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Zhang H, Zhao J, Fan L, Wu X, Li F, Liu J, Bai C, Li X, Li B, Zhang T. Exploring the Structural Plasticity Mechanism of Corticospinal Tract during Stroke Rehabilitation Based Automated Fiber Quantification Tractography. Neurorehabil Neural Repair 2024; 38:425-436. [PMID: 38676561 DOI: 10.1177/15459683241249115] [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] [Indexed: 04/29/2024]
Abstract
BACKGROUND Corticospinal tract (CST) is the principal motor pathway; we aim to explore the structural plasticity mechanism in CST during stroke rehabilitation. METHODS A total of 25 patients underwent diffusion tensor imaging before rehabilitation (T1), 1-month post-rehabilitation (T2), 2 months post-rehabilitation (T3), and 1-year post-discharge (T4). The CST was segmented, and fractional anisotropy (FA), axial diffusion (AD), mean diffusivity (MD), and radial diffusivity (RD) were determined using automated fiber quantification tractography. Baseline level of laterality index (LI) and motor function for correlation analysis. RESULTS The FA values of all segments in the ipsilesional CST (IL-CST) were lower compared with normal CST. Repeated measures analysis of variance showed time-related effects on FA, AD, and MD of the IL-CST, and there were similar dynamic trends in these 3 parameters. At T1, FA, AD, and MD values of the mid-upper segments of IL-CST (around the core lesions) were the lowest; at T2 and T3, values for the mid-lower segments were lower than those at T1, while the values for the mid-upper segments gradually increased; at T4, the values for almost entire IL-CST were higher than before. The highest LI was observed at T2, with a predominance in contralesional CST. The LIs for the FA and AD at T1 were positively correlated with the change rate of motor function. CONCLUSIONS IL-CST showed aggravation followed by improvement from around the lesion to the distal end. Balance of interhemispheric CST may be closely related to motor function, and LIs for FA and AD may have predictive value for mild-to-moderate stroke rehabilitation. Clinical Trial Registration. URL: http://www.chictr.org.cn; Unique Identifier: ChiCTR1800019474.
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Affiliation(s)
- Haojie Zhang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- China Rehabilitation Science Institute, Beijing, China
- Center of Neurological Rehabilitation, China Rehabilitation Research Center, Beijing, China
| | - Jun Zhao
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Neurology, China Rehabilitation Research Center, Beijing, China
| | - Lingzhong Fan
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Xia Wu
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Fang Li
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Neurology, China Rehabilitation Research Center, Beijing, China
| | - Jingya Liu
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of occupational therapy, China Rehabilitation Research Center, Beijing, China
| | - Chen Bai
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- China Rehabilitation Science Institute, Beijing, China
- Center of Neurological Rehabilitation, China Rehabilitation Research Center, Beijing, China
| | - Xingzhu Li
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- China Rehabilitation Science Institute, Beijing, China
- Center of Neurological Rehabilitation, China Rehabilitation Research Center, Beijing, China
| | - Bingjie Li
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Neurology, China Rehabilitation Research Center, Beijing, China
| | - Tong Zhang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- China Rehabilitation Science Institute, Beijing, China
- Center of Neurological Rehabilitation, China Rehabilitation Research Center, Beijing, China
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Al Taie H, Vasandani N, Nasehi A, O'Malley T. An Atypical Presentation of Creutzfeldt-Jakob Disease as a Stroke Mimic: Experience From an Irish Tertiary Center. Cureus 2023; 15:e43066. [PMID: 37680437 PMCID: PMC10481629 DOI: 10.7759/cureus.43066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 09/09/2023] Open
Abstract
Sporadic Creutzfeldt-Jakob Disease (sCJD) is a rare neurodegenerative prion disease that presents with symptoms of rapid neuropsychiatric decline including dementia, behavioural abnormalities, and loss of higher cortical function. Patients commonly present with rapidly progressive neuromotor symptoms such as ataxia and myoclonus. Very few cases of CJD have been reported in which the patient initially presents with stroke symptoms such as hemiparesis as their primary presenting symptom. We present a case of a 56-year-old male who initially presented to the stroke unit with waxing and waning left-sided weakness and a non-corresponding ipsilateral left-sided acute parietal infarct on diffusion-weighted MRI. Over four weeks, his condition progressively worsened with declining cognitive function, motor dysfunction, sphincter dysfunction, and eventual death.
