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Jiang B, Mackay MT, Stence N, Domi T, Dlamini N, Lo W, Wintermark M. Neuroimaging in Pediatric Stroke. Semin Pediatr Neurol 2022; 43:100989. [PMID: 36344022 DOI: 10.1016/j.spen.2022.100989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022]
Abstract
Pediatric stroke is unfortunately not a rare condition. It is associated with severe disability and mortality because of the complexity of potential clinical manifestations, and the resulting delay in seeking care and in diagnosis. Neuroimaging plays an important role in the multidisciplinary response for pediatric stroke patients. The rapid development of adult endovascular thrombectomy has created a new momentum in health professionals caring for pediatric stroke patients. Neuroimaging is critical to make decisions of identifying appropriate candidates for thrombectomy. This review article will review current neuroimaging techniques, imaging work-up strategies and special considerations in pediatric stroke. For resources limited areas, recommendation of substitute imaging approaches will be provided. Finally, promising new techniques and hypothesis-driven research protocols will be discussed.
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Affiliation(s)
- Bin Jiang
- Department of Radiology, Neuroradiology Section, Stanford University, Stanford, CA.
| | - Mark T Mackay
- Murdoch Children's Research Institute, Royal Children's Hospital and Department of Paediatrics, University of Melbourne, Victoria, Australia.
| | - Nicholas Stence
- Department of Radiology, pediatric Neuroradiology Section, University of Colorado School of Medicine, Aurora, CO
| | - Trish Domi
- Department of Neurology, Hospital for Sick Children, Toronto, Canada.
| | - Nomazulu Dlamini
- Department of Neurology, Hospital for Sick Children, Toronto, Canada.
| | - Warren Lo
- Department of Pediatrics and Neurology, The Ohio State University & Nationwide Children's Hospital, Columbus, OH.
| | - Max Wintermark
- Department of Neuroradiology, University of Texas MD Anderson Center, Houston, TX.
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de Montferrand C, Vassel-Hitier J, Yvon-Chaou E, Câmara-Costa H, Dellatolas G, Chevignard M. Language and cognitive outcomes after childhood stroke: Theoretical implications for hemispheric specialization. Cortex 2019; 120:509-523. [PMID: 31520846 DOI: 10.1016/j.cortex.2019.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/21/2019] [Accepted: 07/30/2019] [Indexed: 01/11/2023]
Abstract
The purpose of this study was to investigate language and cognitive outcomes following severe childhood stroke, and the role of age at stroke according to lesion lateralization. We retrospectively included children consecutively admitted to a physical medicine and rehabilitation department between 1992 and 2015 following childhood stroke (age at stroke 1 month to15 years). Data collection included demographic and clinical information, results of cognitive assessments on the Wechsler Intelligence scales, detailed language assessments by speech and language therapists, and long-term academic outcome. Overall, 184 children (52% boys; mean age at assessment = 8.5 years, range .7-15.4 years) were hospitalized following ischemic (n = 79) or hemorrhagic (n = 105) stroke. After a median time since stroke of 4 months (n = 135), mean Full-Scale, Verbal, and Performance Intellectual Quotient (FSIQ, VIQ and PIQ) were 85 (SD = 19), 93 (SD = 22), and 85 (SD = 20), respectively. In language tests (n = 130) assessing lexical and syntactic expression and comprehension, 26%-53% of the children exhibited impairments (scores <2SD). After a median follow-up of 40 months, only 27% of the children were following a normal curriculum without adaptations or delay, and 27% were attending special education programs. School situation was strongly associated with language and FSIQ scores. Language and verbal IQ scores were significantly lower (p < .01) among patients with lesions in the left hemisphere as opposed to the right. After a left hemisphere lesion, language skills were not associated with age at stroke, but for right hemisphere lesions, language was more impaired among children who were younger at stroke onset. PIQ tended to correlate positively with age at stroke in left hemisphere lesions (poorer PIQ in early lesions) and negatively for right hemisphere lesions (poorer PIQ in late lesions). These findings, discussed in the light of the brain vulnerability and plasticity hypotheses, are in favor of a developmental view of hemispheric specialization.
