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Hong W, Zhang X, Liu Z, Li M, Yu Z, Zhao G, Wang Y, Sun C, Yang B, Xu R, Zhao Z. MRI Assessment of the Relationship Between Cortical Morphological Features and Hemiparetic Motor-Related Outcomes in Chronic Subcortical Stroke Patients. J Magn Reson Imaging 2023; 58:571-580. [PMID: 36440811 DOI: 10.1002/jmri.28542] [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: 09/20/2022] [Revised: 11/14/2022] [Accepted: 11/14/2022] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND It is unclear which cortical regions are specific to or commonly associated with the impairments of the upper/lower limbs and the activities of daily life (ADL) in stroke patients. PURPOSE To investigate the relationships between MRI-assessed surface-based morphometry (SBM) features and motor function as well as ADL in participants with chronic stroke. STUDY TYPE Prospective. SUBJECTS Thirty-five participants with subcortical stroke more than 3 months from the first-onset (age: 56.44 ± 9.56 years; 32 male). FIELD STRENGTH/SEQUENCE T1 -weighted images, 3.0 T, three-dimensional fast field-echo sequence. ASSESSMENT FreeSurfer (6.0) was used to parcellate each hemisphere into 34 regions based on the Desikan-Killiany atlas and to extract the surface area, volume, thickness, and curvature. The motor function and ADL were assessed by the Fugl-Meyer Assessment for the Upper/Lower Extremity (FMA-UE/FMA-LE) and the Chinese version of the Modified Barthel Index (MBI-C), respectively. STATISTICAL TESTS A linear mixed-effect model was applied to evaluate the relationship between the morphological features and the FMA-UE, FMA-LE, and MBI-C. A false discovery rate corrected P value < 0.05 was considered statistically significant. RESULTS Correlations between the size of stroke lesion and MRI measurements did not pass the FDR correction (adjusted P > 0.05). SBM features in motor-related and high-order cognitive cortical regions showed significant correlations with FMA-UE and FMA-LE, respectively. Moreover, the thickness in the prefrontal cortex significantly positively correlated, while the surface area in the right supramarginal gyrus significantly negatively correlated, with both FMA-UE, FMA-LE, and MBI-C. The thickness in the left frontal lobe significantly positively correlated with both FMA-UE and MBI-C. DATA CONCLUSION This study's findings suggest that different hemiparetic motor-related outcomes in participants with subcortical stroke which suffered a corticospinal tract-related injury show specific, but also share common, associations with several cortical regions. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Wenjun Hong
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xin Zhang
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zaixing Liu
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ming Li
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhixuan Yu
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Guanchun Zhao
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yuxin Wang
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Cuiyun Sun
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Bo Yang
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Rong Xu
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhiyong Zhao
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
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Liu J, Wang C, Qin W, Guo J, Han T, Cheng J, Yu C. Dynamic reorganization of cortical structure in multi-domain regions after capsular and pontine stroke. J Cereb Blood Flow Metab 2023; 43:1130-1141. [PMID: 37150601 PMCID: PMC10291451 DOI: 10.1177/0271678x231159954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/21/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023]
Abstract
Subcortical stroke may cause widespread structural changes to the cerebral cortex in multiple domains; however, the details of this process remain unclear. In this prospective observational study, we acquired two datasets to investigate the effect of lesion location on cortical structure. One was cross-sectional, comprising 269 patients with chronic stroke, either capsular stroke (CS) or pontine stroke (PS), and the other was longitudinal, comprising 119 patients with CS or PS. In the chronic-stage data, both CS and PS exhibited reduced cortical thickness in the precentral gyrus and increased cortical thickness and area in the frontal, temporal, occipital and insular cortices. Cortical thicknesses were correlated with motor outcomes in the precentral and lingual gyri, and early impairment of the corticospinal tract was associated with cortical thickness in the middle frontal gyrus. In the longitudinal dataset, CS showed gradually decreasing cortical thickness in the precentral gyrus, and both CS and PS showed gradually increasing cortical thickness and area in regions with significant structural reorganization. Subcortical stroke can therefore cause complex cortical structural changes in multi-domain regions involved in motor, primary and higher cognitive areas and have different evolution patterns depending on the subcortical level of the lesion affecting the motor pathways.
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Affiliation(s)
- Jingchun Liu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Caihong Wang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wen Qin
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Guo
- Department of Radiology, Tianjin Huanhu Hospital, Tianjin, China
| | - Tong Han
- Department of Radiology, Tianjin Huanhu Hospital, Tianjin, China
| | - Jingliang Cheng
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Chunshui Yu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
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Liu J, Wang C, Qin W, Ding H, Peng Y, Guo J, Han T, Cheng J, Yu C. Cortical structural changes after subcortical stroke: Patterns and correlates. Hum Brain Mapp 2022; 44:727-743. [PMID: 36189822 PMCID: PMC9842916 DOI: 10.1002/hbm.26095] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 09/11/2022] [Accepted: 09/14/2022] [Indexed: 01/25/2023] Open
Abstract
Subcortical ischemic stroke can lead to persistent structural changes in the cerebral cortex. The evolution of cortical structural changes after subcortical stroke is largely unknown, as are their relations with motor recovery, lesion location, and early impairment of specific subsets of fibers in the corticospinal tract (CST). In this observational study, cortical structural changes were compared between 181 chronic patients with subcortical stroke involving the motor pathway and 113 healthy controls. The impacts of acute lesion location and early impairments of specific CSTs on cortical structural changes were investigated in the patients by combining voxel-based correlation analysis with an association study that compared CST damage and cortical structural changes. Longitudinal patterns of cortical structural change were explored in a group of 81 patients with subcortical stroke using a linear mixed-effects model. In the cross-sectional analyses, patients with partial recovery showed more significant reductions in cortical thickness, surface area, or gray matter volume in the sensorimotor cortex, cingulate gyrus, and gyrus rectus than did patients with complete recovery; however, patients with complete recovery demonstrated more significant increases in the cortical structural measures in frontal, temporal, and occipital regions than did patients with partial recovery. Voxel-based correlation analysis in these patients showed that acute stroke lesions involving the CST fibers originating from the primary motor cortex were associated with cortical thickness reductions in the ipsilesional motor cortex in the chronic stage. Acute stroke lesions in the putamen were correlated with increased surface area in the temporal pole in the chronic stage. The early impairment of the CST fibers originating from the primary sensory area was associated with increased cortical thickness in the occipital cortex. In the longitudinal analyses, patients with partial recovery showed gradually reduced cortical thickness, surface area, and gray matter volume in brain regions with significant structural damage in the chronic stage. Patients with complete recovery demonstrated gradually increasing cortical thickness, surface area, and gray-matter volume in the frontal, temporal, and occipital regions. The directions of slow structural changes in the frontal, occipital, and cingulate cortices were completely different between patients with partial and complete recovery. Complex cortical structural changes and their dynamic evolution patterns were different, even contrasting, in patients with partial and complete recovery, and were associated with lesion location and with impairment of specific CST fiber subsets.