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Affiliation(s)
- Hassan Al Taie
- Internal Medicine, Mayo University Hospital, Castlebar, IRL
| | | | - Armon Nasehi
- Internal Medicine, Mayo University Hospital, Castlebar, IRL
| | - Tom O'Malley
- Internal Medicine, Mayo University Hospital, Castlebar, IRL
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Kajtazi NI, Bafaquh M, Rizvi T, Sheikh SE, Ghamdi JA, Amoudi RA, Jabbar AA, Shammari KA, Saqqur M, Ghamdi SA, Khoja W, Demchuk A, Senani FA, Luft AR. Ipsilateral weakness caused by ipsilateral stroke: A case series. J Stroke Cerebrovasc Dis 2023; 32:107090. [PMID: 37105128 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107090] [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: 10/07/2022] [Revised: 03/10/2023] [Accepted: 03/19/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION There are few reported cases of ipsilateral weakness following ischemic or hemorrhagic stroke. In these rare cases, ipsilateral weakness is typically the result of damage to uncrossed components of the corticospinal tract (CST) which were recruited in response to previous CST injury. PATIENTS AND METHODS We report a series of six cases of acute ipsilateral weakness or numbness following a hemorrhagic or ischemic stroke from three medical institutions in Saudi Arabia. RESULTS Three of these patients presented with right-sided weakness caused by an ipsilateral right hemispheric stroke, while two exhibited left-sided symptoms and one had only left-sided numbness. In all six cases, the ipsilateral corona radiata, internal capsule, basal ganglia, insula, and thalamus were involved. No concomitant opposite hemisphere or brainstem lesion in none of the patients was evident. Two patients had previous strokes affecting the brainstem and left corona radiata, respectively. Complete stroke workup to reveal the cause of stroke was carried out, however no functional MRI was performed. CONCLUSION Ischemic or hemorrhagic stroke may indeed result in ipsilateral weakness or numbness, though in very rare cases. We assume that the most likely mechanism of their ipsilateral weakness subsequent to the ipsilateral stroke was a functional reorganization favoring CST pathways within the ipsilateral hemisphere.
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Affiliation(s)
- Naim I Kajtazi
- Department of Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia; Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Mohammed Bafaquh
- Department of Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Tanvir Rizvi
- Department of Medical Imaging, Neuroradiology, University of Virginia, United States
| | - Souda El Sheikh
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Juman Al Ghamdi
- Intervention Neuroradiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Razan Al Amoudi
- Intervention Neuroradiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Asma Al Jabbar
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Kareem Al Shammari
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Maher Saqqur
- Department of Neurology, University of Alberta, Canada
| | - Saeed Al Ghamdi
- Department of Neurology, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Waleed Khoja
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Fahmi Al Senani
- Department of Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia; Intervention Neuroradiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Andreas R Luft
- Department of Neurology, Switzerland & Cereneo Center for Neurology and Rehabilitation, University of Zürich, Vitznau, Switzerland
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Mala K, Harikrishna GV, Bhat V, Kodapala S. Ipsilateral Hemiparesis in a Patient With Existing Contralateral Hemiparesis: A Case Report of a Rare Presentation of Ischemic Stroke. Cureus 2023; 15:e37069. [PMID: 37153278 PMCID: PMC10155822 DOI: 10.7759/cureus.37069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 04/05/2023] Open
Abstract
Supratentorial strokes causing ipsilateral hemiparesis (ILH) are rare. We report a middle-aged male with multiple atherosclerotic risk factors, who had previously suffered a right-hemispheric stroke that caused left hemiplegia. Subsequently, he presented with worsening left-sided hemiplegia, with imaging revealing a left-hemispheric stroke. Diffusion tensor tract imaging showed crossed motor tracts, with disruption of the left-sided pyramidal tract. During his stay, he developed right hemiplegia due to the expansion of the same left-hemispheric infarct. Potential mechanisms for ILH in a stroke include injury to reorganized tracts following an initial insult and congenitally uncrossed motor tracts. In our patient, after his first stroke, the left hemisphere likely assumed greater ipsilateral motor control, causing ILH after the recent stroke. Our case adds to the literature on this interesting phenomenon and provides further insight into post-stroke recovery.
