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Zhang J, Li L, Ji R, Shang D, Wen X, Hu J, Wang Y, Wu D, Zhang L, He F, Ye X, Luo B. NODDI Identifies Cognitive Associations with In Vivo Microstructural Changes in Remote Cortical Regions and Thalamocortical Pathways in Thalamic Stroke. Transl Stroke Res 2023:10.1007/s12975-023-01221-w. [PMID: 38049671 DOI: 10.1007/s12975-023-01221-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/06/2023]
Abstract
The roles of cerebral structures distal to isolated thalamic infarcts in cognitive deficits remain unclear. We aimed to identify the in vivo microstructural characteristics of remote gray matter (GM) and thalamic pathways and elucidate their roles across cognitive domains. Patients with isolated ischemic thalamic stroke and healthy controls underwent neuropsychological assessment and magnetic resonance imaging. Neurite orientation dispersion and density imaging (NODDI) was modeled to derive the intracellular volume fraction (VFic) and orientation dispersion index. Fiber density (FD) was determined by constrained spherical deconvolution, and tensor-derived fractional anisotropy (FA) was calculated. Voxel-wise GM analysis and thalamic pathway tractography were performed. Twenty-six patients and 26 healthy controls were included. Patients exhibited reduced VFic in remote GM regions, including ipsilesional insular and temporal subregions. The microstructural metrics VFic, FD, and FA within ipsilesional thalamic pathways decreased (false discovery rate [FDR]-p < 0.05). Noteworthy associations emerged as VFic within insular cortices (ρ = -0.791 to -0.630; FDR-p < 0.05) and FD in tracts connecting the thalamus and insula (ρ = 0.830 to 0.971; FDR-p < 0.001) were closely associated with executive function. The VFic in Brodmann area 52 (ρ = -0.839; FDR-p = 0.005) and FA within its thalamic pathway (ρ = -0.799; FDR-p = 0.003) correlated with total auditory memory scores. In conclusion, NODDI revealed neurite loss in remote normal-appearing GM regions and ipsilesional thalamic pathways in thalamic stroke. Reduced cortical dendritic density and axonal density of thalamocortical tracts in specific subregions were associated with improved cognitive functions. Subacute microstructural alterations beyond focal thalamic infarcts might reflect beneficial remodeling indicating post-stroke plasticity.
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Affiliation(s)
- Jie Zhang
- Department of Neurology, Brain Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310003, Hangzhou, China
- Center for Rehabilitation Medicine, Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, 310014, China
| | - Lingling Li
- Department of Neurology, Dongyang People's Hospital, Wenzhou Medical University, Dongyang, 322109, China
| | - Renjie Ji
- Department of Neurology, Brain Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310003, Hangzhou, China
| | - Desheng Shang
- Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Xinrui Wen
- Department of Neurology, Brain Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310003, Hangzhou, China
| | - Jun Hu
- Department of Neurology, Brain Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310003, Hangzhou, China
| | - Yingqiao Wang
- Center for Rehabilitation Medicine, Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, 310014, China
| | - Dan Wu
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, 310027, China
| | - Li Zhang
- Department of Neurology, Brain Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310003, Hangzhou, China
- Center for Rehabilitation Medicine, Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, 310014, China
| | - Fangping He
- Department of Neurology, Brain Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310003, Hangzhou, China
| | - Xiangming Ye
- Center for Rehabilitation Medicine, Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, 310014, China
| | - Benyan Luo
- Department of Neurology, Brain Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310003, Hangzhou, China.
- MOE Frontier Science Center for Brain Science & Brain-Machine Integration, Zhejiang University, Hangzhou, 310003, China.
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Schmidt CC, Achilles EIS, Bolte K, Kleineberg NN, Richter MK, Schloss N, Fink GR, Weiss PH. Association of Circumscribed Subcortical Gray and White Matter Lesions With Apraxic Deficits in Patients With Left Hemisphere Stroke. Neurology 2023; 101:e1137-e1144. [PMID: 37463748 PMCID: PMC10513893 DOI: 10.1212/wnl.0000000000207598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 05/15/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Apraxia is commonly attributed to left hemisphere (LH) lesions of the cortical fronto-temporo-parietal praxis networks or white matter lesions causing disconnections between cortical nodes. By contrast, the contribution of lesions to the subcortical gray matter, that is, basal ganglia or thalamus, to apraxic deficits remains controversial. Here, we investigate whether damage to these subcortical gray matter structures (i.e., caudate nucleus, putamen, globus pallidus, and thalamus) or the adjacent white matter tracts was associated with apraxic deficits. METHODS We identified patients with distinct subcortical lesions with and without apraxia from a large retrospective sample of subacute LH ischemic stroke patients (n = 194). To test which subcortical structures (caudate nucleus, putamen, globus pallidus, thalamus, and adjacent white matter tracts), when lesioned, contributed to apraxic deficits, we statistically compared the proportion of lesioned voxels within subcortical gray and white matter structures between the apraxic and nonapraxic patients. RESULTS Of the 194 stroke patients screened, 39 (median age = 65 years, range 30-82 years; median time poststroke at the apraxia assessment = 7 days, range 1-44 days) had lesions confined to subcortical regions (gray and white matter). Eleven patients showed apraxic deficits when imitating gestures or pantomiming object use. Region-wise statistical lesion comparison (controlled for lesion size) revealed a more significant proportion of damage ('lesion load') in the caudate nucleus in apraxic stroke patients (mean difference = 6.9%, 95% CI 0.4-13.3, p = 0.038, η p 2 = 0.11). By contrast, apraxic patients had lower lesion load in the globus pallidus (mean difference = 9.9%, 95% CI 0.1-19.8, p = 0.048, η p 2 = 0.10), whereas the lesion load in other subcortical structures (putamen, thalamus, and adjacent white matter tracts) did not differ significantly between the apraxic and nonapraxic patients. DISCUSSION These findings provide new insights into the subcortical anatomy of apraxia after LH stroke, suggesting a specific contribution of caudate nucleus lesions to apraxic deficits.
