergic boutons indicated by TH-immunoreactivity. Regarding postsynaptic processes, expression of dopamine receptors (D1- and D2) and a marker of the functional signal cascade (DARPP-32) were visualized histologically. Despite a 25% ipsilesional loss of dopaminergic midbrain neurons after PTS, the number and spatial distribution of dopaminergic neurons projecting to the PIC was not different compared to sham controls. Moreover, the density of dopaminergic innervation in the PIC was significantly higher than in homotopic cortical areas of the sham group. Within the PIC, D1-receptors were expressed in neurons, whereas D2-receptors were confined to astrocytes. The intensity of D1- and DARPP-32 expression appeared to be higher in the PIC compared to the contralesional homotopic cortex. Our data suggest a sprouting of dopaminergic fibers into the PIC and point to a role for dopaminergic signaling in reparative mechanisms post-stroke, potentially related to recovery.
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Affiliation(s)
- Sibylle Frase
- Department of Neurology and Neuroscience, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julius Steddin
- Department of Neurology and Neuroscience, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Enya Paschen
- Experimental Epilepsy Research, Department of Neurosurgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maximilian Lenz
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Pasquale Conforti
- Department of Molecular Embryology, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Carola A Haas
- Experimental Epilepsy Research, Department of Neurosurgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Vlachos
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian Schachtrup
- Department of Molecular Embryology, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jonas A Hosp
- Department of Neurology and Neuroscience, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Zedde M, Grisendi I, Assenza F, Napoli M, Moratti C, Valzania F, Pascarella R. Secondary neurodegeneration of ipsilateral substantia nigra in acute ischemic stroke. Neurol Sci 2023; 44:4099-4102. [PMID: 37526798 DOI: 10.1007/s10072-023-06972-w] [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: 05/14/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION Secondary neurodegeneration after stroke is a complex phenomenon affecting remote and synaptically linked cerebral areas. The involvement of the substantia nigra in this process has been rarely described in infarcts involving the striatum. METHODS We are presenting a case of ischemic stroke involving the right striatum due to atrial fibrillation and associated in a few days with the neuroimaging finding of hyperintensity of the ipsilateral substantia nigra and striatonigral tract on T2-fluid attenuated inversion recovery and diffusion-weighted imaging sequences of brain magnetic resonance imaging. This finding was not related to clinical manifestations and substantially disappeared within 3 months from stroke onset. DISCUSSION The pathophysiology of secondary degeneration of the substantia nigra is poorly understood and it relies on animal models and autoptic studies. The main putative mechanism is not ischemic but excitotoxic with a different role of the internal and external globus pallidus and a different effect on the pars compacta and pars reticularis of the substantia nigra. In animal models, inflammatory mechanisms seem play a role only in the late phase. The main studies on humans were presented in detail. CONCLUSIONS A better understanding of the secondary degeneration of the substantia nigra has the potentiality to offer a chance for neuroprotection in acute stroke, but further studies are needed.
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Affiliation(s)
- Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy.
| | - Ilaria Grisendi
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Federica Assenza
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Manuela Napoli
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Claudio Moratti
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Franco Valzania
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Rosario Pascarella
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
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Lee K, Lee H, Kim YD, Nam HS, Lee HS, Yoo J, Cho S, Heo JH. Association of Substantia Nigra Degeneration with Poor Neurological Recovery in Basal Ganglia Infarctions. J Stroke 2023; 25:169-172. [PMID: 36470247 PMCID: PMC9911844 DOI: 10.5853/jos.2022.02145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/22/2022] [Accepted: 09/24/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Kijeong Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - HyungWoo Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, Korea
| | - Joonsang Yoo
- Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Sunghee Cho
- Burke Neurological Institute, White Plains, NY, USA
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
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Hosp JA, Dressing A, Engesser A, Glauche V, Kümmerer D, Vaidelyte EB, Musso M, Rijntjes M, Weiller C. The Role of Ascending Ventral-Tegmental Fibers for Recovery after Stroke. Ann Neurol 2022; 93:922-933. [PMID: 36585896 DOI: 10.1002/ana.26595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The integrity of cortical motor networks and their descending effector pathway (the corticospinal tract [CST]) is a major determinant motor recovery after stroke. However, this view neglects the importance of ascending tracts and their modulatory effects on cortical physiology. Here, we explore the role of such a tract that connects dopaminergic ventral tegmental midbrain nuclei to the motor cortex (the VTMC tract) for post-stroke recovery. METHODS Lesion data and diffusivity parameters (fractional anisotropy) of the ipsi- and contralesional VTMC tract and CST were obtained from 133 patients (63.9 ± 13.4 years, 45 women) during the acute and chronic stage after the first ever ischemic stroke in the middle cerebral artery territory. Degeneration of VTMC tract and CST was quantified and related to clinical outcome parameters (National Institute of Health Stroke Scale with motor and cortical symptom subscores; modified Fugl-Meyer upper extremity score; modified Ranking Scale [mRS]). RESULTS A significant post-stroke degeneration occurred in both tracts, but only VTMC degeneration was associated with lesion size. Using multiple regression models, we dissected the impact of particular tracts on recovery: Changes in VTMC tract integrity were stronger associated with independence in daily activities (mRS), upper limb motor impairment (modified Fugl-Meyer upper extremity score) and cortical symptoms (aphasia, neglect) captured by National Institute of Health Stroke Scale compared to CST. Changes in CST integrity merely were associated with the degree of hemiparesis (National Institute of Health Stroke Scale motor subscale). INTERPRETATION Post-stroke outcome is influenced by ascending (VTMC) and descending (CST) fiber tracts. Favorable outcome regarding independence (modified Ranking Scale), upper limb motor function (modified Fugl-Meyer upper extremity score), and cortical symptoms (aphasia, neglect) was more strongly related to the ascending than descending tract. ANN NEUROL 2023.