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Affiliation(s)
- Jingchun Liu
- Department of Radiology and Tianjin Key Laboratory of Functional ImagingTianjin Medical University General HospitalTianjinChina
| | - Caihong Wang
- Department of MRIThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Wen Qin
- Department of Radiology and Tianjin Key Laboratory of Functional ImagingTianjin Medical University General HospitalTianjinChina
| | - Hao Ding
- Department of Radiology and Tianjin Key Laboratory of Functional ImagingTianjin Medical University General HospitalTianjinChina,School of Medical ImagingTianjin Medical UniversityTianjinChina
| | - Yanmin Peng
- Department of Radiology and Tianjin Key Laboratory of Functional ImagingTianjin Medical University General HospitalTianjinChina,School of Medical ImagingTianjin Medical UniversityTianjinChina
| | - Jun Guo
- Department of RadiologyTianjin Huanhu HospitalTianjinChina
| | - Tong Han
- Department of RadiologyTianjin Huanhu HospitalTianjinChina
| | - Jingliang Cheng
- Department of MRIThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Chunshui Yu
- Department of Radiology and Tianjin Key Laboratory of Functional ImagingTianjin Medical University General HospitalTianjinChina,CAS Center for Excellence in Brain Science and Intelligence TechnologyChinese Academy of SciencesShanghaiChina
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Graterol Pérez JA, Guder S, Choe CU, Gerloff C, Schulz R. Relationship Between Cortical Excitability Changes and Cortical Thickness in Subcortical Chronic Stroke. Front Neurol 2022; 13:802113. [PMID: 35345406 PMCID: PMC8957093 DOI: 10.3389/fneur.2022.802113] [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: 10/26/2021] [Accepted: 01/31/2022] [Indexed: 11/21/2022] Open
Abstract
Ischemic stroke leads to excitability changes of the motor network as probed by means of transcranial magnetic stimulation (TMS). There is still limited data that shows to what extent structural alterations of the motor network might be linked to excitability changes. Previous results argue that the microstructural state of specific corticofugal motor tracts such as the corticospinal tract associate with cortical excitability in chronic stroke patients. The relationship between changes of cortical anatomy after stroke, as operationalized by means of decreases or increases in local cortical thickness (CT), has scarcely been addressed. In the present study, we re-analyzed TMS data and recruitment curve properties of motor evoked potentials and CT data in a group of 14 well-recovered chronic stroke patients with isolated supratentorial subcortical lesions. CT data of the stroke patients were compared to CT data of 17 healthy controls. Whole-brain and region-of-interest based analyses were conducted to relate CT data to measures of motor cortical excitability and clinical data. We found that stroke patients exhibited significantly reduced CT not only in the ipsilesional primary motor cortex but also in numerous secondary motor and non-motor brain regions, particularly in the ipsilesional hemisphere including areas along the central sulcus, the inferior frontal sulcus, the intraparietal sulcus, and cingulate cortices. We could not detect any significant relationship between the extent of CT reduction and stroke-related excitability changes of the motor network or clinical scores.
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Affiliation(s)
- José A Graterol Pérez
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stephanie Guder
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Chi-Un Choe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robert Schulz
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Cortese AM, Cacciante L, Schuler AL, Turolla A, Pellegrino G. Cortical Thickness of Brain Areas Beyond Stroke Lesions and Sensory-Motor Recovery: A Systematic Review. Front Neurosci 2021; 15:764671. [PMID: 34803596 PMCID: PMC8595399 DOI: 10.3389/fnins.2021.764671] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The clinical outcome of patients suffering from stroke is dependent on multiple factors. The features of the lesion itself play an important role but clinical recovery is remarkably influenced by the plasticity mechanisms triggered by the stroke and occurring at a distance from the lesion. The latter translate into functional and structural changes of which cortical thickness might be easy to quantify one of the main players. However, studies on the changes of cortical thickness in brain areas beyond stroke lesion and their relationship to sensory-motor recovery are sparse. Objectives: To evaluate the effects of cerebral stroke on cortical thickness (CT) beyond the stroke lesion and its association with sensory-motor recovery. Materials and Methods: Five electronic databases (PubMed, Embase, Web of Science, Scopus and the Cochrane Library) were searched. Methodological quality of the included studies was assessed with the Newcastle-Ottawa Scale for non-randomized controlled trials and the Risk of Bias Cochrane tool for randomized controlled trials. Results: The search strategy retrieved 821 records, 12 studies were included and risk of bias assessed. In most of the included studies, cortical thinning was seen at the ipsilesional motor area (M1). Cortical thinning can occur beyond the stroke lesion, typically in regions anatomically connected because of anterograde degeneration. Nonetheless, studies also reported cortical thickening of regions of the unaffected hemisphere, likely related to compensatory plasticity. Some studies revealed a significant correlation between changes in cortical thickness of M1 or somatosensory (S1) cortical areas and motor function recovery. Discussion and Conclusions: Following a stroke, changes in cortical thickness occur both in regions directly connected to the stroke lesion and in contralateral hemisphere areas as well as in the cerebellum. The underlying mechanisms leading to these changes in cortical thickness are still to be fully understood and further research in the field is needed. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020200539; PROSPERO 2020, identifier: CRD42020200539.