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Affiliation(s)
- Camille de Montferrand
- Rehabilitation Department for Children with Acquired Neurological Injury, and Outreach Team for Children and Adolescents with Acquired Brain Injury, Saint Maurice Hospitals, Saint Maurice, France; L'Escale, Service de Médecine Physique et de Réadaptation Pédiatrique, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France
| | - Jeanne Vassel-Hitier
- Rehabilitation Department for Children with Acquired Neurological Injury, and Outreach Team for Children and Adolescents with Acquired Brain Injury, Saint Maurice Hospitals, Saint Maurice, France
| | - Estelle Yvon-Chaou
- Rehabilitation Department for Children with Acquired Neurological Injury, and Outreach Team for Children and Adolescents with Acquired Brain Injury, Saint Maurice Hospitals, Saint Maurice, France
| | - Hugo Câmara-Costa
- Université Paris-Saclay, Université Paris-SUD, UVSQ, CESP, INSERM, Paris, France
| | - Georges Dellatolas
- Université Paris-Saclay, Université Paris-SUD, UVSQ, CESP, INSERM, Paris, France
| | - Mathilde Chevignard
- Rehabilitation Department for Children with Acquired Neurological Injury, and Outreach Team for Children and Adolescents with Acquired Brain Injury, Saint Maurice Hospitals, Saint Maurice, France; Sorbonne Université, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France; French Centre for Paediatric Stroke, Bellevue Hospital, Saint Etienne, France; GRC n°24, Handicap Moteur et Cognitif et Réadaptation (HaMCRe), Sorbonne Université, Paris, France.
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Peterson RK, McDonald KP, Vincent M, Williams TS, Dlamini N, Westmacott R. Characterizing language outcomes following childhood basal ganglia stroke. APPLIED NEUROPSYCHOLOGY-CHILD 2019; 10:14-25. [PMID: 31006275 DOI: 10.1080/21622965.2019.1590202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The basal ganglia are important for movement and executive function, but its contribution to language is less understood. This study explored language outcomes associated with childhood basal ganglia stroke. A detailed language coding scheme, which examined expressive and receptive language, verbal fluency, narrative discourse, pragmatic/applied language, and academics, was developed from qualitative and quantitative data acquired from neuropsychological testing and reports. Overall intellectual functioning and verbal comprehension was in the average range. Twelve participants had psychological diagnoses, including Learning Disorder. No one had a Language Disorder diagnosis. Among the 18 children who did not receive a diagnosis, many exhibited language issues in the mild to severe range according to our coding scheme. These children had higher-order language difficulties in verbal fluency, narrative, and pragmatic language rather than overt expressive difficulties noted in Diagnostic and Statistical Manual (DSM) diagnostic criteria. There was an association between infarct size and ESL/immersion education, math performance, and presence of a psychological diagnosis. Psychological diagnosis was also associated with literacy skills. The results highlight that language issues following basal ganglia stroke may not be fully captured by standardized neuropsychological tests and psychological diagnoses. Findings reinforce the need to integrate quantitative and qualitative findings when examining language functioning.
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Affiliation(s)
- Rachel K Peterson
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kyla P McDonald
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Megan Vincent
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tricia S Williams
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nomazulu Dlamini
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robyn Westmacott
- Children's Stroke Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Pediatrics Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Speech and Language Impairments After Childhood Arterial Ischemic Stroke: Does Hemisphere Matter? Pediatr Neurol 2019; 92:55-59. [PMID: 30594525 DOI: 10.1016/j.pediatrneurol.2018.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 11/01/2018] [Accepted: 11/10/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The association between left hemisphere stroke and acute speech and language impairment is well documented in adults. However, little is known about this association in childhood arterial ischemic stroke. Here we examined potential predictors of acute speech (dysarthria and apraxia) and language impairments after childhood arterial ischemic stroke, including site of lesion. METHODS Children with radiologically confirmed acute arterial ischemic stroke, admitted to a tertiary pediatric hospital from 2004 to 2012, were identified from an institutional registry. We examined the prevalence of dysarthria, apraxia, and language impairment within two weeks of the stroke. Associations with age at stroke event, lesion side (left, right, or bilateral), and arterial territory affected (anterior, posterior, or both) were assessed using logistic regression. RESULTS Sixty-two children with mean age eight years (range three to 17 years) were identified. Strokes were located in the left (32%), right (44%), or both hemispheres (24%). Dysarthria (74%) and language impairment (50%) were frequent. Verbal dyspraxia was less common (11%). There was little evidence that variables of interest, including site of lesion, were significantly associated with increased odds of dysarthria or language impairment (all P > 0.49). CONCLUSIONS Regardless of age, children are at high risk of communication disorders after stroke. Unlike adults, left hemisphere stroke was not associated with either speech or language impairment in our cohort, suggesting there may be bihemispheric contribution to language function. Future studies are needed to examine whether the predictors examined here determine long-term outcomes.