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Affiliation(s)
- Claudia C Schmidt
- From the Cognitive Neuroscience (C.C.S., E.I.S.A., N.N.K., M.K.R., G.R.F., P.H.W.), Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Germany; and Department of Neurology (E.I.S.A., K.B., N.N.K., M.K.R., N.S., G.R.F., P.H.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany.
| | - Elisabeth I S Achilles
- From the Cognitive Neuroscience (C.C.S., E.I.S.A., N.N.K., M.K.R., G.R.F., P.H.W.), Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Germany; and Department of Neurology (E.I.S.A., K.B., N.N.K., M.K.R., N.S., G.R.F., P.H.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Katharina Bolte
- From the Cognitive Neuroscience (C.C.S., E.I.S.A., N.N.K., M.K.R., G.R.F., P.H.W.), Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Germany; and Department of Neurology (E.I.S.A., K.B., N.N.K., M.K.R., N.S., G.R.F., P.H.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Nina N Kleineberg
- From the Cognitive Neuroscience (C.C.S., E.I.S.A., N.N.K., M.K.R., G.R.F., P.H.W.), Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Germany; and Department of Neurology (E.I.S.A., K.B., N.N.K., M.K.R., N.S., G.R.F., P.H.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Monika K Richter
- From the Cognitive Neuroscience (C.C.S., E.I.S.A., N.N.K., M.K.R., G.R.F., P.H.W.), Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Germany; and Department of Neurology (E.I.S.A., K.B., N.N.K., M.K.R., N.S., G.R.F., P.H.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Natalie Schloss
- From the Cognitive Neuroscience (C.C.S., E.I.S.A., N.N.K., M.K.R., G.R.F., P.H.W.), Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Germany; and Department of Neurology (E.I.S.A., K.B., N.N.K., M.K.R., N.S., G.R.F., P.H.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Gereon R Fink
- From the Cognitive Neuroscience (C.C.S., E.I.S.A., N.N.K., M.K.R., G.R.F., P.H.W.), Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Germany; and Department of Neurology (E.I.S.A., K.B., N.N.K., M.K.R., N.S., G.R.F., P.H.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Peter H Weiss
- From the Cognitive Neuroscience (C.C.S., E.I.S.A., N.N.K., M.K.R., G.R.F., P.H.W.), Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Germany; and Department of Neurology (E.I.S.A., K.B., N.N.K., M.K.R., N.S., G.R.F., P.H.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
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Rosenzopf H, Klingbeil J, Wawrzyniak M, Röhrig L, Sperber C, Saur D, Karnath HO. Thalamocortical disconnection involved in pusher syndrome. Brain 2023; 146:3648-3661. [PMID: 36943319 DOI: 10.1093/brain/awad096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/13/2023] [Accepted: 03/02/2023] [Indexed: 03/23/2023] Open
Abstract
The presence of both isolated thalamic and isolated cortical lesions have been reported in the context of pusher syndrome-a disorder characterized by a disturbed perception of one's own upright body posture, following unilateral left- or right-sided stroke. In recent times, indirect quantification of functional and structural disconnection increases the knowledge derived from focal brain lesions by inferring subsequent brain network damage from the respective lesion. We applied both measures to a sample of 124 stroke patients to investigate brain disconnection in pusher syndrome. Our results suggest a hub-like function of the posterior and lateral portions of the thalamus in the perception of one's own postural upright. Lesion network symptom mapping investigating functional disconnection indicated cortical diaschisis in cerebellar, frontal, parietal and temporal areas in patients with thalamic lesions suffering from pusher syndrome, but there was no evidence for functional diaschisis in pusher patients with cortical stroke and no evidence for the convergence of thalamic and cortical lesions onto a common functional network. Structural disconnection mapping identified posterior thalamic disconnection to temporal, pre-, post- and paracentral regions. Fibre tracking between the thalamic and cortical pusher lesion hotspots indicated that in cortical lesions of patients with pusher syndrome, it is disconnectivity to the posterior thalamus caused by accompanying white matter damage, rather than the direct cortical lesions themselves, that lead to the emergence of pusher syndrome. Our analyses thus offer the first evidence for a direct thalamo-cortical (or cortico-thalamic) interconnection and, more importantly, shed light on the location of the respective thalamo-cortical disconnections. Pusher syndrome seems to be a consequence of direct damage or of disconnection of the posterior thalamus.
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Affiliation(s)
- Hannah Rosenzopf
- Center of Neurology, Division of Neuropsychology, Hertie Institute for Clinical Brain Research, University of Tübingen, 72076 Tübingen, Germany
| | - Julian Klingbeil
- Neuroimaging Lab, Department of Neurology, University of Leipzig, 04103 Leipzig, Germany
| | - Max Wawrzyniak
- Neuroimaging Lab, Department of Neurology, University of Leipzig, 04103 Leipzig, Germany
| | - Lisa Röhrig
- Center of Neurology, Division of Neuropsychology, Hertie Institute for Clinical Brain Research, University of Tübingen, 72076 Tübingen, Germany
| | - Christoph Sperber
- Center of Neurology, Division of Neuropsychology, Hertie Institute for Clinical Brain Research, University of Tübingen, 72076 Tübingen, Germany
| | - Dorothee Saur
- Neuroimaging Lab, Department of Neurology, University of Leipzig, 04103 Leipzig, Germany
| | - Hans-Otto Karnath
- Center of Neurology, Division of Neuropsychology, Hertie Institute for Clinical Brain Research, University of Tübingen, 72076 Tübingen, Germany
- Department of Psychology, University of South Carolina, Columbia, SC 29208, USA
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Adachi H, Numata J, Nishida K, Yamasaki H, Futamura N. Dystextia and dystypia due to phonological errors after ischemic stroke: a case report in a Japanese patient. Neurocase 2023; 29:50-57. [PMID: 38676356 DOI: 10.1080/13554794.2024.2345403] [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: 05/16/2023] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
A 69-year-old Japanese male presented with acute dystextia and dystypia, defined as texting and typing impairments, respectively. His text input speed decreased due to a phonologically incorrect kana flick input on his smartphone. Additionally, dystypia occurred due to phonemic paragraphia of Romaji. Brain MRI revealed a new left lenticulostriate infarction sparing the cerebral cortex. SPECT showed reduced cerebral blood flow in the left inferior precentral frontal gyrus as well as in the infarction area. It was concluded that his abnormal phonological processes resulted from hypoperfusion in the left inferior precentral gyrus that is assumed to be an endpoint of the arcuate fasciculus.