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Affiliation(s)
- Anna Maria Cortese
- Laboratory of Rehabilitation Technologies, San Camillo Istituto di Ricovero e Cura a Carattere Scientifico, Venice, Italy
| | - Luisa Cacciante
- Laboratory of Rehabilitation Technologies, San Camillo Istituto di Ricovero e Cura a Carattere Scientifico, Venice, Italy
| | - Anna-Lisa Schuler
- Laboratory of Clinical Imaging and Stimulation, San Camillo Istituto di Ricovero e Cura a Carattere Scientifico, Venice, Italy
| | - Andrea Turolla
- Laboratory of Rehabilitation Technologies, San Camillo Istituto di Ricovero e Cura a Carattere Scientifico, Venice, Italy
| | - Giovanni Pellegrino
- Laboratory of Clinical Imaging and Stimulation, San Camillo Istituto di Ricovero e Cura a Carattere Scientifico, Venice, Italy
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Simis M, Imamura M, Sampaio de Melo P, Marduy A, Battistella L, Fregni F. Deficit of Inhibition as a Marker of Neuroplasticity (DEFINE Study) in Rehabilitation: A Longitudinal Cohort Study Protocol. Front Neurol 2021; 12:695406. [PMID: 34434160 PMCID: PMC8380986 DOI: 10.3389/fneur.2021.695406] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/21/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Brain plasticity is an intrinsic property of the nervous system, which is modified during its lifetime. This is one mechanism of recuperation after injuries with an important role in rehabilitation. Evidence suggests that injuries in the nervous system disturb the stability between inhibition and excitability essential for the recuperation process of neuroplasticity. However, the mechanisms involved in this balance are not completely understood and, besides the advancement in the field, the knowledge has had a low impact on the rehabilitation practice. Therefore, the understanding of the relationship between biomarkers and functional disability may help to optimize and individualize treatments and build consistent studies in the future. Methods: This cohort study, the deficit of inhibition as a marker of neuroplasticity study, will follow four groups (stroke, spinal cord injury, limb amputation, and osteoarthritis) to understand the neuroplasticity mechanisms involved in motor rehabilitation. We will recruit 500 subjects (including 100 age- and sex-matched controls). A battery of neurophysiological assessments, transcranial magnetic stimulation, electroencephalography, functional near-infrared spectroscopy, and magnetic resonance imaging, is going to be used to assess plasticity on the motor cortex before and after rehabilitation. One of the main hypotheses in this cohort is that the level of intracortical inhibition is related to functional deficits. We expect to develop a better understanding of the neuroplasticity mechanisms involved in the rehabilitation, and we expect to build neurophysiological “transdiagnostic” biomarkers, especially the markers of inhibition, which will have great relevance in the scientific and therapeutic improvement in rehabilitation. The relationship between neurophysiological and clinical outcomes will be analyzed using linear and logistic regression models. Discussion: By evaluating the reliability of electroencephalography, functional near-infrared spectroscopy, transcranial magnetic stimulation, and magnetic resonance imaging measures as possible biomarkers for neurologic rehabilitation in different neurologic disorders, this study will aid in the understanding of brain plasticity mechanisms in rehabilitation, allowing more effective approaches and screening methods to take place.
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Affiliation(s)
- Marcel Simis
- Núcleo de Estudos Avançados em Reabilitação, Universidade de São Paulo, São Paulo, Brazil
| | - Marta Imamura
- Núcleo de Estudos Avançados em Reabilitação, Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Sampaio de Melo
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Anna Marduy
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Linamara Battistella
- Núcleo de Estudos Avançados em Reabilitação, Universidade de São Paulo, São Paulo, Brazil
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Boston, MA, United States
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7
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Ferris JK, Neva JL, Vavasour IM, Attard KJ, Greeley B, Hayward KS, Wadden KP, MacKay AL, Boyd LA. Cortical N-acetylaspartate concentrations are impacted in chronic stroke but do not relate to motor impairment: A magnetic resonance spectroscopy study. Hum Brain Mapp 2021; 42:3119-3130. [PMID: 33939206 PMCID: PMC8193507 DOI: 10.1002/hbm.25421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/24/2021] [Accepted: 03/08/2021] [Indexed: 12/11/2022] Open
Abstract
Magnetic resonance spectroscopy (MRS) measures cerebral metabolite concentrations, which can inform our understanding of the neurobiological processes associated with stroke recovery. Here, we investigated whether metabolite concentrations in primary motor and somatosensory cortices (sensorimotor cortex) are impacted by stroke and relate to upper‐extremity motor impairment in 45 individuals with chronic stroke. Cerebral metabolite estimates were adjusted for cerebrospinal fluid and brain tissue composition in the MRS voxel. Upper‐extremity motor impairment was indexed with the Fugl‐Meyer (FM) scale. N‐acetylaspartate (NAA) concentration was reduced bilaterally in stroke participants with right hemisphere lesions (n = 23), relative to right‐handed healthy older adults (n = 15; p = .006). Within the entire stroke sample (n = 45) NAA and glutamate/glutamine (GLX) were lower in the ipsilesional sensorimotor cortex, relative to the contralesional cortex (NAA: p < .001; GLX: p = .003). Lower ipsilesional NAA was related to greater extent of corticospinal tract (CST) injury, quantified by a weighted CST lesion load (p = .006). Cortical NAA and GLX concentrations did not relate to the severity of chronic upper‐extremity impairment (p > .05), including after a sensitivity analysis imputing missing metabolite data for individuals with large cortical lesions (n = 5). Our results suggest that NAA, a marker of neuronal integrity, is sensitive to stroke‐related cortical damage and may provide mechanistic insights into cellular processes of cortical adaptation to stroke. However, cortical MRS metabolites may have limited clinical utility as prospective biomarkers of upper‐extremity outcomes in chronic stroke.
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Affiliation(s)
- Jennifer K Ferris
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason L Neva
- École de Kinésiologie et des Sciences de l'activité Physique, Université of Montréal, Montreal, Quebec, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-sud-de-I'île de Montréal, Montreal, Quebec, Canada
| | - Irene M Vavasour
- Faculty of Medicine, UBC MRI Research Center, University of British Columbia, Vancouver, BC, Canada
| | - Kaitlin J Attard
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Greeley
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathryn S Hayward
- School of Health Sciences, Florey Institute of Neuroscience and Mental Health, NHMRC CRE in Stroke Rehabilitation and Brain Recovery, The University of Melbourne, Parkville, Victoria, Australia
| | - Katie P Wadden
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Alex L MacKay
- Faculty of Medicine, UBC MRI Research Center, University of British Columbia, Vancouver, BC, Canada
| | - Lara A Boyd
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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Hong H, Yu X, Zhang R, Jiaerken Y, Wang S, Luo X, Lou M, Huang P, Zhang M. Cortical degeneration detected by neurite orientation dispersion and density imaging in chronic lacunar infarcts. Quant Imaging Med Surg 2021; 11:2114-2124. [PMID: 33936992 DOI: 10.21037/qims-20-880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Although lacunar infarcts are focal lesions, they may also have more widespread effects. A reduction in cortical thickness in the remote cortex after lacunar infarcts has been detected by structural imaging; however, its underlying microstructural changes are yet to be elucidated. This study aimed to investigate the effects of lacunar infarcts on the microstructural abnormalities associated with cortical thickness reduction in the remote cortex. Methods Thirty-seven patients with chronic lacunar infarcts were included. Brain structural magnetic resonance images (MRIs) and diffusion tensor images were acquired. We constructed the white matter tracts connecting with the lacunar infarcts and identified the connected cortical area based on a standard brain atlas warped into the subject space. Cortical thickness and microstructural neurite orientation dispersion and density imaging (NODDI) metrics of the ipsilesional and contralesional cortices were compared, and correlations between cortical thickness and NODDI metrics were also investigated. Results We found decreased cortical thickness and reduced neurite orientation dispersion index (ODI) in the ipsilesional cortex (2.47 vs. 2.50 mm, P=0.008; 0.451 vs. 0.456, P=0.035, respectively). In patients with precentral gyrus involvement (n=23), we found that ODI in the ipsilesional cortex was correlated with cortical thickness (r=0.437, P=0.037), and ODI in the contralesional cortex was also correlated with contralesional cortical thickness (r=0.440, P=0.036). Conclusions NODDI metrics could reflect cortical microstructural changes following lacunar infarcts. The correlation between decreased ODI and reduced cortical thickness suggests that dendrites' loss might contribute to lacunar infarct-related cortical atrophy.