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O’Keeffe F, Murphy O, Ganesan V, King J, Murphy T. Neuropsychological outcome following childhood stroke – a review. Brain Inj 2017; 31:1575-1589. [DOI: 10.1080/02699052.2017.1332782] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Fiadhnait O’Keeffe
- Research Department of Clinical, Health and Educational Psychology, University College London, London, UK
- Department of Clinical Psychology, National Rehabilitation Hospital, Dun Laoghaire, Co. Dublin, Ireland
| | - Orlagh Murphy
- Department of Clinical Psychology, National Rehabilitation Hospital, Dun Laoghaire, Co. Dublin, Ireland
| | - Vijeya Ganesan
- Institute of Child Health, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - John King
- Research Department of Clinical, Health and Educational Psychology, University College London, London, UK
| | - Tara Murphy
- Institute of Child Health, Great Ormond Street Hospital for Children NHS Trust, London, UK
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Language Representation Following Left MCA Stroke in Children and Adults: An fMRI Study. Can J Neurol Sci 2017; 44:483-497. [PMID: 28468691 DOI: 10.1017/cjn.2017.44] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In this case series, functional magnetic resonance imaging was used to examine brain networks that mediate different aspects of language function in 4 young adults (17-22 years) with a history of left middle cerebral artery (MCA) stroke in childhood (40 years of age). Although it is widely believed that altered lateralization patterns are more likely to occur following early brain injuries compared with later brain injuries, the presumed plasticity of the young brain has been challenged in recent years, particularly in the domain of language. METHODS We explored this issue by contrasting the brain activation patterns of individuals with childhood left MCA stroke and adult left MCA stroke while performing two language tasks: verb generation and picture-word matching. Importantly, both groups showed significant recovery of language function, based on standard clinical indicators. RESULTS Controls showed left lateralized activation for both tasks, although much more pronounced for verb generation. Adult stroke patients also showed left lateralization for both tasks, though somewhat weaker than controls. Childhood stroke patients exhibited significantly weaker lateralization than the adult group for verb generation, but there was no significant group difference for picture-word matching. CONCLUSIONS These preliminary findings suggest that successful reorganization of language function is more likely to involve bilateral recruitment following left MCA stroke in childhood than in adulthood. Of importance, although childhood stroke patients had primarily subcortical lesions, there were substantial alterations in cortical activation patterns.
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Cai J, Ji Q, Xin R, Zhang D, Na X, Peng R, Li K. Contralesional Cortical Structural Reorganization Contributes to Motor Recovery after Sub-Cortical Stroke: A Longitudinal Voxel-Based Morphometry Study. Front Hum Neurosci 2016; 10:393. [PMID: 27536229 PMCID: PMC4971124 DOI: 10.3389/fnhum.2016.00393] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 07/22/2016] [Indexed: 12/22/2022] Open
Abstract
Although changes in brain gray matter after stroke have been identified in some neuroimaging studies, lesion heterogeneity and individual variability make the detection of potential neuronal reorganization difficult. This study attempted to investigate the potential structural cortical reorganization after sub-cortical stroke using a longitudinal voxel-based gray matter volume (GMV) analysis. Eleven right-handed patients with first-onset, subcortical, ischemic infarctions involving the basal ganglia regions underwent structural magnetic resonance imaging in addition to National Institutes of Health Stroke Scale (NIHSS) and Motricity Index (MI) assessments in the acute (<5 days) and chronic stages (1 year later). The GMVs were calculated and compared between the two stages using nonparametric permutation paired t-tests. Moreover, the Spearman correlations between the GMV changes and clinical recoveries were analyzed. Compared with the acute stage, significant decreases in GMV were observed in the ipsilesional (IL) precentral gyrus (PreCG), paracentral gyrus (ParaCG), and contralesional (CL) cerebellar lobule VII in the chronic stage. Additionally, significant increases in GMV were found in the CL orbitofrontal cortex (OFC) and middle (MFG) and inferior frontal gyri (IFG). Furthermore, severe GMV atrophy in the IL PreCG predicted poorer clinical recovery, and greater GMV increases in the CL OFG and MFG predicted better clinical recovery. Our findings suggest that structural reorganization of the CL “cognitive” cortices might contribute to motor recovery after sub-cortical stroke.