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Affiliation(s)
- Jonas A Hosp
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Andrea Dressing
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anika Engesser
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Volkmar Glauche
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dorothee Kümmerer
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ema B Vaidelyte
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Mariachristina Musso
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michel Rijntjes
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cornelius Weiller
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Frase S, Löffler F, Hosp JA. Enhancing Post-Stroke Rehabilitation and Preventing Exo-Focal Dopaminergic Degeneration in Rats-A Role for Substance P. Int J Mol Sci 2022; 23:ijms23073848. [PMID: 35409207 PMCID: PMC8999050 DOI: 10.3390/ijms23073848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 12/10/2022] Open
Abstract
Dopaminergic signaling is a prerequisite for motor learning. Delayed degeneration of dopaminergic neurons after stroke is linked to motor learning deficits impairing motor rehabilitation. This study investigates safety and efficacy of substance P (SP) treatment on post-stroke rehabilitation, as this neuropeptide combines neuroprotective and plasticity-promoting properties. Male Sprague Dawley rats received a photothrombotic stroke within the primary motor cortex (M1) after which a previously acquired skilled reaching task was rehabilitated. Rats were treated with intraperitoneal saline (control group, n = 7) or SP-injections (250 µg/kg) 30 min before (SP-pre; n = 7) or 16 h (SP-post; n = 6) after rehabilitation training. Dopaminergic neurodegeneration, microglial activation and substance P-immunoreactivity (IR) were analyzed immunohistochemically. Systemic SP significantly facilitated motor rehabilitation. This effect was more pronounced in SP-pre compared to SP-post animals. SP prevented dopaminergic cell loss after stroke, particularly in the SP-pre condition. Despite its proinflammatory propensity, SP administration did not increase stroke volumes, post-stroke deficits or activation of microglia in the midbrain. Finally, SP administration prevented ipsilesional hypertrophy of striatal SPergic innervation, particularly in the SP-post condition. Mechanistically, SP-pre likely involved plasticity-promoting effects in the early phase of rehabilitation, whereas preservation of dopaminergic signaling may have ameliorated rehabilitative success in both SP groups during later stages of training. Our results demonstrate the facilitating effect of SP treatment on motor rehabilitation after stroke, especially if administered prior to training. SP furthermore prevented delayed dopaminergic degeneration and preserved physiological endogenous SPergic innervation.
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Widmer M, Held JPO, Wittmann F, Valladares B, Lambercy O, Sturzenegger C, Palla A, Lutz K, Luft AR. Reward During Arm Training Improves Impairment and Activity After Stroke: A Randomized Controlled Trial. Neurorehabil Neural Repair 2022; 36:140-150. [PMID: 34937456 PMCID: PMC8796156 DOI: 10.1177/15459683211062898] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Learning and learning-related neuroplasticity in motor cortex are potential mechanisms mediating recovery of movement abilities after stroke. These mechanisms depend on dopaminergic projections from midbrain that may encode reward information. Likewise, therapist experience confirms the role of feedback/reward for training efficacy after stroke. OBJECTIVE To test the hypothesis that rehabilitative training can be enhanced by adding performance feedback and monetary rewards. METHODS This multicentric, assessor-blinded, randomized controlled trial used the ArmeoSenso virtual reality rehabilitation system to train 37 first-ever subacute stroke patients in arm-reaching to moving targets. The rewarded group (n = 19) trained with performance feedback (gameplay) and contingent monetary reward. The control group (n = 18) used the same system without monetary reward and with graphically minimized performance feedback. Primary outcome was the change in the two-dimensional reaching space until the end of the intervention period. Secondary clinical assessments were performed at baseline, after 3 weeks of training (15 1-hour sessions), and at 3 month follow-up. Duration and intensity of the interventions as well as concomitant therapy were comparable between groups. RESULTS The two-dimensional reaching space showed an overall improvement but no difference between groups. The rewarded group, however, showed significantly greater improvements from baseline in secondary outcomes assessing arm activity (Box and Block Test at post-training: 6.03±2.95, P = .046 and 3 months: 9.66±3.11, P = .003; Wolf Motor Function Test [Score] at 3 months: .63±.22, P = .007) and arm impairment (Fugl-Meyer Upper Extremity at 3 months: 8.22±3.11, P = .011). CONCLUSIONS Although neutral in its primary outcome, the trial signals a potential facilitating effect of reward on training-mediated improvement of arm paresis. TRIAL REGISTRATION ClinicalTrials.gov (ID: NCT02257125).