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Affiliation(s)
- Hui Hong
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xinfeng Yu
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ruiting Zhang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Yeerfan Jiaerken
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Shuyue Wang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xiao Luo
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Min Lou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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Tanev KS, Federico LE, Sydnor VJ, Leveroni CL, Hassan K, Biffi A. Neuropsychiatric symptoms in a occipito-temporal infarction with remarkable long-term functional recovery. Cortex 2021; 137:205-214. [PMID: 33640852 DOI: 10.1016/j.cortex.2021.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/12/2020] [Accepted: 01/13/2021] [Indexed: 11/18/2022]
Abstract
Posterior circulation infarctions (PCI) constitute 5-25% of ischemic strokes. PCI of the occipital lobe present with a panoply of symptoms including quadrantanopsia, topographical disorientation, and executive dysfunction. Long-term cognitive recovery after PCI is not well described. However, the adult brain is remarkably plastic, capable of adapting and remodeling. We describe a 43-year-old right-handed woman who complained of black spots in both eyes, headaches, photophobia, and a feeling she would faint. Initial neurological exam and a CT scan were normal; she was diagnosed with ocular migraine. A second neurological exam a week later showed left superior quadrantopsia; an MRI scan suggested right occipito-temporal infarct. In subsequent months, the patient complained of fatigue, quadrantanopsia, memory problems, and topographical disorientation. The patient participated in multi-modality treatment, and in self-directed arts projects and physical activities. Six years later, she reported noticeable improvements in cognition and daily functioning, which were documented on neurocognitive testing. Comparison between initial and subsequent MRIs using FreeSurfer 5.3 identified neuroplastic brain changes in areas serving similar functions to the areas injured from the stroke. The case illustrates the neuropsychiatric presentation after right occipito-temporal stroke, the value of formal and self-directed cognitive rehabilitation, the extended time to cognitive recovery, and the ability of the brain to undergo neuroplastic changes.
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Affiliation(s)
| | | | - Valerie J Sydnor
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA.
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Chen H, Shi M, Geng W, Jiang L, Yin X, Chen YC. A preliminary study of cortical morphology changes in acute brainstem ischemic stroke patients. Medicine (Baltimore) 2021; 100:e24262. [PMID: 33429834 PMCID: PMC7793415 DOI: 10.1097/md.0000000000024262] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 12/13/2020] [Indexed: 01/05/2023] Open
Abstract
The study aimed to explore the cortical thickness and gyrification abnormalities in acute brainstem ischemic patients in both the ipsilateral and contralateral hemisphere compared with healthy controls. Structural magnetic resonance imaging data were prospectively acquired in 48 acute brainstem ischemic patients, 21 patients with left lesion and 27 with right lesion, respectively. Thirty healthy controls were recruited. Cortical morphometry based on surface-based data analysis driven by CAT12 toolbox implemented in SPM12 was used to compare changes in cortical thickness and gyrification. Significant decreases of cortical thickness loss were found in bilateral cerebral hemispheres of the brainstem ischemic patients compared to the healthy controls (P < .05, family-wise error (FWE)-corrected). We also found significant gyrification decreases in the insula, transverse temporal, supramarginal of the ipsilateral on hemisphere in the right brainstem ischemic patients compared to the healthy controls (P < .05, FWE-corrected). Brainstem ischemic patients have widely morphological changes in the early phase and may be helpful in designing individualized rehabilitative strategies for these patients.
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Mostafa MM, Awad EM, Hazzou AM, Elewa MKA, Aziz TTA, Samy DM. Biochemical and structural magnetic resonance imaging in chronic stroke and the relationship with upper extremity motor function. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00183-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Recovery of upper extremity (UE) motor function after stroke is variable from one to another due to heterogeneity of stroke pathology. Structural and biochemical magnetic resonance imaging of the primary motor cortex (M1) have been used to document reorganization of neural activity after stroke.
Objective
To assess cortical biochemical and structural causes of delayed recovery of UE motor function impairment in chronic subcortical ischemic stroke patients.
Methodology
A cross-sectional study with fifty patients were enrolled: thirty patients with chronic (> 6 months) subcortical ischemic stroke suffering from persistent UE motor function impairment (not improved group) and twenty patients with chronic subcortical ischemic stroke and improved UE motor function (improved group). We recruited a group of (16) age-matched healthy subjects. Single voxel proton magnetic resonance spectroscopy (1H-MRS) was performed to measure n-acetylaspartate (NAA) and glutamate+glutamine (Glx) ratios relative to creatine (Cr) in the precentral gyrus which represent M1of hand area in both ipsilesional and contralesional hemispheres. Brain magnetic resonance imaging (MRI) to measure precentral gyral thickness is representing the M1of hand area. UE motor function assessment is using the Fugl Meyer Assessment (FMA-UE) Scale.
Results
The current study found that ipslesional cortical thickness was significantly lower than contralesional cortical thickness among all stroke patients. Our study found that ipsilesional NAA/Cr ratio was lower than contralesional NAA/Cr among stroke patients. UE and hand motor function by FMA-UE showed highly statistically significant correlation with ipsilesional cortical thickness and ipsilesional NAA/Cr ratio, more powerful with NAA/Cr ratio.
Conclusion
We concluded that persistent motor impairment in individuals with chronic subcortical stroke may be at least in part related to ipsilesional structural and biochemical changes in motor areas remote from infarction in form of decreased cortical thickness and NAA/Cr ratio which had the strongest relationship with that impairment.
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12
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Liu H, Peng X, Dahmani L, Wang H, Zhang M, Shan Y, Rong D, Guo Y, Li J, Li N, Wang L, Lin Y, Pan R, Lu J, Wang D. Patterns of motor recovery and structural neuroplasticity after basal ganglia infarcts. Neurology 2020; 95:e1174-e1187. [PMID: 32586896 DOI: 10.1212/wnl.0000000000010149] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/02/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To elucidate the timeframe and spatial patterns of cortical reorganization after different stroke-induced basal ganglia lesions, we measured cortical thickness at 5 time points over a 6-month period. We hypothesized that cortical reorganization would occur very early and that, along with motor recovery, it would vary based on the stroke lesion site. METHODS Thirty-three patients with unilateral basal ganglia stroke and 23 healthy control participants underwent MRI scanning and behavioral testing. To further decrease heterogeneity, we split patients into 2 groups according to whether or not the lesions mainly affect the striatal motor network as defined by resting-state functional connectivity. A priori measures included cortical thickness and motor outcome, as assessed with the Fugl-Meyer scale. RESULTS Within 14 days poststroke, cortical thickness already increased in widespread brain areas (p = 0.001), mostly in the frontal and temporal cortices rather than in the motor cortex. Critically, the 2 groups differed in the severity of motor symptoms (p = 0.03) as well as in the cerebral reorganization they exhibited over a period of 6 months (Dice overlap index = 0.16). Specifically, the frontal and temporal regions demonstrating cortical thickening showed minimal overlap between these 2 groups, indicating different patterns of reorganization. CONCLUSIONS Our findings underline the importance of assessing patients early and of considering individual differences, as patterns of cortical reorganization differ substantially depending on the precise location of damage and occur very soon after stroke. A better understanding of the macrostructural brain changes following stroke and their relationship with recovery may inform individualized treatment strategies.