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Affiliation(s)
- Jianxin Cai
- Department of Radiology, Beijing Luhe Hospital, Capital Medical University Beijing, China
| | - Qiling Ji
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University Beijing, China
| | - Ruiqiang Xin
- Department of Radiology, Beijing Luhe Hospital, Capital Medical University Beijing, China
| | - Dianping Zhang
- Department of Radiology, Beijing Luhe Hospital, Capital Medical University Beijing, China
| | - Xu Na
- Department of Radiology, Beijing Luhe Hospital, Capital Medical University Beijing, China
| | - Ruchen Peng
- Department of Radiology, Beijing Luhe Hospital, Capital Medical University Beijing, China
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University Beijing, China
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Greenham M, Gordon A, Anderson V, Mackay MT. Outcome in Childhood Stroke. Stroke 2016; 47:1159-64. [DOI: 10.1161/strokeaha.115.011622] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 02/18/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Mardee Greenham
- From the Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia (M.G., V.A., M.T.M.); School of Psychological Sciences (M.G., V.A.) and Department of Paediatrics (M.T.M), University of Melbourne, Melbourne, Australia; Department of Paediatric Neuroscience, Evelina London Children’s Hospital, London, United Kingdom (A.G.); Institute of Psychology, Psychiatry, and Neuroscience, Kings College London, London, United Kingdom (A.G.); and Department of Psychology (V.A.) and Neurology
| | - Anne Gordon
- From the Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia (M.G., V.A., M.T.M.); School of Psychological Sciences (M.G., V.A.) and Department of Paediatrics (M.T.M), University of Melbourne, Melbourne, Australia; Department of Paediatric Neuroscience, Evelina London Children’s Hospital, London, United Kingdom (A.G.); Institute of Psychology, Psychiatry, and Neuroscience, Kings College London, London, United Kingdom (A.G.); and Department of Psychology (V.A.) and Neurology
| | - Vicki Anderson
- From the Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia (M.G., V.A., M.T.M.); School of Psychological Sciences (M.G., V.A.) and Department of Paediatrics (M.T.M), University of Melbourne, Melbourne, Australia; Department of Paediatric Neuroscience, Evelina London Children’s Hospital, London, United Kingdom (A.G.); Institute of Psychology, Psychiatry, and Neuroscience, Kings College London, London, United Kingdom (A.G.); and Department of Psychology (V.A.) and Neurology
| | - Mark T. Mackay
- From the Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia (M.G., V.A., M.T.M.); School of Psychological Sciences (M.G., V.A.) and Department of Paediatrics (M.T.M), University of Melbourne, Melbourne, Australia; Department of Paediatric Neuroscience, Evelina London Children’s Hospital, London, United Kingdom (A.G.); Institute of Psychology, Psychiatry, and Neuroscience, Kings College London, London, United Kingdom (A.G.); and Department of Psychology (V.A.) and Neurology
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Xing S, Lacey EH, Skipper-Kallal LM, Jiang X, Harris-Love ML, Zeng J, Turkeltaub PE. Right hemisphere grey matter structure and language outcomes in chronic left hemisphere stroke. Brain 2015; 139:227-41. [PMID: 26521078 DOI: 10.1093/brain/awv323] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/23/2015] [Indexed: 11/13/2022] Open
Abstract
The neural mechanisms underlying recovery of language after left hemisphere stroke remain elusive. Although older evidence suggested that right hemisphere language homologues compensate for damage in left hemisphere language areas, the current prevailing theory suggests that right hemisphere engagement is ineffective or even maladaptive. Using a novel combination of support vector regression-based lesion-symptom mapping and voxel-based morphometry, we aimed to determine whether local grey matter volume in the right hemisphere independently contributes to aphasia outcomes after chronic left hemisphere stroke. Thirty-two left hemisphere stroke survivors with aphasia underwent language assessment with the Western Aphasia Battery-Revised and tests of other cognitive domains. High-resolution T1-weighted images were obtained in aphasia patients and 30 demographically matched healthy controls. Support vector regression-based multivariate lesion-symptom mapping was