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Affiliation(s)
- Mario Widmer
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
- cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
- cereneo Advanced Rehabilitation Institute (CARINg), Vitznau, Switzerland
- Department of Therapy, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Jeremia P. O. Held
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Frieder Wittmann
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Belen Valladares
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
- cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Christian Sturzenegger
- Klinik Lengg, Zürcher RehaZentren, Zurich, Switzerland
- Bellikon Rehabilitation Clinic, Bellikon, Switzerland
| | - Antonella Palla
- Klinik Wald, Zürcher RehaZentren, Wald, Switzerland
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
| | - Kai Lutz
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
- cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
- squipe GmbH, Wädenswil, Switzerland
| | - Andreas R. Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
- cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
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Neuromelanin accumulation in Substantia nigra in vascular parkinsonism. J Neural Transm (Vienna) 2020; 127:1089-1091. [DOI: 10.1007/s00702-020-02191-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/14/2020] [Indexed: 11/26/2022]
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8
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Hosp JA, Greiner KL, Martinez Arellano L, Roth F, Löffler F, Reis J, Fritsch B. Progressive secondary exo-focal dopaminergic neurodegeneration occurs in not directly connected midbrain nuclei after pure motor-cortical stroke. Exp Neurol 2020; 327:113211. [PMID: 31987834 DOI: 10.1016/j.expneurol.2020.113211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/20/2020] [Accepted: 01/24/2020] [Indexed: 10/25/2022]
Abstract
Transsynaptic anterograde and retrograde degeneration of neurons and neural fibers are assumed to trigger local excitotoxicity and inflammatory processes. These processes in turn are thought to drive exo-focal neurodegeneration in remote areas connected to the infarcted tissue after ischemic stroke. In the case of middle cerebral artery occlusion (MCAO), in which striato-nigral connections are affected, the hypothesis of inflammation-induced remote neurodegeneration is based on the temporal dynamics of an early appearance of inflammatory markers in midbrain followed by dopaminergic neuronal loss. To test the hypothesis of a direct transsynaptic mediation of secondary exo-focal post-ischemic neurodegeneration, we used a photochemical induction of a stroke (PTS) in Sprague-Dawley rats restricted to motor cortex (MC), thereby sparing the striatal connections to dopaminergic midbrain nuclei. To dissect the temporal dynamics of post-ischemic neurodegeneration, we analyzed brain sections harvested at day 7 and 14 post stroke. Here, an unexpectedly pronounced and widespread loss of dopaminergic neurons occurred 14 days after stroke also affecting dopaminergic nuclei that are not directly coupled to MC. Since the pattern of neurodegeneration in case of a pure motor stroke is similar to a major stroke including the striatum, it is unlikely that direct synaptic coupling is a prerequisite for delayed secondary exo-focal post ischemic neurodegeneration. Furthermore, dopaminergic neurodegeneration was already detected by Fluoro-Jade C staining at day 7, coinciding with a solely slight inflammatory response. Thus, inflammation cannot be assumed to be the primary driver of exo-focal post-ischemic cell death. Moreover, nigral substance P (SP) expression indicated intact striato-nigral innervation after PTS, whereas opposing effects on SP expression after striatal infarcts argue against a critical role of SP in neurodegenerative or inflammatory processes during exo-focal neurodegeneration.
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Affiliation(s)
- J A Hosp
- Department of Neurology and Neuroscience, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - K L Greiner
- Department of Neurology and Neuroscience, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - L Martinez Arellano
- Department of Neurology and Neuroscience, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - F Roth
- Department of Neurology and Neuroscience, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - F Löffler
- Department of Neurology and Neuroscience, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J Reis
- Department of Neurology and Neuroscience, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - B Fritsch
- Department of Neurology and Neuroscience, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Rimmele DL, Frey BM, Cheng B, Schulz R, Krawinkel LA, Bönstrup M, Braass H, Gerloff C, Thomalla G. Association of Extrapyramidal Tracts' Integrity With Performance in Fine Motor Skills After Stroke. Stroke 2019; 49:2928-2932. [PMID: 30571408 DOI: 10.1161/strokeaha.118.022706] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background and Purpose- Tractography by diffusion tensor imaging has extended our knowledge on the contribution of damage to different pathways to residual motor function after stroke. Integrity of the corticospinal tract (CST), for example, has been identified to characterize and predict its course. Yet there is only scarce data that allow a judgment on the impact of extrapyramidal pathways between the basal ganglia on motor function poststroke. We aimed at studying their association with performance in fine motor skills after stroke. Methods- We performed probabilistic tractography and reconstructed nigro-pallidal tracts connecting substantia nigra and globus pallidus, as well as the CST in 26 healthy subjects. Resulting tracts were registered to the individual images of 20 patients 3 months after stroke, and their microstructural integrity was measured by fractional anisotropy. Clinical examination of the patients' gross (grip force) and fine (nine-hole peg test) motor skills was performed 1 year after stroke. For assessment of factors influencing nine-hole peg test, we used a multivariate model. Results- Nigro-pallidal tracts were traceable in all participants, had no overlap to the CST and passed the nucleus subthalamicus. In stroke patients, nigro-pallidal tracts ipsilateral to the stroke lesion showed a significantly reduced fractional anisotropy (ratio, 0.96±0.02; P=0.021). One year after stroke, nine-hole peg test values were significantly slower for the affected hand, while grip force was comparable between both hands. Reduced integrity of the nigro-pallidal tracts was associated with worse performance in the nine-hole peg test ( P=0.040), as was reduced integrity of the CST ( P<0.001) and younger age ( P<0.001). Conclusions- Nigro-pallidal tracts with containing connections of the nucleus subthalamicus represent a relevant part of the extrapyramidal system and specifically contribute to residual fine motor skills after stroke beyond the well-known contribution of the CST. They may deliver supportive information for prediction of motor recovery after stroke.
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Affiliation(s)
- D Leander Rimmele
- From the Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany (L.R., B.M.F., B.C., R.S., L.A.K., M.B., H.B., C.G., G.T.)
| | - Benedikt M Frey
- From the Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany (L.R., B.M.F., B.C., R.S., L.A.K., M.B., H.B., C.G., G.T.)
| | - Bastian Cheng
- From the Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany (L.R., B.M.F., B.C., R.S., L.A.K., M.B., H.B., C.G., G.T.)
| | - Robert Schulz
- From the Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany (L.R., B.M.F., B.C., R.S., L.A.K., M.B., H.B., C.G., G.T.)
| | - Lutz A Krawinkel
- From the Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany (L.R., B.M.F., B.C., R.S., L.A.K., M.B., H.B., C.G., G.T.)
| | - Marlene Bönstrup
- From the Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany (L.R., B.M.F., B.C., R.S., L.A.K., M.B., H.B., C.G., G.T.).,Human Cortical Physiology and Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (M.B.)
| | - Hanna Braass
- From the Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany (L.R., B.M.F., B.C., R.S., L.A.K., M.B., H.B., C.G., G.T.)
| | - Christian Gerloff
- From the Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany (L.R., B.M.F., B.C., R.S., L.A.K., M.B., H.B., C.G., G.T.)
| | - Götz Thomalla
- From the Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany (L.R., B.M.F., B.C., R.S., L.A.K., M.B., H.B., C.G., G.T.)