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Affiliation(s)
- Hesheng Liu
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (H.L., X.P., L.D., H.W., J. Li, N.L., R.P., D.W.), Massachusetts General Hospital, Harvard Medical School, Charlestown; Beijing Institute for Brain Disorders (H.L.), Departments of Radiology (M.Z., Y.S., D.R., J. Lu) and Nuclear Medicine (J. Lu), Xuanwu Hospital, and Department of Neurology, Beijing Friendship Hospital (Y.G.), Capital Medical University; Liaoyuan Hospital of Traditional Chinese Medicine (L.W.); Department of Neurosurgery (Y.L.), First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Neuroscience (H.L., X.P.), Medical University of South Carolina, Charleston; Department of Radiology (X.P.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Changchun University of Chinese Medicine (H.W.); and Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics (M.Z., Y.S., D.R., J. Lu), China
| | - Xiaolong Peng
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (H.L., X.P., L.D., H.W., J. Li, N.L., R.P., D.W.), Massachusetts General Hospital, Harvard Medical School, Charlestown; Beijing Institute for Brain Disorders (H.L.), Departments of Radiology (M.Z., Y.S., D.R., J. Lu) and Nuclear Medicine (J. Lu), Xuanwu Hospital, and Department of Neurology, Beijing Friendship Hospital (Y.G.), Capital Medical University; Liaoyuan Hospital of Traditional Chinese Medicine (L.W.); Department of Neurosurgery (Y.L.), First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Neuroscience (H.L., X.P.), Medical University of South Carolina, Charleston; Department of Radiology (X.P.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Changchun University of Chinese Medicine (H.W.); and Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics (M.Z., Y.S., D.R., J. Lu), China
| | - Louisa Dahmani
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (H.L., X.P., L.D., H.W., J. Li, N.L., R.P., D.W.), Massachusetts General Hospital, Harvard Medical School, Charlestown; Beijing Institute for Brain Disorders (H.L.), Departments of Radiology (M.Z., Y.S., D.R., J. Lu) and Nuclear Medicine (J. Lu), Xuanwu Hospital, and Department of Neurology, Beijing Friendship Hospital (Y.G.), Capital Medical University; Liaoyuan Hospital of Traditional Chinese Medicine (L.W.); Department of Neurosurgery (Y.L.), First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Neuroscience (H.L., X.P.), Medical University of South Carolina, Charleston; Department of Radiology (X.P.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Changchun University of Chinese Medicine (H.W.); and Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics (M.Z., Y.S., D.R., J. Lu), China
| | - Hongfeng Wang
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (H.L., X.P., L.D., H.W., J. Li, N.L., R.P., D.W.), Massachusetts General Hospital, Harvard Medical School, Charlestown; Beijing Institute for Brain Disorders (H.L.), Departments of Radiology (M.Z., Y.S., D.R., J. Lu) and Nuclear Medicine (J. Lu), Xuanwu Hospital, and Department of Neurology, Beijing Friendship Hospital (Y.G.), Capital Medical University; Liaoyuan Hospital of Traditional Chinese Medicine (L.W.); Department of Neurosurgery (Y.L.), First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Neuroscience (H.L., X.P.), Medical University of South Carolina, Charleston; Department of Radiology (X.P.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Changchun University of Chinese Medicine (H.W.); and Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics (M.Z., Y.S., D.R., J. Lu), China
| | - Miao Zhang
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (H.L., X.P., L.D., H.W., J. Li, N.L., R.P., D.W.), Massachusetts General Hospital, Harvard Medical School, Charlestown; Beijing Institute for Brain Disorders (H.L.), Departments of Radiology (M.Z., Y.S., D.R., J. Lu) and Nuclear Medicine (J. Lu), Xuanwu Hospital, and Department of Neurology, Beijing Friendship Hospital (Y.G.), Capital Medical University; Liaoyuan Hospital of Traditional Chinese Medicine (L.W.); Department of Neurosurgery (Y.L.), First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Neuroscience (H.L., X.P.), Medical University of South Carolina, Charleston; Department of Radiology (X.P.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Changchun University of Chinese Medicine (H.W.); and Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics (M.Z., Y.S., D.R., J. Lu), China
| | - Yi Shan
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (H.L., X.P., L.D., H.W., J. Li, N.L., R.P., D.W.), Massachusetts General Hospital, Harvard Medical School, Charlestown; Beijing Institute for Brain Disorders (H.L.), Departments of Radiology (M.Z., Y.S., D.R., J. Lu) and Nuclear Medicine (J. Lu), Xuanwu Hospital, and Department of Neurology, Beijing Friendship Hospital (Y.G.), Capital Medical University; Liaoyuan Hospital of Traditional Chinese Medicine (L.W.); Department of Neurosurgery (Y.L.), First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Neuroscience (H.L., X.P.), Medical University of South Carolina, Charleston; Department of Radiology (X.P.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Changchun University of Chinese Medicine (H.W.); and Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics (M.Z., Y.S., D.R., J. Lu), China
| | - Dongdong Rong
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (H.L., X.P., L.D., H.W., J. Li, N.L., R.P., D.W.), Massachusetts General Hospital, Harvard Medical School, Charlestown; Beijing Institute for Brain Disorders (H.L.), Departments of Radiology (M.Z., Y.S., D.R., J. Lu) and Nuclear Medicine (J. Lu), Xuanwu Hospital, and Department of Neurology, Beijing Friendship Hospital (Y.G.), Capital Medical University; Liaoyuan Hospital of Traditional Chinese Medicine (L.W.); Department of Neurosurgery (Y.L.), First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Neuroscience (H.L., X.P.), Medical University of South Carolina, Charleston; Department of Radiology (X.P.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Changchun University of Chinese Medicine (H.W.); and Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics (M.Z., Y.S., D.R., J. Lu), China