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Affiliation(s)
| | - Jun Numata
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, Hyogo, Japan
- Department of Gastroenterology, Sanda City Hospital, Hyogo, Japan
| | - Katsuya Nishida
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, Hyogo, Japan
| | - Hiroshi Yamasaki
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, Hyogo, Japan
| | - Naonobu Futamura
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, Hyogo, Japan
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5
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Zhuo B, Deng S, Li B, Zhu W, Zhang M, Qin C, Meng Z. Possible Effects of Acupuncture in Poststroke Aphasia. Behav Neurol 2023; 2023:9445381. [PMID: 37091130 PMCID: PMC10115536 DOI: 10.1155/2023/9445381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 12/30/2022] [Accepted: 04/02/2023] [Indexed: 04/25/2023] Open
Abstract
Neural plasticity promotes the reorganization of language networks and is an essential recovery mechanism for poststroke aphasia (PSA). Neuroplasticity may be a pivotal bridge to elucidate the potential recovery mechanisms of acupuncture for aphasia. Therefore, understanding the neuroplasticity mechanism of acupuncture in PSA is crucial. However, the underlying therapeutic mechanism of neuroplasticity in PSA after acupuncture needs to be explored. Excitotoxicity after brain injury affects the activity of neurotransmitters and disrupts the transmission of normal neuron information. Thus, a helpful strategy of acupuncture might be to improve PSA by affecting the availability of these neurotransmitters and glutamate receptors at synapses. In addition, the regulation of neuroplasticity by acupuncture may also be related to the regulation of astrocytes. Considering the guiding significance of acupuncture for clinical treatment, it is necessary to carry out further study about the influence of acupuncture on the recovery of aphasia after stroke. This study summarizes the current research on the neural mechanism of acupuncture in treating PSA. It seeks to elucidate the potential effect of acupuncture on the recovery of PSA from the perspective of synaptic plasticity and integrity of gray and white matter.
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Affiliation(s)
- Bifang Zhuo
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Shizhe Deng
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Boxuan Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Weiming Zhu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Menglong Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Chenyang Qin
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Zhihong Meng
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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Wiesen D, Bonilha L, Rorden C, Karnath HO. Disconnectomics to unravel the network underlying deficits of spatial exploration and attention. Sci Rep 2022; 12:22315. [PMID: 36566307 PMCID: PMC9789971 DOI: 10.1038/s41598-022-26491-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 12/15/2022] [Indexed: 12/25/2022] Open
Abstract
Spatial attention and exploration are related to a predominantly right hemispheric network structure. However, the areas of the brain involved and their exact role is still debated. Spatial neglect following right hemispheric stroke lesions has been frequently viewed as a model to study these processes in humans. Previous investigations on the anatomical basis on spatial neglect predominantly focused on focal brain damage and lesion-behaviour mapping analyses. This approach might not be suited to detect remote areas structurally spared but which might contribute to the behavioural deficit. In the present study of a sample of 203 right hemispheric stroke patients, we combined connectome lesion-symptom mapping with multivariate support vector regression to unravel the complex and disconnected network structure in spatial neglect. We delineated three central nodes that were extensively disconnected from other intrahemispheric areas, namely the right superior parietal lobule, the insula, and the temporal pole. Additionally, the analysis allocated central roles within this network to the inferior frontal gyrus (pars triangularis and opercularis), right middle temporal gyrus, right temporal pole and left and right orbitofrontal cortices, including interhemispheric disconnection. Our results suggest that these structures-although not necessarily directly damaged-might play a role within the network underlying spatial neglect in humans.
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Affiliation(s)
- Daniel Wiesen
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076, Tübingen, Germany.
| | | | | | - Hans-Otto Karnath
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076, Tübingen, Germany
- Department of Psychology, University of South Carolina, Columbia, USA
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Sharif MS, Goldberg EB, Walker A, Hillis AE, Meier EL. The contribution of white matter pathology, hypoperfusion, lesion load, and stroke recurrence to language deficits following acute subcortical left hemisphere stroke. PLoS One 2022; 17:e0275664. [PMID: 36288353 PMCID: PMC9604977 DOI: 10.1371/journal.pone.0275664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022] Open
Abstract
Aphasia, the loss of language ability following damage to the brain, is among the most disabling and common consequences of stroke. Subcortical stroke, occurring in the basal ganglia, thalamus, and/or deep white matter can result in aphasia, often characterized by word fluency, motor speech output, or sentence generation impairments. The link between greater lesion volume and acute aphasia is well documented, but the independent contributions of lesion location, cortical hypoperfusion, prior stroke, and white matter degeneration (leukoaraiosis) remain unclear, particularly in subcortical aphasia. Thus, we aimed to disentangle the contributions of each factor on language impairments in left hemisphere acute subcortical stroke survivors. Eighty patients with acute ischemic left hemisphere subcortical stroke (less than 10 days post-onset) participated. We manually traced acute lesions on diffusion-weighted scans and prior lesions on T2-weighted scans. Leukoaraiosis was rated on T2-weighted scans using the Fazekas et al. (1987) scale. Fluid-attenuated inversion recovery (FLAIR) scans were evaluated for hyperintense vessels in each vascular territory, providing an indirect measure of hypoperfusion in lieu of perfusion-weighted imaging. We found that language performance was negatively correlated with acute/total lesion volumes and greater damage to substructures of the deep white matter and basal ganglia. We conducted a LASSO regression that included all variables for which we found significant univariate relationships to language performance, plus nuisance regressors. Only total lesion volume was a significant predictor of global language impairment severity. Further examination of three participants with severe language impairments suggests that their deficits result from impairment in domain-general, rather than linguistic, processes. Given the variability in language deficits and imaging markers associated with such deficits, it seems likely that subcortical aphasia is a heterogeneous clinical syndrome with distinct causes across individuals.
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Affiliation(s)
- Massoud S. Sharif
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Emily B. Goldberg
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Alexandra Walker
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Cognitive Science, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Erin L. Meier
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail:
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Tang H, Fan S, Niu X, Li Z, Xiao P, Zeng J, Xing S. Remote cortical atrophy and language outcomes after chronic left subcortical stroke with aphasia. Front Neurosci 2022; 16:853169. [PMID: 35992910 PMCID: PMC9381815 DOI: 10.3389/fnins.2022.853169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Subcortical stroke can cause a variety of language deficits. However, the neural mechanisms underlying subcortical aphasia after stroke remain incompletely elucidated. We aimed to determine the effects of distant cortical structures on aphasia outcomes and examine the correlation of cortical thickness measures with connecting tracts integrity after chronic left subcortical stroke. Methods Thirty-two patients and 30 healthy control subjects underwent MRI scanning and language assessment with the Western Aphasia Battery-Revised (WAB-R) subtests. Among patients, the cortical thickness in brain regions that related to language performance were assessed by the FreeSurfer software. Fiber tracts connecting the identified cortical regions to stroke lesions were reconstructed to determine its correlations with the cortical thickness measures across individual patient. Results Cortical thickness in different parts of the left fronto-temporo-parietal (FTP) regions were positively related to auditory-verbal comprehension, spontaneous speech and naming/word finding abilities when controlling for key demographic variables and lesion size. Cortical thickness decline in the identified cortical regions was positively correlated with integrity loss of fiber tracts connected to stroke lesions. Additionally, no significant difference in cortical thickness was found across the left hemisphere between the subgroup of patients with hypoperfusion (HP) and those without HP at stroke onset. Conclusions These findings suggest that remote cortical atrophy independently predicts language outcomes in patients with chronic left subcortical stroke and aphasia and that cortical thinning in these regions might relate to integrity loss of fiber tracts connected to stroke lesions.