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10
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Remote Postischemic Conditioning Promotes Stroke Recovery by Shifting Circulating Monocytes to CCR2 + Proinflammatory Subset. J Neurosci 2019; 39:7778-7789. [PMID: 31427395 DOI: 10.1523/jneurosci.2699-18.2019] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 06/17/2019] [Accepted: 07/26/2019] [Indexed: 02/06/2023] Open
Abstract
Brain injury from stroke is typically considered an event exclusive to the CNS, but injury progression and repair processes are profoundly influenced by peripheral immunity. Stroke stimulates an acute inflammatory response that results in a massive infiltration of peripheral immune cells into the ischemic area. While these cells contribute to the development of brain injury, their recruitment has been considered as a key step for tissue repair. The paradoxical role of inflammatory monocytes in stroke raises the possibility that the manipulation of peripheral immune cells before infiltration into the brain could influence stroke outcome. One such manipulation is remote ischemic limb conditioning (RLC), which triggers an endogenous tolerance mechanism. We observed that mice subjected to poststroke RLC shifted circulating monocytes to a CCR2+ proinflammatory monocyte subset and had reduced acute brain injury, swelling, and improved motor/gait function in chronic stroke. The RLC benefits were observed regardless of injury severity, with a greater shift to a CCR2+ subset in severe stroke. Adoptive transfer of CCR2-deficient monocytes abolished RLC-mediated protection. The study demonstrates the importance of RLC-induced shift of monocytes to a CCR2+ proinflammatory subset in attenuating acute injury and promoting functional recovery in chronic stroke. The defined immune-mediated mechanism underlying RLC benefits allows for an evidence-based framework for the development of immune-based therapeutic strategies for stroke patients.SIGNIFICANCE STATEMENT Stroke is the leading cause of physical disability worldwide but has few treatment options for patients. Because remote ischemic limb conditioning (RLC) elicits endogenous tolerance in neither an organ- nor a tissue-specific manner, the immune system has been considered a mediator for an RLC-related benefit. Application of RLC after stroke increased a proinflammatory CCR2+ monocyte subset in the blood and the brain. RLC reduced acute stroke injury and promoted motor/gait function during the recovery phase. The RLC benefits were absent in mice that received CCR2-deficient monocytes. This preclinical study shows the importance of CCR2+ proinflammatory monocytes in RLC benefits in stroke and provides a therapeutic RLC platform as a novel immune strategy to improve outcomes in stroke patients.
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Vernooij MW. Remote Brain Iron Accumulation: A Useful Biomarker for Stroke Recovery? Radiology 2019; 291:449-450. [PMID: 30860452 DOI: 10.1148/radiol.2019190336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Meike W Vernooij
- From the Departments of Radiology and Epidemiology, Erasmus MC University Medical Center, Dr. Molewaterplein 40, 3015 CE Rotterdam, the Netherlands
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Linck PA, Kuchcinski G, Munsch F, Griffier R, Lopes R, Okubo G, Sagnier S, Renou P, Asselineau J, Perez P, Dousset V, Sibon I, Tourdias T. Neurodegeneration of the Substantia Nigra after Ipsilateral Infarct: MRI R2* Mapping and Relationship to Clinical Outcome. Radiology 2019; 291:438-448. [PMID: 30860451 DOI: 10.1148/radiol.2019182126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background The substantia nigra (SN) is suspected to be affected after remote infarction, in view of its large array of connections with the supratentorial brain. Whether secondary involvement of SN worsens overall clinical outcome after a supratentorial stroke has not previously been studied. Purpose To assess longitudinal changes in SN R2* by using MRI in the setting of ipsilesional supratentorial infarct and the relationship of SN signal change to clinical outcome. Materials and Methods Participants prospectively included from 2012 to 2015 were evaluated at 24-72 hours (baseline visit) and at 1 year with MRI to quantify R2*. The SN was segmented bilaterally to calculate an R2* asymmetry index (SN-AI); greater SN-AI indicated greater relative R2* in the ipsilateral compared with contralateral SN. The 95th percentile of R2* (hereafter, SN-AI95) was compared according to infarct location with mixed linear regression models. We also conducted voxel-based comparisons of R2* and identified individual infarcted voxels associated with high SN-AI95 through voxel-based lesion-symptom mapping. Multivariable regression models tested the association between SN-AI95 and clinical scores. Results A total of 181 participants were evaluated (127 men, 54 women; mean age ± standard deviation, 64.2 years ± 13.1; 75 striatum infarcts, 106 other locations). Visual inspection, SN-AI95, and average maps consistently showed higher SN R2* at 1 year if ipsilateral striatum was infarcted than if it was not (SN-AI95, 4.25 vs -0.88; P < .001), but this was not observed at baseline. The striatal location of the infarct was associated with higher SN-AI95 at 1 year independently from infarct volume, SN-AI95 at baseline, microbleeds, age, and sex (β = 4.99; P < .001). Voxel-based lesion-symptom mapping confirmed that striatum but also insula, internal capsule, and external capsule were associated with higher SN-AI95 at 1 year. SN-AI95 was an independent contributor of poor motor outcome (Box and Block Test, β = -.62 points; P = .01). Conclusion In patients with stroke, greater substantia nigra R2*, likely reflective of greater iron content, can be observed at 1 year ipsilateral from remote infarcts of specific location, which is associated with worse motor function. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Vernooij in this issue.