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Recurrent stroke with ipsilateral hemiparesis: an unusual phenomenon. Acta Neurol Belg 2022:10.1007/s13760-022-02163-0. [DOI: 10.1007/s13760-022-02163-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
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Luan Y, Bao Y, Wang F. Artesunate regulates the proliferation and differentiation of neural stem cells by activating the JAK‑2/STAT‑3 signaling pathway in ischemic stroke. Exp Ther Med 2022; 25:2. [PMID: 36561626 PMCID: PMC9748661 DOI: 10.3892/etm.2022.11701] [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: 02/13/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
Ischemic stroke is one of the most common causes of disability and death globally; therefore, the repair and reconstruction of the central nervous system (CNS) after stroke is very important. Neural stem/progenitor cells (NSPCs) may be the key to cell replacement therapy to treat CNS damage. It has previously been reported that artesunate (ART) is involved in the regulation of the biological functions of NSPCs; however, the mechanism of action of ART remains unclear. In the present study, different concentrations of ART were used to treat NSPCs following oxygen-glucose deprivation (OGD). Cell viability and apoptosis were analyzed using Cell Counting Kit-8 assay and flow cytometry, respectively, whereas immunofluorescence analysis was used to measure the expression levels of the differentiation-related molecule doublecortin (DCX) and proliferating cell nuclear antigen (PCNA). Western blotting was performed to analyze the expression levels of molecules related to the JAK-2/STAT-3 signaling pathway. The present results indicated that treatment with ART following OGD significantly promoted the viability of NSPCs, inhibited the apoptosis of NSPCs, and promoted the expression of PCNA and DCX. Moreover, ART significantly downregulated the protein expression levels of phosphorylated (p)-JAK-2 and p-STAT-3. Furthermore, activation of the JAK-2/STAT-3 signaling pathway and treatment with ART reversed the effects of ART on the proliferation, apoptosis and differentiation of NSPCs. In conclusion, the present data suggested that ART may promote the proliferation and differentiation of NSPCs, and reduce the apoptosis of NSPCs, by inhibiting the JAK-2/STAT-3 signaling pathway. ART may potentially be used for the treatment of ischemic stroke.
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Affiliation(s)
- Yumin Luan
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Yanan Bao
- Department of Thoracic Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Fei Wang
- Department of Intensive Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China,Correspondence to: Professor Fei Wang, Department of Intensive Medicine, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming, Yunnan 650032, P.R. China
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Du X. Atrophic cerebral peduncle may be a hallmark for evaluating the compensatory ability of the contralateral hemisphere. JOURNAL OF NEURORESTORATOLOGY 2022. [DOI: 10.1016/j.jnrt.2022.100024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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8
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Diagnostic Value of Image Features of Magnetic Resonance Imaging in Intracranial Hemorrhage and Cerebral Infarction. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:6495568. [PMID: 35935302 PMCID: PMC9296345 DOI: 10.1155/2022/6495568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022]
Abstract
This study aimed to investigate the differential diagnosis value of routine magnetic resonance imaging (MRI) and magnetic resonance diffusion-weighted imaging (DWI) in hyperacute intracranial hemorrhage (HICH) and hyperacute cerebral infarction (HCI). Fifty-five patients with HICH were set as group A, and 55 patients with HCI were selected as group B. All the patients underwent routine MRI and DWI examinations. The morphological distribution and signal characteristics (low, high, or mixed) of the lesions in the two groups were recorded. The diagnostic accuracy, sensitivity, and specificity of routine MRI and DWI were compared for distinguishing HICH and HCI. The results suggested that the lesions in patients with HICH were mainly manifested as mixed signals (40 cases), while those in patients with HCI showed high signals (48 cases). HICH occurred in the basal ganglia in 44 cases, in the brain stem in 6 cases, in the cerebellum in 4 cases, in the cerebral cortex in 0 cases, and in the corpus callosum in 1 case. HCI occurred in the basal ganglia area, brain stem, cerebellum, cerebral cortex, and corpus callosum in 5, 3, 35, 12, and 0 cases, respectively. The diagnostic accuracy, specificity, and sensitivity of DWI for HICH and HCI were significantly higher than those of routine MRI (P < 0.05). It was indicated that compared with routine MRI, DWI was more effective in the diagnosis of HICH and HCI, with clearer and more accurate images and better diagnostic performance.