| | - Yanjun Guo
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (H.L., X.P., L.D., H.W., J. Li, N.L., R.P., D.W.), Massachusetts General Hospital, Harvard Medical School, Charlestown; Beijing Institute for Brain Disorders (H.L.), Departments of Radiology (M.Z., Y.S., D.R., J. Lu) and Nuclear Medicine (J. Lu), Xuanwu Hospital, and Department of Neurology, Beijing Friendship Hospital (Y.G.), Capital Medical University; Liaoyuan Hospital of Traditional Chinese Medicine (L.W.); Department of Neurosurgery (Y.L.), First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Neuroscience (H.L., X.P.), Medical University of South Carolina, Charleston; Department of Radiology (X.P.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Changchun University of Chinese Medicine (H.W.); and Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics (M.Z., Y.S., D.R., J. Lu), China
| | - Junchao Li
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (H.L., X.P., L.D., H.W., J. Li, N.L., R.P., D.W.), Massachusetts General Hospital, Harvard Medical School, Charlestown; Beijing Institute for Brain Disorders (H.L.), Departments of Radiology (M.Z., Y.S., D.R., J. Lu) and Nuclear Medicine (J. Lu), Xuanwu Hospital, and Department of Neurology, Beijing Friendship Hospital (Y.G.), Capital Medical University; Liaoyuan Hospital of Traditional Chinese Medicine (L.W.); Department of Neurosurgery (Y.L.), First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Neuroscience (H.L., X.P.), Medical University of South Carolina, Charleston; Department of Radiology (X.P.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Changchun University of Chinese Medicine (H.W.); and Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics (M.Z., Y.S., D.R., J. Lu), China
| | - Nianlin Li
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (H.L., X.P., L.D., H.W., J. Li, N.L., R.P., D.W.), Massachusetts General Hospital, Harvard Medical School, Charlestown; Beijing Institute for Brain Disorders (H.L.), Departments of Radiology (M.Z., Y.S., D.R., J. Lu) and Nuclear Medicine (J. Lu), Xuanwu Hospital, and Department of Neurology, Beijing Friendship Hospital (Y.G.), Capital Medical University; Liaoyuan Hospital of Traditional Chinese Medicine (L.W.); Department of Neurosurgery (Y.L.), First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Neuroscience (H.L., X.P.), Medical University of South Carolina, Charleston; Department of Radiology (X.P.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Changchun University of Chinese Medicine (H.W.); and Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics (M.Z., Y.S., D.R., J. Lu), China
| | - Long Wang
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (H.L., X.P., L.D., H.W., J. Li, N.L., R.P., D.W.), Massachusetts General Hospital, Harvard Medical School, Charlestown; Beijing Institute for Brain Disorders (H.L.), Departments of Radiology (M.Z., Y.S., D.R., J. Lu) and Nuclear Medicine (J. Lu), Xuanwu Hospital, and Department of Neurology, Beijing Friendship Hospital (Y.G.), Capital Medical University; Liaoyuan Hospital of Traditional Chinese Medicine (L.W.); Department of Neurosurgery (Y.L.), First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Neuroscience (H.L., X.P.), Medical University of South Carolina, Charleston; Department of Radiology (X.P.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Changchun University of Chinese Medicine (H.W.); and Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics (M.Z., Y.S., D.R., J. Lu), China
| | - Yuanxiang Lin
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (H.L., X.P., L.D., H.W., J. Li, N.L., R.P., D.W.), Massachusetts General Hospital, Harvard Medical School, Charlestown; Beijing Institute for Brain Disorders (H.L.), Departments of Radiology (M.Z., Y.S., D.R., J. Lu) and Nuclear Medicine (J. Lu), Xuanwu Hospital, and Department of Neurology, Beijing Friendship Hospital (Y.G.), Capital Medical University; Liaoyuan Hospital of Traditional Chinese Medicine (L.W.); Department of Neurosurgery (Y.L.), First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Neuroscience (H.L., X.P.), Medical University of South Carolina, Charleston; Department of Radiology (X.P.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Changchun University of Chinese Medicine (H.W.); and Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics (M.Z., Y.S., D.R., J. Lu), China
| | - Ruiqi Pan
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (H.L., X.P., L.D., H.W., J. Li, N.L., R.P., D.W.), Massachusetts General Hospital, Harvard Medical School, Charlestown; Beijing Institute for Brain Disorders (H.L.), Departments of Radiology (M.Z., Y.S., D.R., J. Lu) and Nuclear Medicine (J. Lu), Xuanwu Hospital, and Department of Neurology, Beijing Friendship Hospital (Y.G.), Capital Medical University; Liaoyuan Hospital of Traditional Chinese Medicine (L.W.); Department of Neurosurgery (Y.L.), First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Neuroscience (H.L., X.P.), Medical University of South Carolina, Charleston; Department of Radiology (X.P.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Changchun University of Chinese Medicine (H.W.); and Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics (M.Z., Y.S., D.R., J. Lu), China
| | - Jie Lu
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (H.L., X.P., L.D., H.W., J. Li, N.L., R.P., D.W.), Massachusetts General Hospital, Harvard Medical School, Charlestown; Beijing Institute for Brain Disorders (H.L.), Departments of Radiology (M.Z., Y.S., D.R., J. Lu) and Nuclear Medicine (J. Lu), Xuanwu Hospital, and Department of Neurology, Beijing Friendship Hospital (Y.G.), Capital Medical University; Liaoyuan Hospital of Traditional Chinese Medicine (L.W.); Department of Neurosurgery (Y.L.), First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Neuroscience (H.L., X.P.), Medical University of South Carolina, Charleston; Department of Radiology (X.P.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Changchun University of Chinese Medicine (H.W.); and Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics (M.Z., Y.S., D.R., J. Lu), China.