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Affiliation(s)
- Huijia Tang
- Department of Neurology and Stroke Center, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shuhan Fan
- Department of Neurology and Stroke Center, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xingyang Niu
- Department of Neurology and Stroke Center, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhuhao Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Peiyi Xiao
- Department of Neurology and Stroke Center, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinsheng Zeng
- Department of Neurology and Stroke Center, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shihui Xing
- Department of Neurology and Stroke Center, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Shihui Xing,
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Wawrzyniak M, Schneider HR, Klingbeil J, Stockert A, Hartwigsen G, Weiller C, Saur D. Resolution of diaschisis contributes to early recovery from post-stroke aphasia. Neuroimage 2022; 251:119001. [PMID: 35172200 DOI: 10.1016/j.neuroimage.2022.119001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 01/31/2022] [Accepted: 02/12/2022] [Indexed: 11/15/2022] Open
Abstract
Diaschisis is a phenomenon observed in stroke that is defined as neuronal dysfunction in regions spared by the infarction but connected to the lesion site. We combined lesion network mapping and task-based functional MRI in 71 patients with post-stroke aphasia to investigate, whether diaschisis and its resolution contribute to early loss and recovery of language functions. Language activation acquired in the acute, subacute and chronic phase was analyzed in compartments with high and low normative resting-state functional connectivity to the lesion site on an individual basis. Regions with high compared to regions with low lesion connectivity showed a steeper increase in language reactivation from the acute to the subacute phase. This finding is compatible with the assumption of resolution of diaschisis. Additionally, language performance in the subacute phase and improvement from the subacute to the chronic phase significantly correlated with the diaschisis effect and its resolution, respectively, suggesting a behavioral relevance of this effect. We therefore assume that undamaged but functionally connected regions become dysfunctional due to missing input from the lesion contributing to the aphasic deficit. Since these regions are structurally intact, dysfunction resolves over time contributing to the rapid early behavioral improvement observed in aphasic stroke patients. Our results demonstrate that diaschisis and its resolution might be a relevant mechanism of early loss and recovery of language function in acute stroke patients.
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Affiliation(s)
- Max Wawrzyniak
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany.
| | - Hans R Schneider
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Julian Klingbeil
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Anika Stockert
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Gesa Hartwigsen
- Lise Meitner Research Group 'Cognition and Plasticity', Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Cornelius Weiller
- Freiburg Brain Imaging Center, Department of Neurology, University of Freiburg, Freiburg, Germany
| | - Dorothee Saur
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
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Saxena S, Keser Z, Rorden C, Bonilha L, Fridriksson J, Walker A, Hillis AE. Disruptions of the Human Connectome Associated With Hemispatial Neglect. Neurology 2022; 98:e107-e114. [PMID: 35263271 PMCID: PMC8762585 DOI: 10.1212/wnl.0000000000013050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 11/02/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Hemispatial neglect is a heterogeneous and complex disorder that can be classified by frame of reference for "left" vs "right," including viewer-centered neglect (VCN, affecting the contralesional side of the view), stimulus-centered neglect (SCN, affecting the contralesional side of the stimulus, irrespective of its location with respect to the viewer), or both. We investigated the effect of acute stroke lesions on the connectivity of neural networks that underlie VCN or SCN. METHODS A total of 174 patients within 48 hours of acute right hemispheric infarct underwent a detailed hemispatial neglect assessment that included oral reading, scene copy, line cancellation, gap detection, horizontal line bisection tests, and MRI. Each patient's connectivity map was generated. We performed a linear association analysis between network connectivity strength and continuous measures of neglect to identify lesion-induced disconnections associated with the presence or severity of VCN and SCN. Results were corrected for multiple comparisons. RESULTS About 42% of the participants with right hemisphere stroke had at least one type of neglect. The presence of any type of neglect was associated with lesions to tracts connecting the right inferior parietal cortex, orbitofrontal cortex, and right thalamus to other right-hemispheric structures. VCN only was strongly associated with tracts connecting the right putamen to other brain regions and tracts connecting right frontal regions with other brain regions. The presence of both types of neglect was most strongly associated with tracts connecting the right inferior and superior parietal cortex to other brain regions and those connecting left or right mesial temporal cortex to other brain regions. DISCUSSION Our study provides new evidence for the specific white matter tracts where disruption can cause hemispatial neglect in a relatively large number of participants and homogeneous time after onset. We obtained MRI and behavioral testing acutely, before the opportunity for rehabilitation or substantial recovery. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that damage to specific white matter tracts identified on MRI are associated with the presence of neglect following right hemispheric stroke.
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Affiliation(s)
- Sadhvi Saxena
- From the Departments of Neurology (S.S., Z.K., A.W., A.E.H.) and Physical and Medicine & Rehabilitation (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD; Departments of Psychology (C.R.) and Communication Sciences and Disorders (J.F.), University of South Carolina, Columbia; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; and Department of Cognitive Science (A.E.H.), Johns Hopkins University, Baltimore, MD
| | - Zafer Keser
- From the Departments of Neurology (S.S., Z.K., A.W., A.E.H.) and Physical and Medicine & Rehabilitation (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD; Departments of Psychology (C.R.) and Communication Sciences and Disorders (J.F.), University of South Carolina, Columbia; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; and Department of Cognitive Science (A.E.H.), Johns Hopkins University, Baltimore, MD
| | - Chris Rorden
- From the Departments of Neurology (S.S., Z.K., A.W., A.E.H.) and Physical and Medicine & Rehabilitation (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD; Departments of Psychology (C.R.) and Communication Sciences and Disorders (J.F.), University of South Carolina, Columbia; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; and Department of Cognitive Science (A.E.H.), Johns Hopkins University, Baltimore, MD
| | - Leonardo Bonilha
- From the Departments of Neurology (S.S., Z.K., A.W., A.E.H.) and Physical and Medicine & Rehabilitation (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD; Departments of Psychology (C.R.) and Communication Sciences and Disorders (J.F.), University of South Carolina, Columbia; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; and Department of Cognitive Science (A.E.H.), Johns Hopkins University, Baltimore, MD
| | - Julius Fridriksson
- From the Departments of Neurology (S.S., Z.K., A.W., A.E.H.) and Physical and Medicine & Rehabilitation (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD; Departments of Psychology (C.R.) and Communication Sciences and Disorders (J.F.), University of South Carolina, Columbia; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; and Department of Cognitive Science (A.E.H.), Johns Hopkins University, Baltimore, MD
| | - Alexandra Walker
- From the Departments of Neurology (S.S., Z.K., A.W., A.E.H.) and Physical and Medicine & Rehabilitation (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD; Departments of Psychology (C.R.) and Communication Sciences and Disorders (J.F.), University of South Carolina, Columbia; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; and Department of Cognitive Science (A.E.H.), Johns Hopkins University, Baltimore, MD
| | - Argye Elizabeth Hillis
- From the Departments of Neurology (S.S., Z.K., A.W., A.E.H.) and Physical and Medicine & Rehabilitation (A.E.H.), Johns Hopkins University School of Medicine, Baltimore, MD; Departments of Psychology (C.R.) and Communication Sciences and Disorders (J.F.), University of South Carolina, Columbia; Department of Neurology (L.B.), Medical University of South Carolina, Charleston; and Department of Cognitive Science (A.E.H.), Johns Hopkins University, Baltimore, MD.