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Wei J, Zhang Y. Hemichorea in a patient with ipsilateral cortical infarction: a case report. BMC Neurol 2021; 21:420. [PMID: 34715809 PMCID: PMC8555348 DOI: 10.1186/s12883-021-02420-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/29/2021] [Indexed: 12/04/2022] Open
Abstract
Background Hemichorea is usually caused by contralateral deep structures of brain. It rarely results from acute cortical ischemic stroke and that caused by ipsilateral brain lesions is even rarer. Case presentation A 64-year-old female presented with acute obtuseness and left-sided hemichorea. She had a history of right frontal lobe surgery and radiotherapy due to brain metastasis from lung cancer 8 years ago. MRI revealed acute left frontal lobe infarction in addition to an old right frontal lobe lesion. 18FDG PET-CT showed hypometabolism in the left frontal lobe and hypermetabolism in the right basal ganglia region and central sulcus. The choreatic movement remitted after antipsychotic treatment. Conclusion The mechanism of hemichorea after ipsilateral cortical infarction is poorly understood. We assume both previous contralateral brain lesion and recent ipsilateral ischemic stroke contributed to the strange manifestation in this case. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02420-4.
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Affiliation(s)
- Jie Wei
- Department of Neurology, 905th Hospital of PLA Navy, No 1328 Huashan Road, Changning District, Shanghai, 200052, China
| | - Yue Zhang
- Department of Neurology, Huashan Hospital, Fudan University, No.12 Wulumuqi Road, Jing'an District, Shanghai, 200040, China.
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Aphasia Induced by Infratentorial Ischemic Stroke: Two Case Reports. Cogn Behav Neurol 2021; 34:129-139. [PMID: 34074867 DOI: 10.1097/wnn.0000000000000266] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 08/26/2020] [Indexed: 10/21/2022]
Abstract
Aphasia induced by an infratentorial stroke has rarely been reported, and its mechanism has not been fully identified. We evaluated two individuals who had been admitted to Saiseikai Kumamoto Hospital in Kumamoto, Japan, due to acute ischemic stroke in order to determine whether their aphasia was induced by an infratentorial stroke. The first patient, a 59-year-old man with a history of left parietal embolic stroke with very mild sequelae of anomia, developed Wernicke's aphasia, nonfluent speech, and right limb ataxia as a result of the stroke. The second patient, a 76-year-old woman with a history of chronic renal failure, experienced transcortical sensory aphasia and right one-and-a-half syndrome as a result of the stroke. Both patients' recent ischemic lesions were limited to the right cerebellar hemisphere and the right medial portion of the midbrain. However, SPECT showed low-uptake lesions in both patients' left cerebral hemisphere that did not include the recent ischemic lesions but that had spread to an extent that was difficult to be explained by the old or recent ischemic lesions and that might be responsible for their recent aphasia. We believe that the aphasia experienced by these two patients may have been caused by crossed cerebello-cerebral diaschisis.
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11
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Lim N, Lee G, Won KH, Kang JS, Lee S, Cho Y, Lee HK, Kang E. Usefulness of Diffusion Tensor Imaging in Unexplained Ipsilateral Hemiplegia. Korean J Neurotrauma 2021; 17:61-66. [PMID: 33981645 PMCID: PMC8093020 DOI: 10.13004/kjnt.2021.17.e4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/04/2020] [Accepted: 11/18/2020] [Indexed: 12/03/2022] Open
Abstract
Ipsilateral hemiparesis is a rare and challenging sign in clinical neurological practice. Although the etiology of this manifestation is poorly understood, recent studies have attempted to probe the pathomechanism of this sign with advanced radiological techniques. Additional knowledge about the lesion and unraveling the pathomechanisms causing neurological impairments are important to predict the prognosis and clinical course and to aid in rehabilitation. Therefore, we present a case of a patient with a traumatic subdural hematoma on the left hemisphere and left spastic hemiparesis. Using diffusion tensor imaging (DTI), we concluded that the right corticospinal tract injury caused by compression of the cerebral peduncle accounted for the ipsilateral hemiparesis, also known as Kernohan's notch phenomenon. Thus, this case report highlights the usefulness of the newer radiological techniques, such as DTI, to identify the pathomechanisms of neurological presentations.