used to identify critical language areas in the left hemisphere and then to quantify each stroke survivor's lesion burden in these areas. After controlling for these direct effects of the stroke on language, voxel-based morphometry was then used to determine whether local grey matter volumes in the right hemisphere explained additional variance in language outcomes. In brain areas in which grey matter volumes related to language outcomes, we then compared grey matter volumes in patients and healthy controls to assess post-stroke plasticity. Lesion-symptom mapping showed that specific left hemisphere regions related to different language abilities. After controlling for lesion burden in these areas, lesion size, and demographic factors, grey matter volumes in parts of the right temporoparietal cortex positively related to spontaneous speech, naming, and repetition scores. Examining whether domain general cognitive functions might explain these relationships, partial correlations demonstrated that grey matter volumes in these clusters related to verbal working memory capacity, but not other cognitive functions. Further, grey matter volumes in these areas were greater in stroke survivors than healthy control subjects. To confirm this result, 10 chronic left hemisphere stroke survivors with no history of aphasia were identified. Grey matter volumes in right temporoparietal clusters were greater in stroke survivors with aphasia compared to those without history of aphasia. These findings suggest that the grey matter structure of right hemisphere posterior dorsal stream language homologues independently contributes to language production abilities in chronic left hemisphere stroke, and that these areas may undergo hypertrophy after a stroke causing aphasia.
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Affiliation(s)
- Shihui Xing
- 1 Department of Neurology, Georgetown University Medical Center, Washington, D.C., USA 2 Department of Neurology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Elizabeth H Lacey
- 1 Department of Neurology, Georgetown University Medical Center, Washington, D.C., USA 3 Research Division, MedStar National Rehabilitation Hospital, Washington, D.C., USA
| | | | - Xiong Jiang
- 4 Department of Neuroscience, Georgetown University Medical Center, Washington, D.C., USA
| | - Michelle L Harris-Love
- 3 Research Division, MedStar National Rehabilitation Hospital, Washington, D.C., USA 5 Department of Rehabilitation Science, George Mason University, Fairfax, V.A., USA
| | - Jinsheng Zeng
- 2 Department of Neurology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Peter E Turkeltaub
- 1 Department of Neurology, Georgetown University Medical Center, Washington, D.C., USA 3 Research Division, MedStar National Rehabilitation Hospital, Washington, D.C., USA
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Humphreys GW, Chechlacz M. A Neural Decomposition of Visual Search Using Voxel-based Morphometry. J Cogn Neurosci 2015; 27:1854-69. [DOI: 10.1162/jocn_a_00828] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Abstract
The ability to search efficiently for visual targets among distractors can break down after a variety of brain lesions, but the specific processes affected by the lesions are unclear. We examined search over space (conjunction search) and over time plus space (preview search) in a consecutive series of patients with acquired brain lesions. We also assessed performance on standard neuropsychological measures of visuospatial short-term memory (Corsi Block), sustained attention and memory updating (the contrast between forward and backward digit span), and visual neglect. Voxel-based morphometry analyses revealed regions in the occipital (middle occipital gyrus), posterior parietal (angular gyrus), and temporal cortices (superior and middle temporal gyri extending to the insula), along with underlying white matter pathways, associated with poor search. Going beyond standard voxel-based morphometry analyses, we then report correlation measures of structural damage in these regions and the independent neuropsychological measures of other cognitive functions. We find distinct patterns of correlation in areas linked to poor search, suggesting that the areas play functionally different roles in search. We conclude that neuropsychological disorders of search can be linked to necessary and distinct cognitive functions, according to the site of lesion.