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11
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Rangus I, Fritsch M, Endres M, Udke B, Nolte CH. Frequency and phenotype of thalamic aphasia. J Neurol 2022; 269:368-376. [PMID: 34100990 PMCID: PMC8739316 DOI: 10.1007/s00415-021-10640-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Aphasia is a recognized presenting symptom of thalamic lesions. Little is known regarding its frequency and phenotype. We examined the frequency of thalamic aphasia following Isolated Acute unilateral ischemic Lesions in the Thalamus (IALT) with respect to lesion location. Furthermore, we characterized thalamic aphasia according to affected language domains and severity. METHODS Fifty-two patients with IALT were analyzed [44% female, median age: 73 years (IQR: 60-79)]. Lesion location was determined using 3-Tesla magnetic resonance imaging and categorized as anterior, posterior, paramedian or inferolateral. Standardized language assessment was performed using the validated Aphasia checklist (ACL) directly after symptom onset. Aphasia was defined as an ACL sum score of < 135 (range: 0-148). RESULTS Of 52 patients, 23 (44%) fulfilled the ACL diagnostic criteria for aphasia, including nearly all lesion locations and both sides. The average ACL sum score was 132 ± 11 (range: 98-147). Aphasia was characterized by deficits within domains of complex understanding of speech and verbal fluency. Patients with left anterior IALT were most severely affected, having significantly lower ACL scores than all other patients (117 ± 13 vs. 135 ± 8; p < 0.001). In particular, aphasia in patients with left anterior IALT was characterized by significantly worse performance in the rating of verbal communication, verbal fluency, and naming (all p ≤ 0.001). CONCLUSION Aphasia occurs in almost half of patients with focal thalamic lesions. Thalamic aphasia is not confined to one predefined thalamic lesion location, but language deficits are particularly pronounced in patients with left anterior IALT presenting with a distinct pattern.
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Affiliation(s)
- Ida Rangus
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Merve Fritsch
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Matthias Endres
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.,Center for Stroke Research Berlin, Berlin, Germany.,ExcellenceCluster NeuroCure, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Birgit Udke
- Department of Audiology and Phoniatrics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian H Nolte
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.,Center for Stroke Research Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Berlin, Germany
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12
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Keser Z, Meier EL, Stockbridge MD, Breining BL, Sebastian R, Hillis AE. Thalamic Nuclei and Thalamocortical Pathways After Left Hemispheric Stroke and Their Association with Picture Naming. Brain Connect 2021; 11:553-565. [PMID: 33797954 DOI: 10.1089/brain.2020.0831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Previous studies utilized lesion-centric approaches to study the role of the thalamus in language. In this study, we tested the hypotheses that non-lesioned dorsomedial and ventral anterior nuclei (DMVAC) and pulvinar lateral posterior nuclei complexes (PLC) of the thalamus and their projections to the left hemisphere show secondary effects of the strokes, and that their microstructural integrity is closely related to language-related functions. Methods: Subjects with language impairments after a left-hemispheric cortical and/or subcortical, early stroke (n = 31, ≤6 months) or late stroke (n = 30, ≥12 months) sparing thalamus underwent the Boston Naming Test (BNT) and diffusion tensor imaging (DTI). The tissue integrity of DMVAC, PLC, and their cortical projections was quantified with DTI. The right-left asymmetry profiles of these structures were evaluated in relation to the time since stroke. The association between microstructural integrity and BNT score was investigated in relation to stroke chronicity with partial correlation analyses adjusted for confounds. Results: In both early stroke and late stroke groups, left-sided tracts showed significantly higher mean diffusivities (MDs), which were likely due to Wallerian degeneration. Higher MD values of the cortical projections from the left PLC (r = -0.5, p = 0.005) and DMVAC (r = -0.53, p = 0.002) were correlated with lower BNT score in the late stroke but not early stroke group. Conclusion: Nonlesioned thalamic nuclei and thalamocortical pathways show rightward lateralization of the microstructural integrity after a left hemispheric stroke, and this pattern is associated with poorer naming.
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Affiliation(s)
- Zafer Keser
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erin L Meier
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Melissa D Stockbridge
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bonnie L Breining
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rajani Sebastian
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Gupta A, Padma Srivastava MV. Newer Paradigms in Language Neurobiology. Ann Indian Acad Neurol 2020; 23:S73-S81. [PMID: 33343130 PMCID: PMC7731670 DOI: 10.4103/aian.aian_487_20] [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: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 11/23/2022] Open
Abstract
The field of language research has seen tremendous progress in the last two decades. Advances in neuro-imaging and stimulation mapping have changed the way we conceive the neural basis of speech and language processing. In the past, the Wernicke-Lichtheim model was the most influential model explaining the neuro-anatomical basis of language. More recently, the concept of dual stream language processing has emerged, wherein separate dorsal and ventral networks are synergistically involved in phonological (sound to articulation) and semantic (sound to meaning) processing respectively. In this review article, we highlight new insights and approaches to the neurobiology of language, across different aspects of language processing like perception, comprehension, production, hemisphere lateralization, role of subcortical structures and effect of damage to language networks.