| | - Danhong Wang
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (H.L., X.P., L.D., H.W., J. Li, N.L., R.P., D.W.), Massachusetts General Hospital, Harvard Medical School, Charlestown; Beijing Institute for Brain Disorders (H.L.), Departments of Radiology (M.Z., Y.S., D.R., J. Lu) and Nuclear Medicine (J. Lu), Xuanwu Hospital, and Department of Neurology, Beijing Friendship Hospital (Y.G.), Capital Medical University; Liaoyuan Hospital of Traditional Chinese Medicine (L.W.); Department of Neurosurgery (Y.L.), First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Neuroscience (H.L., X.P.), Medical University of South Carolina, Charleston; Department of Radiology (X.P.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Changchun University of Chinese Medicine (H.W.); and Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics (M.Z., Y.S., D.R., J. Lu), China
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13
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Nickel A, Kessner S, Niebuhr A, Schröder J, Malherbe C, Fischer F, Heinze M, Cheng B, Fiehler J, Pinnschmidt H, Larena-Avellaneda A, Gerloff C, Thomalla G. Cortical thickness and cognitive performance in asymptomatic unilateral carotid artery stenosis. BMC Cardiovasc Disord 2019; 19:154. [PMID: 31238977 PMCID: PMC6593546 DOI: 10.1186/s12872-019-1127-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/07/2019] [Indexed: 11/22/2022] Open
Abstract
Background We investigated changes of cortical thickness and its association with cognitive performance in patients with high-grade carotid artery stenosis without ischemic brain lesions. Methods We studied 25 patients with unilateral carotid artery stenosis ≥50% and 25 age-matched controls. All subjects underwent T1-weighted MRI, and cortical thickness was measured in 33 regions of interest in each hemisphere, as well as in brain regions belonging to the vascular territory of the middle cerebral artery (MCA). General linear mixed models were fitted to the dependent variable cortical thickness. Cognitive assessment comprised the Stroop Test and Trail Making Test B. Results In the linear mixed model, presence of carotid stenosis had no effect on cortical thickness. There was a significant interaction of stenosis and region with a trend towards lower cortical thickness in the MCA region on the side of carotid stenosis. Patients with carotid stenosis performed significantly worse on the Stroop test than controls, but there was no correlation with cortical thickness. Conclusion In patients with carotid stenosis without ischemic brain lesions, neither a clear pattern of reduced cortical thickness nor an association of cortical thickness with cognitive function was observed. Our data do not support the hypothesized association of cortical thinning and cognitive impairment in carotid stenosis. Electronic supplementary material The online version of this article (10.1186/s12872-019-1127-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alina Nickel
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Klinik und Poliklinik für Neurologie Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Simon Kessner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Niebuhr
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Schröder
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Caroline Malherbe
- Center for Experimental Medicine, Institute of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix Fischer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marlene Heinze
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Neuroradiological diagnostics and intervention, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans Pinnschmidt
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Larena-Avellaneda
- Department of Vascular Medicine, University Heart Center Hamburg GmbH (UHZ), Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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14
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Buetefisch CM, Revill KP, Haut MW, Kowalski GM, Wischnewski M, Pifer M, Belagaje SR, Nahab F, Cobia DJ, Hu X, Drake D, Hobbs G. Abnormally reduced primary motor cortex output is related to impaired hand function in chronic stroke. J Neurophysiol 2018; 120:1680-1694. [PMID: 29924707 DOI: 10.1152/jn.00715.2017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Stroke often involves primary motor cortex (M1) and its corticospinal projections (CST). As hand function is critically dependent on these structures, its recovery is often incomplete. The neuronal substrate supporting affected hand function is not well understood but likely involves reorganized M1 and CST of the lesioned hemisphere (M1IL and CSTIL). We hypothesized that affected hand function in chronic stroke is related to structural and functional reorganization of M1IL and CSTIL. We tested 18 patients with chronic ischemic stroke involving M1 or CST. Their hand function was compared with 18 age-matched healthy subjects. M1IL thickness and CSTIL fractional anisotropy (FA) were determined with MRI and compared with measures of the other hemisphere. Transcranial magnetic stimulation (TMS) was applied to M1IL to determine its input-output function [stimulus response curve (SRC)]. The plateau of the SRC (MEPmax), inflection point, and slope parameters of the curve were extracted. Results were compared with measures in 12 age-matched healthy controls. MEPmax of M1IL was significantly smaller ( P = 0.02) in the patients, indicating reduced CSTIL motor output, and was correlated with impaired hand function ( P = 0.02). M1IL thickness ( P < 0.01) and CSTIL-FA ( P < 0.01) were reduced but did not correlate with hand function. The results indicate that employed M1IL or CSTIL structural measures do not explain the extent of impairment in hand function once M1 and CST are sufficiently functional for TMS to evoke a motor potential. Instead, impairment of hand function is best explained by the abnormally low output from M1IL. NEW & NOTEWORTHY Hand function often remains impaired after stroke. While the critical role of the primary motor cortex (M1) and its corticospinal output (CST) for hand function has been described in the nonhuman primate stroke model, their structure and function have not been systematically evaluated for patients after stroke. We report that in chronic stroke patients with injury to M1 and/or CST an abnormally reduced M1 output is related to impaired hand function.
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Affiliation(s)
- C M Buetefisch
- Department of Neurology, Emory University , Atlanta, Georgia.,Department of Rehabilitation Medicine, Emory University , Atlanta, Georgia
| | - K P Revill
- Department of Psychology, Emory University , Atlanta, Georgia
| | - M W Haut
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine , Morgantown, West Virginia.,Department of Neurology, West Virginia University School of Medicine , Morgantown, West Virginia.,Department of Radiology, West Virginia University School of Medicine , Morgantown, West Virginia
| | - G M Kowalski
- Department of Neurology, Emory University , Atlanta, Georgia
| | - M Wischnewski
- Department of Neurology, Emory University , Atlanta, Georgia
| | - M Pifer
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine , Morgantown, West Virginia
| | - S R Belagaje
- Department of Neurology, Emory University , Atlanta, Georgia.,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital , Atlanta, Georgia
| | - F Nahab
- Department of Neurology, Emory University , Atlanta, Georgia
| | - D J Cobia
- Department of Psychology and Neuroscience Center, Brigham Young University , Provo, Utah
| | - X Hu
- Department of Bioengineering, University of California Riverside , Riverside, California
| | - D Drake
- Department of Biostatistics, The Mailman School of Public Health, Columbia University , New York, New York
| | - G Hobbs
- Department of Statistics, West Virginia University , Morgantown, West Virginia
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15
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Ferris JK, Peters S, Brown KE, Tourigny K, Boyd LA. Type-2 diabetes mellitus reduces cortical thickness and decreases oxidative metabolism in sensorimotor regions after stroke. J Cereb Blood Flow Metab 2018; 38:823-834. [PMID: 28401788 PMCID: PMC5987933 DOI: 10.1177/0271678x17703887] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Individuals with type-2 diabetes mellitus experience poor motor outcomes after ischemic stroke. Recent research suggests that type-2 diabetes adversely impacts neuronal integrity and function, yet little work has considered how these neuronal changes affect sensorimotor outcomes after stroke. Here, we considered how type-2 diabetes impacted the structural and metabolic function of the sensorimotor cortex after stroke using volumetric magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS). We hypothesized that the combination of chronic stroke and type-2 diabetes would negatively impact the integrity of sensorimotor cortex as compared to individuals with chronic stroke alone. Compared to stroke alone, individuals with stroke and diabetes had lower cortical thickness bilaterally in the primary somatosensory cortex, and primary and secondary motor cortices. Individuals with stroke and diabetes also showed reduced creatine levels bilaterally in the sensorimotor cortex. Contralesional primary and secondary motor cortex thicknesses were negatively related to sensorimotor outcomes in the paretic upper-limb in the stroke and diabetes group such that those with thinner primary and secondary motor cortices had better motor function. These data suggest that type-2 diabetes alters cerebral energy metabolism, and is associated with thinning of sensorimotor cortex after stroke. These factors may influence motor outcomes after stroke.