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Geva S, Baron JC, Jones PS, Price CJ, Warburton EA. A comparison of VLSM and VBM in a cohort of patients with post-stroke aphasia. NEUROIMAGE-CLINICAL 2012; 1:37-47. [PMID: 24179735 PMCID: PMC3757730 DOI: 10.1016/j.nicl.2012.08.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 08/20/2012] [Accepted: 08/22/2012] [Indexed: 01/18/2023]
Abstract
Studies attempting to map post-stroke cognitive or motor symptoms to lesion location have been available in the literature for over 150 years. In the last two decades, two computational techniques have been developed to identify the lesion sites associated with behavioural impairments. Voxel Based Morphometry (VBM) has now been used extensively for this purpose in many different patient populations. More recently, Voxel-based Lesion Symptom Mapping (VLSM) was developed specifically for the purpose of identifying lesion–symptom relationships in stroke patients, and has been used extensively to study, among others functions, language, motor abilities and attention. However, no studies have compared the results of these two techniques so far. In this study we compared VLSM and VBM in a cohort of 20 patients with chronic post-stroke aphasia. Comparison of the two techniques showed overlap in regions previously found to be relevant for the tasks used, suggesting that using both techniques and looking for overlaps between them can increase the reliability of the results obtained. However, overall VBM and VLSM provided only partially concordant results and the differences between the two techniques are discussed.
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Affiliation(s)
- Sharon Geva
- Department of Clinical Neurosciences, University of Cambridge, R3 Neurosciences, Box 83, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
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Gordon AL, Wood A, Tournier JD, Hunt RW. Corticospinal tract integrity and motor function following neonatal stroke: a case study. BMC Neurol 2012; 12:53. [PMID: 22776078 PMCID: PMC3464897 DOI: 10.1186/1471-2377-12-53] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 07/09/2012] [Indexed: 11/23/2022] Open
Abstract
Background New MRI techniques enable visualisation of corticospinal tracts and cortical motor activity. The objective of this case study was to describe the magnetic resonance evidence of corticospinal pathway reorganisation following neonatal stroke. Case presentation An 11 year old boy with a neonatal right middle cerebral artery territory ischaemic stroke was studied. Functional MRI was undertaken with a whole hand squeezing task, comparing areas of cortical activation between hands. White matter tracts, seeded from the area of peak activation in the cortex, were visualised using a diffusion weighted imaging probabilistic tractography method. Standardised evaluations of unilateral and bilateral motor function were undertaken. Clinically, the child presented with a left hemiparesis. Functional MRI demonstrated that movement of the hemiparetic hand resulted in activation in the ipsi-lesional (right) hemisphere only. Diffusion tractography revealed pathways in the right (lesioned) hemisphere tracked perilesionally to the cortical area identified by functional MRI. Conclusion Our case demonstrates that neonatal stroke is associated with maintenance of organization of corticospinal pathways sufficient to maintain some degree of hand function in the affected hemisphere. Functional MRI and diffusion weighted imaging tractography may inform our understanding of recovery, organisation and reorganisation and have the potential to monitor responses to intervention following neonatal stroke.
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Affiliation(s)
- Anne L Gordon
- Evelina Children’s Hospital, Guys’ & St Thomas’ Hospital NHS Trust, London, UK
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Cognitive Differences Between Patients with Left-sided and Right-sided Parkinson’s Disease. A Review. Neuropsychol Rev 2011; 21:405-24. [DOI: 10.1007/s11065-011-9182-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 09/06/2011] [Indexed: 10/17/2022]
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Liégeois FJ, Morgan AT. Neural bases of childhood speech disorders: lateralization and plasticity for speech functions during development. Neurosci Biobehav Rev 2011; 36:439-58. [PMID: 21827785 DOI: 10.1016/j.neubiorev.2011.07.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 07/07/2011] [Accepted: 07/23/2011] [Indexed: 11/27/2022]
Abstract
Current models of speech production in adults emphasize the crucial role played by the left perisylvian cortex, primary and pre-motor cortices, the basal ganglia, and the cerebellum for normal speech production. Whether similar brain-behaviour relationships and leftward cortical dominance are found in childhood remains unclear. Here we reviewed recent evidence linking motor speech disorders (apraxia of speech and dysarthria) and brain abnormalities in children and adolescents with developmental, progressive, or childhood-acquired conditions. We found no evidence that unilateral damage can result in apraxia of speech, or that left hemisphere lesions are more likely to result in dysarthria than lesion to the right. The few studies reporting on childhood apraxia of speech converged towards morphological, structural, metabolic or epileptic anomalies affecting the basal ganglia, perisylvian and rolandic cortices bilaterally. Persistent dysarthria, similarly, was commonly reported in individuals with syndromes and conditions affecting these same structures bilaterally. In conclusion, for the first time we provide evidence that longterm and severe childhood speech disorders result predominantly from bilateral disruption of the neural networks involved in speech production.