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Affiliation(s)
- Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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14
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Suarez A, Saxena S, Oishi K, Oishi K, Walker A, Rorden C, Hillis AE. Influence of age, lesion volume, and damage to dorsal versus ventral streams to viewer- and stimulus-centered hemispatial neglect in acute right hemisphere stroke. Cortex 2020; 126:73-82. [PMID: 32062471 PMCID: PMC7201372 DOI: 10.1016/j.cortex.2019.12.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/04/2019] [Accepted: 12/10/2019] [Indexed: 11/21/2022]
Abstract
We studied 156 individuals with acute, right hemisphere ischemic stroke on a battery of hemispatial neglect tests to distinguish between viewer-centered and stimulus-centered neglect and MRI diffusion weighted imaging. We identified the relative contributions of age, total lesion volume, and damage to subcortical and cortical grey matter regions as well as white matter tracts to both the severity and presence of significant viewer-centered and stimulus-centered neglect, using multivariable regression tests. We found that age, volume of lesion, and percent damage to the regions of interest were each independently associated with the severity of viewer-centered neglect (r2 = .31; p < .0001). However, only age (t = 3.20; p = .002) and percent damage to the angular gyrus (t = 2.63, p = .010), a dorsal stream area, predicted severity of viewer-centered neglect independently of the other variables. The same variables predicted the presence of significant viewer-centered neglect. In contrast, these variables did not significantly predict the severity of stimulus-centered neglect. However, we found that percent damage to ventral stream regions of interest (middle temporal gyrus, inferior temporal gyrus, fusiform gyrus, inferior frontal occipital gyrus, sagittal stratum, along with total infarct volume were associated with the presence of significant stimulus-centered neglect (pseudo r2 = .70, p < .0004). Only percent damage to right inferior temporal gyrus predicted stimulus-centered neglect independently of the other variables (p = .018).
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Affiliation(s)
- Adrian Suarez
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sadhvi Saxena
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kenichi Oishi
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Imaging Science, Johns Hopkins University, Baltimore, MD, USA; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Kumiko Oishi
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Imaging Science, Johns Hopkins University, Baltimore, MD, USA; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Alexandra Walker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Cognitive Science, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, USA.
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15
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Matsuzono K, Furuya K, Karube A, Horikiri A, Ozawa T, Mashiko T, Shimazaki H, Koide R, Tanaka R, Fujimoto S. Left thalamus infarction in the thalamotuberal artery perfusion area causing subcortical diaschisis and transcortical sensory aphasia. J Neurol Sci 2020; 411:116708. [DOI: 10.1016/j.jns.2020.116708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/18/2020] [Accepted: 01/24/2020] [Indexed: 11/17/2022]
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Brandel MG, Lee RR, U HS. Transient Aphasia Following Resection of a Thalamic Cavernous Malformation. World Neurosurg 2020; 136:390-393.e3. [PMID: 32004743 DOI: 10.1016/j.wneu.2020.01.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/18/2020] [Accepted: 01/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The thalamus has a demonstrated role in language, particularly through its connectivity to frontal language cortices. CASE DESCRIPTION A 59-year-old man with transient mixed aphasia following resection of a left-sided thalamic cavernous malformation is reported. No operative complications were encountered, and there was no surgical contact with cortical language areas. The patient recovered full language function within a week postoperatively. CONCLUSIONS The role of thalamic nuclei in language processes and other reports of transient thalamic aphasia are reviewed.
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Affiliation(s)
- Michael G Brandel
- Department of Neurosurgery, Veterans Administration Healthcare System, University of California San Diego, San Diego, California, USA.
| | - Roland R Lee
- Department of Radiology, Veterans Administration Healthcare System, University of California San Diego, San Diego, California, USA
| | - Hoi Sang U
- Department of Neurosurgery, Veterans Administration Healthcare System, University of California San Diego, San Diego, California, USA
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Fritsch M, Krause T, Klostermann F, Villringer K, Ihrke M, Nolte CH. “Thalamic aphasia” after stroke is associated with left anterior lesion location. J Neurol 2019; 267:106-112. [DOI: 10.1007/s00415-019-09560-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/22/2019] [Accepted: 09/24/2019] [Indexed: 11/24/2022]
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Atypical language representation is unfavorable for language abilities following childhood stroke. Eur J Paediatr Neurol 2019; 23:102-116. [PMID: 30314763 PMCID: PMC6339521 DOI: 10.1016/j.ejpn.2018.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/29/2018] [Accepted: 09/17/2018] [Indexed: 12/13/2022]
Abstract
Brain plasticity has often been quoted as a reason for the more favorable outcome in childhood stroke compared to adult stroke. We investigated the relationship between language abilities and language localization in childhood stroke. Seventeen children and adolescents with left- or right-sided ischemic stroke and 18 healthy controls were tested with a comprehensive neurolinguistic test battery, and the individual neural representation of language was measured with an fMRI language paradigm. Overall, 12 of 17 stroke patients showed language abilities below average, and five patients exhibited impaired language performance. fMRI revealed increased activity in right hemisphere areas homotopic to left hemisphere language regions. In sum, seven stroke patients revealed atypical, i.e. bilateral or right lateralized language representation. Typical left hemispheric language lateralization was associated with better performance in naming and word fluency, whereas increased involvement of right homologues was accompanied by worse language outcome. In contrast, lesion lateralization or lesion volume did not correlate with language outcome or atypical language lateralization. Thus, atypical language lateralization is unfavorable for language outcome, and right homologues do not have the same cognitive capacity, even in young children.
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Wright A, Tippett D, Saxena S, Sebastian R, Breining B, Faria A, Hillis AE. Leukoaraiosis is independently associated with naming outcome in poststroke aphasia. Neurology 2018; 91:e526-e532. [PMID: 29980639 DOI: 10.1212/wnl.0000000000005945] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 05/08/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that severity of leukoaraiosis in the noninfarcted hemisphere at onset is associated with poorer language outcome after poststroke aphasia independently of volume of infarct, damage to 3 critical language areas (left inferior frontal gyrus, superior longitudinal fasciculus, and superior temporal gyrus), comorbid conditions, and time since stroke. METHODS In this cross-sectional study, we evaluated naming outcome (>3 months after stroke) in 42 individuals who initially had aphasia after stroke. We rated leukoaraiosis in the right hemisphere 1 to 4 weeks from onset of stroke using the Cardiovascular Health Study rating scale. We evaluated associations between severity of leukoaraiosis and each measure of naming using Spearman correlations and evaluated the independent contributions of leukoaraiosis, lesion volume, months since onset, comorbid conditions, and damage to critical nodes of the language network on language outcomes using logistic regression. We also evaluated associations between dichotomously defined leukoaraiosis and language outcomes using χ2 tests. RESULTS Severity of leukoaraiosis at onset correlated with object naming (ρ = -0.56, p = 0.0008) and word fluency (ρ = -0.37, p = 0.01) outcomes. Severe leukoaraiosis was associated with failure to achieve the highest quartile of object naming and word fluency. Severity of leukoaraiosis was associated with degree of naming outcome with the use of both measures after controlling for lesion volume, months since stroke, comorbid conditions, and damage to specific locations. CONCLUSION Naming outcome after poststroke aphasia is influenced by the initial severity of right hemisphere leukoaraiosis independently of other variables. Degree of recovery from aphasia may depend on the integrity of the noninfarcted brain tissue.