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Affiliation(s)
- Pierre Antoine Linck
- From the Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology and Diagnostic Neuroimaging, Bordeaux, France (P.A.L., F.M., V.D., T.T.); University of Bordeaux, Bordeaux, France (P.A.L., F.M., G.O., S.S., V.D., I.S., T.T.); CHU de Lille, Department of Neuroradiology, Lille, France (G.K., R.L.); University of Lille, Lille, France (G.K., R.L.); CHU de Bordeaux, Public Health Center, Methodological Support Unit for Clinical and Epidemiological Research, Bordeaux, France (R.G., J.A., P.P.); CHU de Bordeaux, Neurovascular Unit, Bordeaux, France (S.S., P.R., I.S.); and Institut National de la Santé et de la Recherche Médicale, Neurocentre Magendie, Bordeaux, France (V.D., T.T.)
| | - Gregory Kuchcinski
- From the Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology and Diagnostic Neuroimaging, Bordeaux, France (P.A.L., F.M., V.D., T.T.); University of Bordeaux, Bordeaux, France (P.A.L., F.M., G.O., S.S., V.D., I.S., T.T.); CHU de Lille, Department of Neuroradiology, Lille, France (G.K., R.L.); University of Lille, Lille, France (G.K., R.L.); CHU de Bordeaux, Public Health Center, Methodological Support Unit for Clinical and Epidemiological Research, Bordeaux, France (R.G., J.A., P.P.); CHU de Bordeaux, Neurovascular Unit, Bordeaux, France (S.S., P.R., I.S.); and Institut National de la Santé et de la Recherche Médicale, Neurocentre Magendie, Bordeaux, France (V.D., T.T.)
| | - Fanny Munsch
- From the Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology and Diagnostic Neuroimaging, Bordeaux, France (P.A.L., F.M., V.D., T.T.); University of Bordeaux, Bordeaux, France (P.A.L., F.M., G.O., S.S., V.D., I.S., T.T.); CHU de Lille, Department of Neuroradiology, Lille, France (G.K., R.L.); University of Lille, Lille, France (G.K., R.L.); CHU de Bordeaux, Public Health Center, Methodological Support Unit for Clinical and Epidemiological Research, Bordeaux, France (R.G., J.A., P.P.); CHU de Bordeaux, Neurovascular Unit, Bordeaux, France (S.S., P.R., I.S.); and Institut National de la Santé et de la Recherche Médicale, Neurocentre Magendie, Bordeaux, France (V.D., T.T.)
| | - Romain Griffier
- From the Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology and Diagnostic Neuroimaging, Bordeaux, France (P.A.L., F.M., V.D., T.T.); University of Bordeaux, Bordeaux, France (P.A.L., F.M., G.O., S.S., V.D., I.S., T.T.); CHU de Lille, Department of Neuroradiology, Lille, France (G.K., R.L.); University of Lille, Lille, France (G.K., R.L.); CHU de Bordeaux, Public Health Center, Methodological Support Unit for Clinical and Epidemiological Research, Bordeaux, France (R.G., J.A., P.P.); CHU de Bordeaux, Neurovascular Unit, Bordeaux, France (S.S., P.R., I.S.); and Institut National de la Santé et de la Recherche Médicale, Neurocentre Magendie, Bordeaux, France (V.D., T.T.)
| | - Renaud Lopes
- From the Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology and Diagnostic Neuroimaging, Bordeaux, France (P.A.L., F.M., V.D., T.T.); University of Bordeaux, Bordeaux, France (P.A.L., F.M., G.O., S.S., V.D., I.S., T.T.); CHU de Lille, Department of Neuroradiology, Lille, France (G.K., R.L.); University of Lille, Lille, France (G.K., R.L.); CHU de Bordeaux, Public Health Center, Methodological Support Unit for Clinical and Epidemiological Research, Bordeaux, France (R.G., J.A., P.P.); CHU de Bordeaux, Neurovascular Unit, Bordeaux, France (S.S., P.R., I.S.); and Institut National de la Santé et de la Recherche Médicale, Neurocentre Magendie, Bordeaux, France (V.D., T.T.)
| | - Gosuke Okubo
- From the Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology and Diagnostic Neuroimaging, Bordeaux, France (P.A.L., F.M., V.D., T.T.); University of Bordeaux, Bordeaux, France (P.A.L., F.M., G.O., S.S., V.D., I.S., T.T.); CHU de Lille, Department of Neuroradiology, Lille, France (G.K., R.L.); University of Lille, Lille, France (G.K., R.L.); CHU de Bordeaux, Public Health Center, Methodological Support Unit for Clinical and Epidemiological Research, Bordeaux, France (R.G., J.A., P.P.); CHU de Bordeaux, Neurovascular Unit, Bordeaux, France (S.S., P.R., I.S.); and Institut National de la Santé et de la Recherche Médicale, Neurocentre Magendie, Bordeaux, France (V.D., T.T.)
| | - Sharmila Sagnier
- From the Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology and Diagnostic Neuroimaging, Bordeaux, France (P.A.L., F.M., V.D., T.T.); University of Bordeaux, Bordeaux, France (P.A.L., F.M., G.O., S.S., V.D., I.S., T.T.); CHU de Lille, Department of Neuroradiology, Lille, France (G.K., R.L.); University of Lille, Lille, France (G.K., R.L.); CHU de Bordeaux, Public Health Center, Methodological Support Unit for Clinical and Epidemiological Research, Bordeaux, France (R.G., J.A., P.P.); CHU de Bordeaux, Neurovascular Unit, Bordeaux, France (S.S., P.R., I.S.); and Institut National de la Santé et de la Recherche Médicale, Neurocentre Magendie, Bordeaux, France (V.D., T.T.)