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Affiliation(s)
- Frédérique J Liégeois
- Developmental Cognitive Neuroscience Unit, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
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Arterial ischemic stroke in children--recent advances. Indian J Pediatr 2008; 75:1149-57. [PMID: 19132317 DOI: 10.1007/s12098-008-0239-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Accepted: 10/16/2008] [Indexed: 10/21/2022]
Abstract
Childhood stroke syndromes are an important cause of mortality and morbidity. This paper focuses on the recent advances in arterial ischaemic stroke beyond the neonatal period. Vascular risk factors are identified in the majority of children and guide both acute and longer term treatments, as well as determining prognosis. Contrary to popular belief many children have residual impairments encompassing a wide range of domains. National and international collaborations are facilitating an increase in the understanding of childhood stroke and have the eventual aim of conducting trials of potential therapeutic interventions.
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De Diego-Balaguer R, Couette M, Dolbeau G, Dürr A, Youssov K, Bachoud-Lévi AC. Striatal degeneration impairs language learning: evidence from Huntington's disease. Brain 2008; 131:2870-81. [PMID: 18842608 DOI: 10.1093/brain/awn242] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although the role of the striatum in language processing is still largely unclear, a number of recent proposals have outlined its specific contribution. Different studies report evidence converging to a picture where the striatum may be involved in those aspects of rule-application requiring non-automatized behaviour. This is the main characteristic of the earliest phases of language acquisition that require the online detection of distant dependencies and the creation of syntactic categories by means of rule learning. Learning of sequences and categorization processes in non-language domains has been known to require striatal recruitment. Thus, we hypothesized that the striatum should play a prominent role in the extraction of rules in learning a language. We studied 13 pre-symptomatic gene-carriers and 22 early stage patients of Huntington's disease (pre-HD), both characterized by a progressive degeneration of the striatum and 21 late stage patients Huntington's disease (18 stage II, two stage III and one stage IV) where cortical degeneration accompanies striatal degeneration. When presented with a simplified artificial language where words and rules could be extracted, early stage Huntington's disease patients (stage I) were impaired in the learning test, demonstrating a greater impairment in rule than word learning compared to the 20 age- and education-matched controls. Huntington's disease patients at later stages were impaired both on word and rule learning. While spared in their overall performance, gene-carriers having learned a set of abstract artificial language rules were then impaired in the transfer of those rules to similar artificial language structures. The correlation analyses among several neuropsychological tests assessing executive function showed that rule learning correlated with tests requiring working memory and attentional control, while word learning correlated with a test involving episodic memory. These learning impairments significantly correlated with the bicaudate ratio. The overall results support striatal involvement in rule extraction from speech and suggest that language acquisition requires several aspects of memory and executive functions for word and rule learning.
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Affiliation(s)
- R De Diego-Balaguer
- INSERM U841, Team 1: Interventional Neuropsychology, IM3-Paris 12, Créteil, France.
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Wahl M, Marzinzik F, Friederici AD, Hahne A, Kupsch A, Schneider GH, Saddy D, Curio G, Klostermann F. The Human Thalamus Processes Syntactic and Semantic Language Violations. Neuron 2008; 59:695-707. [DOI: 10.1016/j.neuron.2008.07.011] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Revised: 06/23/2008] [Accepted: 07/09/2008] [Indexed: 10/21/2022]
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