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Affiliation(s)
- Amy Wright
- From the Departments of Neurology (A.W., D.T., S.S., R.S., B.B., A.E.H.), Physical Medicine & Rehabilitation (D.T., A.E.H.), Otolaryngology and Head & Neck Surgery (D.T.), and Radiology (A.F.), Johns Hopkins University School of Medicine; and Department of Cognitive Science (A.E.H.), Johns Hopkins University, Baltimore, MD
| | - Donna Tippett
- From the Departments of Neurology (A.W., D.T., S.S., R.S., B.B., A.E.H.), Physical Medicine & Rehabilitation (D.T., A.E.H.), Otolaryngology and Head & Neck Surgery (D.T.), and Radiology (A.F.), Johns Hopkins University School of Medicine; and Department of Cognitive Science (A.E.H.), Johns Hopkins University, Baltimore, MD
| | - Sadhvi Saxena
- From the Departments of Neurology (A.W., D.T., S.S., R.S., B.B., A.E.H.), Physical Medicine & Rehabilitation (D.T., A.E.H.), Otolaryngology and Head & Neck Surgery (D.T.), and Radiology (A.F.), Johns Hopkins University School of Medicine; and Department of Cognitive Science (A.E.H.), Johns Hopkins University, Baltimore, MD
| | - Rajani Sebastian
- From the Departments of Neurology (A.W., D.T., S.S., R.S., B.B., A.E.H.), Physical Medicine & Rehabilitation (D.T., A.E.H.), Otolaryngology and Head & Neck Surgery (D.T.), and Radiology (A.F.), Johns Hopkins University School of Medicine; and Department of Cognitive Science (A.E.H.), Johns Hopkins University, Baltimore, MD
| | - Bonnie Breining
- From the Departments of Neurology (A.W., D.T., S.S., R.S., B.B., A.E.H.), Physical Medicine & Rehabilitation (D.T., A.E.H.), Otolaryngology and Head & Neck Surgery (D.T.), and Radiology (A.F.), Johns Hopkins University School of Medicine; and Department of Cognitive Science (A.E.H.), Johns Hopkins University, Baltimore, MD
| | - Andreia Faria
- From the Departments of Neurology (A.W., D.T., S.S., R.S., B.B., A.E.H.), Physical Medicine & Rehabilitation (D.T., A.E.H.), Otolaryngology and Head & Neck Surgery (D.T.), and Radiology (A.F.), Johns Hopkins University School of Medicine; and Department of Cognitive Science (A.E.H.), Johns Hopkins University, Baltimore, MD
| | - Argye E Hillis
- From the Departments of Neurology (A.W., D.T., S.S., R.S., B.B., A.E.H.), Physical Medicine & Rehabilitation (D.T., A.E.H.), Otolaryngology and Head & Neck Surgery (D.T.), and Radiology (A.F.), Johns Hopkins University School of Medicine; and Department of Cognitive Science (A.E.H.), Johns Hopkins University, Baltimore, MD.
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Patel S, Oishi K, Wright A, Sutherland-Foggio H, Saxena S, Sheppard SM, Hillis AE. Right Hemisphere Regions Critical for Expression of Emotion Through Prosody. Front Neurol 2018; 9:224. [PMID: 29681885 PMCID: PMC5897518 DOI: 10.3389/fneur.2018.00224] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/22/2018] [Indexed: 11/13/2022] Open
Abstract
Impaired expression of emotion through pitch, loudness, rate, and rhythm of speech (affective prosody) is common and disabling after right hemisphere (RH) stroke. These deficits impede all social interactions. Previous studies have identified cortical areas associated with impairments of expression, recognition, or repetition of affective prosody, but have not identified critical white matter tracts. We hypothesized that: (1) differences across patients in specific acoustic features correlate with listener judgment of affective prosody and (2) these differences are associated with infarcts of specific RH gray and white matter regions. To test these hypotheses, 41 acute ischemic RH stroke patients had MRI diffusion weighted imaging and described a picture. Affective prosody of picture descriptions was rated by 21 healthy volunteers. We identified percent damage (lesion load) to each of seven regions of interest previously associated with expression of affective prosody and two control areas that have been associated with recognition but not expression of prosody. We identified acoustic features that correlated with listener ratings of prosody (hereafter “prosody acoustic measures”) with Spearman correlations and linear regression. We then identified demographic variables and brain regions where lesion load independently predicted the lowest quartile of each of the “prosody acoustic measures” using logistic regression. We found that listener ratings of prosody positively correlated with four acoustic measures. Furthermore, the lowest quartile of each of these four “prosody acoustic measures” was predicted by sex, age, lesion volume, and percent damage to the seven regions of interest. Lesion load in pars opercularis, supramarginal gyrus, or associated white matter tracts (and not control regions) predicted lowest quartile of the four “prosody acoustic measures” in logistic regression. Results indicate that listener perception of reduced affective prosody after RH stroke is due to reduction in specific acoustic features caused by infarct in right pars opercularis or supramarginal gyrus, or associated white matter tracts.
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Affiliation(s)
- Sona Patel
- Seton Hall University, South Orange, NJ, United States
| | - Kenichi Oishi
- Johns Hopkins Medicine, Baltimore, MD, United States
| | - Amy Wright
- Johns Hopkins Medicine, Baltimore, MD, United States
| | | | - Sadhvi Saxena
- Johns Hopkins Medicine, Baltimore, MD, United States
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22
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Sebastian R, Long C, Purcell JJ, Faria AV, Lindquist M, Jarso S, Race D, Davis C, Posner J, Wright A, Hillis AE. Imaging network level language recovery after left PCA stroke. Restor Neurol Neurosci 2018; 34:473-89. [PMID: 27176918 PMCID: PMC5003759 DOI: 10.3233/rnn-150621] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Purpose: The neural mechanisms that support aphasia recovery are not yet fully understood. Our goal was to evaluate longitudinal changes in naming recovery in participants with posterior cerebral artery (PCA) stroke using a case-by-case analysis. Methods: Using task based and resting state functional magnetic resonance imaging (fMRI) and detailed language testing, we longitudinally studied the recovery of the naming network in four participants with PCA stroke with naming deficits at the acute (0 week), sub acute (3–5 weeks), and chronic time point (5–7 months) post stroke. Behavioral and imaging analyses (task related and resting state functional connectivity) were carried out to elucidate longitudinal changes in naming recovery. Results: Behavioral and imaging analysis revealed that an improvement in naming accuracy from the acute to the chronic stage was reflected by increased connectivity within and between left and right hemisphere “language” regions. One participant who had persistent moderate naming deficit showed weak and decreasing connectivity longitudinally within and between left and right hemisphere language regions. Conclusions: These findings emphasize a network view of aphasia recovery, and show that the degree of inter- and intra- hemispheric balance between the language-specific regions is necessary for optimal recovery of naming, at least in participants with PCA stroke.