| | - Pauline Renou
- From the Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology and Diagnostic Neuroimaging, Bordeaux, France (P.A.L., F.M., V.D., T.T.); University of Bordeaux, Bordeaux, France (P.A.L., F.M., G.O., S.S., V.D., I.S., T.T.); CHU de Lille, Department of Neuroradiology, Lille, France (G.K., R.L.); University of Lille, Lille, France (G.K., R.L.); CHU de Bordeaux, Public Health Center, Methodological Support Unit for Clinical and Epidemiological Research, Bordeaux, France (R.G., J.A., P.P.); CHU de Bordeaux, Neurovascular Unit, Bordeaux, France (S.S., P.R., I.S.); and Institut National de la Santé et de la Recherche Médicale, Neurocentre Magendie, Bordeaux, France (V.D., T.T.)
| | - Julien Asselineau
- From the Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology and Diagnostic Neuroimaging, Bordeaux, France (P.A.L., F.M., V.D., T.T.); University of Bordeaux, Bordeaux, France (P.A.L., F.M., G.O., S.S., V.D., I.S., T.T.); CHU de Lille, Department of Neuroradiology, Lille, France (G.K., R.L.); University of Lille, Lille, France (G.K., R.L.); CHU de Bordeaux, Public Health Center, Methodological Support Unit for Clinical and Epidemiological Research, Bordeaux, France (R.G., J.A., P.P.); CHU de Bordeaux, Neurovascular Unit, Bordeaux, France (S.S., P.R., I.S.); and Institut National de la Santé et de la Recherche Médicale, Neurocentre Magendie, Bordeaux, France (V.D., T.T.)
| | - Paul Perez
- From the Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology and Diagnostic Neuroimaging, Bordeaux, France (P.A.L., F.M., V.D., T.T.); University of Bordeaux, Bordeaux, France (P.A.L., F.M., G.O., S.S., V.D., I.S., T.T.); CHU de Lille, Department of Neuroradiology, Lille, France (G.K., R.L.); University of Lille, Lille, France (G.K., R.L.); CHU de Bordeaux, Public Health Center, Methodological Support Unit for Clinical and Epidemiological Research, Bordeaux, France (R.G., J.A., P.P.); CHU de Bordeaux, Neurovascular Unit, Bordeaux, France (S.S., P.R., I.S.); and Institut National de la Santé et de la Recherche Médicale, Neurocentre Magendie, Bordeaux, France (V.D., T.T.)
| | - Vincent Dousset
- From the Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology and Diagnostic Neuroimaging, Bordeaux, France (P.A.L., F.M., V.D., T.T.); University of Bordeaux, Bordeaux, France (P.A.L., F.M., G.O., S.S., V.D., I.S., T.T.); CHU de Lille, Department of Neuroradiology, Lille, France (G.K., R.L.); University of Lille, Lille, France (G.K., R.L.); CHU de Bordeaux, Public Health Center, Methodological Support Unit for Clinical and Epidemiological Research, Bordeaux, France (R.G., J.A., P.P.); CHU de Bordeaux, Neurovascular Unit, Bordeaux, France (S.S., P.R., I.S.); and Institut National de la Santé et de la Recherche Médicale, Neurocentre Magendie, Bordeaux, France (V.D., T.T.)
| | - Igor Sibon
- From the Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology and Diagnostic Neuroimaging, Bordeaux, France (P.A.L., F.M., V.D., T.T.); University of Bordeaux, Bordeaux, France (P.A.L., F.M., G.O., S.S., V.D., I.S., T.T.); CHU de Lille, Department of Neuroradiology, Lille, France (G.K., R.L.); University of Lille, Lille, France (G.K., R.L.); CHU de Bordeaux, Public Health Center, Methodological Support Unit for Clinical and Epidemiological Research, Bordeaux, France (R.G., J.A., P.P.); CHU de Bordeaux, Neurovascular Unit, Bordeaux, France (S.S., P.R., I.S.); and Institut National de la Santé et de la Recherche Médicale, Neurocentre Magendie, Bordeaux, France (V.D., T.T.)
| | - Thomas Tourdias
- From the Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology and Diagnostic Neuroimaging, Bordeaux, France (P.A.L., F.M., V.D., T.T.); University of Bordeaux, Bordeaux, France (P.A.L., F.M., G.O., S.S., V.D., I.S., T.T.); CHU de Lille, Department of Neuroradiology, Lille, France (G.K., R.L.); University of Lille, Lille, France (G.K., R.L.); CHU de Bordeaux, Public Health Center, Methodological Support Unit for Clinical and Epidemiological Research, Bordeaux, France (R.G., J.A., P.P.); CHU de Bordeaux, Neurovascular Unit, Bordeaux, France (S.S., P.R., I.S.); and Institut National de la Santé et de la Recherche Médicale, Neurocentre Magendie, Bordeaux, France (V.D., T.T.)