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Affiliation(s)
- Jennifer K Ferris
- 1 Faculty of Medicine, Graduate program of Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
| | - Sue Peters
- 1 Faculty of Medicine, Graduate program of Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
| | - Katlyn E Brown
- 1 Faculty of Medicine, Graduate program of Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
| | - Katherine Tourigny
- 2 Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Lara A Boyd
- 1 Faculty of Medicine, Graduate program of Rehabilitation Sciences, University of British Columbia, Vancouver, Canada.,3 Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,4 Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
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16
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Altered cerebral hemodyamics and cortical thinning in asymptomatic carotid artery stenosis. PLoS One 2017; 12:e0189727. [PMID: 29240808 PMCID: PMC5730122 DOI: 10.1371/journal.pone.0189727] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 11/30/2017] [Indexed: 11/19/2022] Open
Abstract
Cortical thinning is a potentially important biomarker, but the pathophysiology in cerebrovascular disease is unknown. We investigated the association between regional cortical blood flow and regional cortical thickness in patients with asymptomatic unilateral high-grade internal carotid artery disease without stroke. Twenty-nine patients underwent high resolution anatomical and single-delay, pseudocontinuous arterial spin labeling magnetic resonance imaging with partial volume correction to assess gray matter baseline flow. Cortical thickness was estimated using Freesurfer software, followed by co-registration onto each patient's cerebral blood flow image space. Paired t-tests assessed regional cerebral blood flow in motor cortex (supplied by the carotid artery) and visual cortex (indirectly supplied by the carotid) on the occluded and unoccluded side. Pearson correlations were calculated between cortical thickness and regional cerebral blood flow, along with age, hypertension, diabetes and white matter hyperintensity volume. Multiple regression and generalized estimating equation were used to predict cortical thickness bilaterally and in each hemisphere separately. Cortical blood flow correlated with thickness in motor cortex bilaterally (p = 0.0002), and in the occluded and unoccluded sides individually; age (p = 0.002) was also a predictor of cortical thickness in the motor cortex. None of the variables predicted cortical thickness in visual cortex. Blood flow was significantly lower on the occluded versus unoccluded side in the motor cortex (p<0.0001) and in the visual cortex (p = 0.018). On average, cortex was thinner on the side of occlusion in motor but not in visual cortex. The association between cortical blood flow and cortical thickness in carotid arterial territory with greater thinning on the side of the carotid occlusion suggests that altered cerebral hemodynamics is a factor in cortical thinning.
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Carlson HL, MacMaster FP, Harris AD, Kirton A. Spectroscopic biomarkers of motor cortex developmental plasticity in hemiparetic children after perinatal stroke. Hum Brain Mapp 2017; 38:1574-1587. [PMID: 27859933 PMCID: PMC6866903 DOI: 10.1002/hbm.23472] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 10/20/2016] [Accepted: 11/07/2016] [Indexed: 01/26/2023] Open
Abstract
Perinatal stroke causes hemiparetic cerebral palsy and lifelong motor disability. Bilateral motor cortices are key hubs within the motor network and their neurophysiology determines clinical function. Establishing biomarkers of motor cortex function is imperative for developing and evaluating restorative interventional strategies. Proton magnetic resonance spectroscopy (MRS) quantifies metabolite concentrations indicative of underlying neuronal health and metabolism in vivo. We used functional magnetic resonance imaging (MRI)-guided MRS to investigate motor cortex metabolism in children with perinatal stroke. Children aged 6-18 years with MRI-confirmed perinatal stroke and hemiparetic cerebral palsy were recruited from a population-based cohort. Metabolite concentrations were assessed using a PRESS sequence (3T, TE = 30 ms, voxel = 4 cc). Voxel location was guided by functional MRI activations during finger tapping tasks. Spectra were analysed using LCModel. Metabolites were quantified, cerebral spinal fluid corrected and compared between groups (ANCOVA) controlling for age. Associations with clinical motor performance (Assisting Hand, Melbourne, Box-and-Blocks) were assessed. Fifty-two participants were studied (19 arterial, 14 venous, 19 control). Stroke participants demonstrated differences between lesioned and nonlesioned motor cortex N-acetyl-aspartate [NAA mean concentration = 10.8 ± 1.9 vs. 12.0 ± 1.2, P < 0.01], creatine [Cre 8.0 ± 0.9 vs. 7.4 ± 0.9, P < 0.05] and myo-Inositol [Ins 6.5 ± 0.84 vs. 5.8 ± 1.1, P < 0.01]. Lesioned motor cortex NAA and creatine were strongly correlated with motor performance in children with arterial but not venous strokes. Interrogation of motor cortex by fMRI-guided MRS is feasible in children with perinatal stroke. Metabolite differences between hemispheres, stroke types and correlations with motor performance support functional relevance. MRS may be valuable in understanding the neurophysiology of developmental neuroplasticity in cerebral palsy. Hum Brain Mapp 38:1574-1587, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Helen L. Carlson
- Calgary Pediatric Stroke ProgramAlberta Children's HospitalCalgaryABCanada
- Alberta Children's Hospital Research Institute (ACHRI)ABCanadaCalgary
- NeurosciencesAlberta Children's HospitalCalgaryABCanada
- Department of PediatricsUniversity of CalgaryCalgaryABCanada
| | - Frank P. MacMaster
- Alberta Children's Hospital Research Institute (ACHRI)ABCanadaCalgary
- Department of PediatricsUniversity of CalgaryCalgaryABCanada
- Hotchkiss Brain Institute, University of CalgaryCalgaryABCanada
- Department of PsychiatryUniversity of CalgaryABCanada
- The Mathison Centre for Mental Health Research and Education, University of CalgaryCalgaryABCanada
- Child and Adolescent Imaging Research (CAIR) Programs, Alberta Children's HospitalCalgaryABCanada
- Strategic Clinical Network for Addictions and Mental HealthAlberta Health ServicesCalgaryABCanada
| | - Ashley D. Harris
- Alberta Children's Hospital Research Institute (ACHRI)ABCanadaCalgary
- Hotchkiss Brain Institute, University of CalgaryCalgaryABCanada
- Child and Adolescent Imaging Research (CAIR) Programs, Alberta Children's HospitalCalgaryABCanada
- Department of RadiologyUniversity of CalgaryCalgaryABCanada
| | - Adam Kirton
- Calgary Pediatric Stroke ProgramAlberta Children's HospitalCalgaryABCanada
- Alberta Children's Hospital Research Institute (ACHRI)ABCanadaCalgary
- NeurosciencesAlberta Children's HospitalCalgaryABCanada
- Department of PediatricsUniversity of CalgaryCalgaryABCanada
- Hotchkiss Brain Institute, University of CalgaryCalgaryABCanada
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