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Affiliation(s)
- Rajani Sebastian
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charltien Long
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeremy J Purcell
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
| | - Andreia V Faria
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Martin Lindquist
- Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA
| | - Samson Jarso
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Race
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cameron Davis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph Posner
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy Wright
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
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23
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Abstract
Unilateral spatial neglect is a disabling neurologic deficit, most frequent and severe after right-hemispheric lesions. In most patients neglect involves the left side of space, contralateral to a right-hemispheric lesion. About 50% of stroke patients exhibit neglect in the acute phase. Patients fail to orient, respond to, and report sensory events occurring in the contralateral sides of space and of the body, to explore these portions of space through movements by action effectors (eye, limbs), and to move the contralateral limbs. Neglect is a multicomponent higher-level disorder of spatial awareness, cognition, and attention. Spatial neglect may occur independently of elementary sensory and motor neurologic deficits, but it can mimic and make them more severe. Diagnostic tests include: motor exploratory target cancellation; setting the midpoint of a horizontal line (bisection), that requires the estimation of lateral extent; drawing by copy and from memory; reading, assessing neglect dyslexia; and exploring the side of the body contralateral to the lesion. Activities of daily living scales are also used. Patients are typically not aware of neglect, although they may exhibit varying degrees of awareness toward different components of the deficit. The neural correlates include lesions to the inferior parietal lobule of the posterior parietal cortex, which was long considered the unique neuropathologic correlate of neglect, to the premotor and to the dorsolateral prefrontal cortices, to the posterior superior temporal gyrus, at the temporoparietal junction, to subcortical gray nuclei (thalamus, basal ganglia), and to parietofrontal white-matter fiber tracts, such as the superior longitudinal fascicle. Damage to the inferior parietal lobule of the posterior parietal cortex is specifically associated with the mainly egocentric, perceptual, and exploratory extrapersonal, and with the personal, bodily components of neglect. Productive manifestations, such as perseveration, are not a correlate of posterior parietal cortex damage.
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24
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Abstract
The sequelae of post-stroke aphasia are considerable, necessitating an understanding of the functional neuroanatomy of language, cognitive processes underlying various language tasks, and the mechanisms of recovery after stroke. This knowledge is vital in providing optimal care of individuals with aphasia and counseling to their families and caregivers. The standard of care in the rehabilitation of aphasia dictates that treatment be evidence-based and person-centered. Promising techniques, such as cortical stimulation as an adjunct to behavioral therapy, are just beginning to be explored. These topics are discussed in this review.
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Affiliation(s)
- Donna C. Tippett
- Department of Neurology, Johns Hopkins University School of Medicine, Phipps 446, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Phipps 446, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
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25
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Aphasia and unilateral spatial neglect due to acute thalamic hemorrhage: clinical correlations and outcomes. Neurol Sci 2016; 37:565-72. [PMID: 26796359 DOI: 10.1007/s10072-016-2476-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 01/09/2016] [Indexed: 10/22/2022]
Abstract
Thalamic hemorrhages are associated with a variety of cognitive dysfunctions, and it is well known that such cognitive changes constitute a limiting factor of recovery of the activities of daily living (ADL). The relationship between cognitive dysfunction and hematomas is unclear. In this study, we investigated the relationship between aphasia/neglect and hematoma volume, hematoma type, and the ADL. One hundred fifteen patients with thalamic hemorrhage (70 men and 45 women) were studied. Their mean age was 68.9 ± 10.3 years, and patients with both left and right lesions were included. We calculated hematoma volume and examined the presence or absence of aphasia/neglect and the relationships between these dysfunctions and hematoma volume, hematoma type, and the ADL. Fifty-nine patients were found to have aphasia and 35 were found to have neglect. Although there was no relationship between hematoma type and cognitive dysfunction, hematoma volume showed a correlation with the severity of cognitive dysfunction. The ADL score and ratio of patient discharge for patients with aphasia/neglect were lower than those for patients without aphasia/neglect. We observed a correlation between the hematoma volume in thalamic hemorrhage and cognitive dysfunction. Aphasia/neglect is found frequently in patients with acute thalamic hemorrhage and may influence the ADL.
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26
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Abstract
The sequelae of post-stroke aphasia are considerable, with implications at the societal and personal levels. An understanding of the mechanisms of recovery of cognitive and language processes after stroke and the factors associated with increased risk of post-stroke language and cognitive deficits is vital in providing optimal care of individuals with aphasia and in counseling to their families and caregivers. Advances in neuroimaging facilitate the identification of dysfunctional or damaged brain tissue responsible for these cognitive/language deficits and contribute insights regarding the functional neuroanatomy of language. Evidence-based person-centered behavioral therapy remains the mainstay for rehabilitation of aphasia, although emerging evidence shows that neuromodulation is a promising adjunct to traditional therapy. These topics are discussed in this review, illustrating with recent studies from the Stroke Cognitive Outcomes and REcovery (SCORE) lab.
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Affiliation(s)
- Donna C. Tippett
- Department of Neurology, Department of Physical Medicine and Rehabilitation, and Department of Otolaryngology—Head and Neck Surgery Johns Hopkins University School of Medicine6th Floor, Johns Hopkins Outpatient Center, 601 North Caroline StreetBaltimoreMD21287-0910USA
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27
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Hillis AE, Baron JC. Editorial: the ischemic penumbra: still the target for stroke therapies? Front Neurol 2015; 6:85. [PMID: 25954244 PMCID: PMC4406067 DOI: 10.3389/fneur.2015.00085] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/06/2015] [Indexed: 11/25/2022] Open
Affiliation(s)
- Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine , Baltimore, MD , USA ; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine , Baltimore, MD , USA ; Department of Cognitive Science, Johns Hopkins University , Baltimore, MD , USA
| | - Jean-Claude Baron
- Clinical Neurosciences, University of Cambridge , Cambridge , UK ; INSERM U894, Centre de Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Sorbonne Paris Cité , Paris , France
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