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Tsai RJ, Hsieh LC, Cheng SJ, Chen CY. Secondary pallidonigral degeneration mimicking recurrent acute stroke in clinical presentation and magnetic resonance imaging: a case report. BMC Neurol 2017; 17:215. [PMID: 29228907 PMCID: PMC5725823 DOI: 10.1186/s12883-017-1000-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Secondary pallidonigral transneuronal degeneration after a remote primary cerebral infarct can mimic recurrent stroke at clinical presentation. We describe a patient with secondary pallidonigral degeneration following a previous putaminal infarct, which was diagnosed through diffusion-weighted (DWI) and T2-weighted imaging (T2WI). CASE PRESENTATION A 64-year-old man complained of an acute relapse of right-lower-limb weakness following a cerebral infarction 2 months before presentation. Recurrent cerebral stroke was initially diagnosed in the emergency room. DWI of the brain revealed a subacute to chronic infarct in the left putamen and new acute cytotoxic edema in the left substantia nigra (SN) and globus pallidus while T2WI also showed hyperintensity in the same regions. The SN was outside the aforementioned middle cerebral arterial territory, which includes the putamen. These findings are compatible with the diagnosis of acute pallidonigral injury secondary to striatal infarction. The patient had fully recovered from his right-lower-limb weakness after 1 month. CONCLUSIONS Secondary pallidonigral degeneration may mimic recurrent stroke. DWI along with T2WI facilitates elucidation of this clinicopathological entity, and thus unnecessary treatment can be avoided.
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Affiliation(s)
- Ruei-Je Tsai
- Department of Medical Imaging, Taipei Medical University Hospital, 252 Wu Hsing Street, Taipei, 110, Taiwan
| | - Li-Chun Hsieh
- Department of Medical Imaging, Taipei Medical University Hospital, 252 Wu Hsing Street, Taipei, 110, Taiwan.,Translational Imaging Research Center (TIRC), College of Medicine, Taipei Medical University, 252 Wu Hsing Street, Taipei, 110, Taiwan
| | - Sho-Jen Cheng
- Department of Medical Imaging, Taipei Medical University Hospital, 252 Wu Hsing Street, Taipei, 110, Taiwan
| | - Cheng-Yu Chen
- Department of Medical Imaging, Taipei Medical University Hospital, 252 Wu Hsing Street, Taipei, 110, Taiwan. .,Translational Imaging Research Center (TIRC), College of Medicine, Taipei Medical University, 252 Wu Hsing Street, Taipei, 110, Taiwan. .,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, 252 Wu Hsing Street, Taipei, 110, Taiwan.
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14
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Shin C, Kwon YN, Lee D, Hong IK, Kim HG, Lee KM, Ahn TB. Anterior cingulate cortex as an element of a possible novel motor circuit of the basal ganglia. Parkinsonism Relat Disord 2017; 46:90-91. [PMID: 29097082 DOI: 10.1016/j.parkreldis.2017.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/01/2017] [Accepted: 10/22/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Chaewon Shin
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Young Nam Kwon
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Dokyung Lee
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Il Ki Hong
- Department of Nuclear Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Hyug-Gi Kim
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Kyung Mi Lee
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Tae-Beom Ahn
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea.
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15
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Yanev P, Seevinck PR, Rudrapatna US, Bouts MJ, van der Toorn A, Gertz K, Kronenberg G, Endres M, van Tilborg GA, Dijkhuizen RM. Magnetic resonance imaging of local and remote vascular remodelling after experimental stroke. J Cereb Blood Flow Metab 2017; 37:2768-2779. [PMID: 27798270 PMCID: PMC5536787 DOI: 10.1177/0271678x16674737] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The pattern of vascular remodelling in relation to recovery after stroke remains largely unclear. We used steady-state contrast-enhanced magnetic resonance imaging to assess the development of cerebral blood volume and microvascular density in perilesional and exofocal areas from (sub)acutely to chronically after transient stroke in rats. Microvascular density was verified histologically after infusion with Evans Blue dye. At day 1, microvascular cerebral blood volume and microvascular density were reduced in and around the ischemic lesion (intralesional borderzone: microvascular cerebral blood volume = 72 ± 8%; microvascular density = 76 ± 8%) (P < 0.05), while total cerebral blood volume remained relatively unchanged. Perilesional microvascular cerebral blood volume and microvascular density subsequently normalized (day 7) and remained relatively stable (day 70). In remote ipsilateral areas in the thalamus and substantia nigra - not part of the ischemic lesion - microvascular density gradually increased between days 1 and 70 (thalamic ventral posterior nucleus: microvascular density = 119 ± 9%; substantia nigra: microvascular density = 122 ± 8% (P < 0.05)), which was confirmed histologically. Our data indicate that initial microvascular collapse, with maintained collateral flow in larger vessels, is followed by dynamic revascularization in perilesional tissue. Furthermore, progressive neovascularization in non-ischemic connected areas may offset secondary neuronal degeneration and/or contribute to non-neuronal tissue remodelling. The complex spatiotemporal pattern of vascular remodelling, involving regions outside the lesion territory, may be a critical endogenous process to promote post-stroke brain reorganization.
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Affiliation(s)
- Pavel Yanev
- 1 Biomedical MR Imaging and Spectroscopy Group, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter R Seevinck
- 1 Biomedical MR Imaging and Spectroscopy Group, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Umesh S Rudrapatna
- 1 Biomedical MR Imaging and Spectroscopy Group, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mark Jrj Bouts
- 1 Biomedical MR Imaging and Spectroscopy Group, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annette van der Toorn
- 1 Biomedical MR Imaging and Spectroscopy Group, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karen Gertz
- 2 Department of Neurology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.,3 Center for Stroke Research Berlin, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Golo Kronenberg
- 2 Department of Neurology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.,4 German Center for Cardiovascular Research (DZHK), Universitaetsmedizin Berlin, Berlin, Germany
| | - Matthias Endres
- 2 Department of Neurology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.,3 Center for Stroke Research Berlin, Charité - Universitaetsmedizin Berlin, Berlin, Germany.,4 German Center for Cardiovascular Research (DZHK), Universitaetsmedizin Berlin, Berlin, Germany.,5 German Center for Neurodegenerative Diseases (DZNE), Universitaetsmedizin Berlin, Berlin, Germany.,6 Berlin Institute of Health (BIH), Berlin, Germany
| | - Geralda A van Tilborg
- 1 Biomedical MR Imaging and Spectroscopy Group, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rick M Dijkhuizen
- 1 Biomedical MR Imaging and Spectroscopy Group, University Medical Center Utrecht, Utrecht, The Netherlands
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16
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Ong LK, Zhao Z, Kluge M, Walker FR, Nilsson M. Chronic stress exposure following photothrombotic stroke is associated with increased levels of Amyloid beta accumulation and altered oligomerisation at sites of thalamic secondary neurodegeneration in mice. J Cereb Blood Flow Metab 2017; 37:1338-1348. [PMID: 27342322 PMCID: PMC5453455 DOI: 10.1177/0271678x16654920] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Exposure to severe stress following stroke is recognised to complicate the recovery process. We have identified that stress can exacerbate the severity of post-stroke secondary neurodegeneration in the thalamus. In this study, we investigated whether exposure to stress could influence the accumulation of the neurotoxic protein Amyloid-β. Using an experimental model of focal cortical ischemia in adult mice combined with exposure to chronic restraint stress, we examined changes within the contra- and ipsilateral thalamus at six weeks post-stroke using Western blotting and immunohistochemical approaches. Western blotting analysis indicated that stroke was associated with a significant enhancement of the 25 and 50 kDa oligomers within the ipsilateral hemisphere and the 20 kDa oligomer within the contralateral hemisphere. Stroked animals exposed to stress exhibited an additional increase in multiple forms of Amyloid-beta oligomers. Immunohistochemistry analysis confirmed that stroke was associated with a significant accumulation of Amyloid-beta within the thalami of both hemispheres, an effect that was exacerbated in stroke animals exposed to stress. Given that Amyloid-beta oligomers, most notably the 30-40 and 50 kDa oligomers, are recognised to correlate with accelerated cognitive decline, our results suggest that monitoring stress levels in patients recovering from stroke may merit consideration in the future.
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Affiliation(s)
- Lin Kooi Ong
- 1 School of Biomedical Sciences and Pharmacy and the Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, Newcastle, NSW, Australia.,3 NHMRC Centre of Research Excellence Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
| | - Zidan Zhao
- 1 School of Biomedical Sciences and Pharmacy and the Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Murielle Kluge
- 1 School of Biomedical Sciences and Pharmacy and the Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Frederick R Walker
- 1 School of Biomedical Sciences and Pharmacy and the Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, Newcastle, NSW, Australia.,3 NHMRC Centre of Research Excellence Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
| | - Michael Nilsson
- 1 School of Biomedical Sciences and Pharmacy and the Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, Newcastle, NSW, Australia.,3 NHMRC Centre of Research Excellence Stroke Rehabilitation and Brain Recovery, Heidelberg, VIC, Australia
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17
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Kaesmacher J, Maegerlein C, Kaesmacher M, Zimmer C, Poppert H, Friedrich B, Boeckh-Behrens T, Kleine JF. Thrombus Migration in the Middle Cerebral Artery: Incidence, Imaging Signs, and Impact on Success of Endovascular Thrombectomy. J Am Heart Assoc 2017; 6:e005149. [PMID: 28202431 PMCID: PMC5523786 DOI: 10.1161/jaha.116.005149] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/20/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Thrombus migration (TM) in intracranial vessels during ischemic stroke has been reported in the form of case reports, but its incidence, impact on the technical success of subsequent endovascular thrombectomy and patients' outcome have never been studied systematically. METHODS AND RESULTS Retrospective analysis was done of 409 patients with isolated middle cerebral artery occlusions treated with endovascular thrombectomy. TM was observed (1) by analyzing discrepancies between computed tomographic angiography and digital subtraction angiography and (2) by comparing infarct pattern in the striatocapsular region with exact, angiographically assessed thrombus location within the M1-segment and the involvement of the middle cerebral artery perforators. Preinterventional infarction of discrepant regions (infarction in regions supplied by more proximal vessels than those occluded by the clot) was ensured by carefully reviewing available preinterventional multimodal imaging. Adequate imaging inclusion criteria were met by 325 patients. Ninety-seven patients showed signs of TM (26 with direct evidence, 71 with indirect evidence). There was no difference in the frequency of preinterventional intravenous recombinant tissue plasminogen activator administration between patients with TM and those without (63.9% vs 64.9%, P=0.899). TM was associated with lower rates of complete reperfusion (Thrombolysis in Cerebral Infarction score 3) (adjusted odds ratio 0.400, 95% CI 0.226-0.707). Subsequently, preinterventional TM was associated with lower rates of substantial neurologic improvement (adjusted odds ratio 0.541, 95% CI 0.309-0.946). CONCLUSIONS Preinterventional TM does not seem to be facilitated by intravenous recombinant tissue plasminogen activator and often occurs spontaneously. However, TM is associated with the risk of incomplete reperfusion in subsequent thrombectomy, suggesting increased clot fragility. Occurrence of TM may thereby have a substantial impact on the outcome of endovascularly treated stroke patients.
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Affiliation(s)
- Johannes Kaesmacher
- Department of Neuroradiology, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Christian Maegerlein
- Department of Neuroradiology, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Mirjam Kaesmacher
- Department of Neuroradiology, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Holger Poppert
- Department of Neurology, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Benjamin Friedrich
- Department of Neuroradiology, Klinikum rechts der Isar, TU München, Munich, Germany
| | | | - Justus F Kleine
- Department of Neuroradiology, Klinikum rechts der Isar, TU München, Munich, Germany
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