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Affiliation(s)
- Nana Lim
- Department of Rehabilitation Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Geunsu Lee
- Department of Rehabilitation Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Ki Hong Won
- Department of Rehabilitation Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Jin Sun Kang
- Department of Rehabilitation Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Sunghoon Lee
- Department of Rehabilitation Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Younkyung Cho
- Department of Rehabilitation Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Hyun Kyung Lee
- Department of Rehabilitation Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Eunyoung Kang
- Department of Rehabilitation Medicine, Kwangju Christian Hospital, Gwangju, Korea
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12
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Yuan X, Yang Y, Cao N, Jiang C. Promotion of Poststroke Motor-Function Recovery with Repetitive Transcranial Magnetic Stimulation by Regulating the Interhemispheric Imbalance. Brain Sci 2020; 10:brainsci10090648. [PMID: 32961836 PMCID: PMC7563987 DOI: 10.3390/brainsci10090648] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/25/2020] [Accepted: 09/10/2020] [Indexed: 02/06/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain-stimulation technique that transiently modulates cerebral cortex excitability, achieving overall positive results in poststroke motor-function recovery. Excessive inhibition of the ipsilesional-affected hemisphere by the contralesional-unaffected hemisphere has seriously hindered poststroke motor-function recovery. Hence, intracortical disinhibition can be used as an approach to managing poststroke brain injury. This technique promotes neural plasticity for faster motor-function recovery. rTMS relieves unilateral inhibition of the brain function by regulatinga interhemispheric-imbalanced inhibition. This paper summarized 12 studies from 2016 to date, focusing on rTMS on motor function after acute and chronic stroke by regulating the interhemispheric imbalance of inhibitory inputs. Although rTMS studies have shown promising outcomes on recovery of motor functions in stroke patients, different intervention methods may lead to discrepancies in results. A uniform optimal stimulus model cannot routinely be used, mainly due to the stimulus schemes, stroke types and outcome-measuring differences among studies. Thus, the effect of rTMS on poststroke motor-function recovery should be investigated further to standardize the rTMS program for optimal poststroke motor-function recovery. More randomized, placebo-controlled clinical trials with standardized rTMS protocols are needed to ensure the effectiveness of the treatment.
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Affiliation(s)
- Xiaoxia Yuan
- Beijing Key Laboratory of Physical Fitness Evaluation and Technical Analysis, Capital University of Physical Education and Sports, Beijing 100089, China;
- The Center of Neuroscience and Sports, Capital University of Physical Education and Sports, Beijing 100089, China
| | - Yuan Yang
- College of Physical Education and Sports, Beijing Normal University, Beijing 100875, China;
| | - Na Cao
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo 153-8902, Japan;
| | - Changhao Jiang
- Beijing Key Laboratory of Physical Fitness Evaluation and Technical Analysis, Capital University of Physical Education and Sports, Beijing 100089, China;
- The Center of Neuroscience and Sports, Capital University of Physical Education and Sports, Beijing 100089, China
- Correspondence: ; Tel.: +86-010-82-099-197
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Zhou LW, Chew J, Field TS. Teaching NeuroImages: Stroke With Nondecussating Corticospinal Tracts Causing Ipsilateral Weakness: Straight Forward. Neurology 2020; 96:e480-e481. [PMID: 32907963 DOI: 10.1212/wnl.0000000000010804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Lily W Zhou
- From the Department of Neurology (L.W.Z., T.S.F.), University of British Columbia; and Department of Radiology (J.C.), University of British Columbia, Vancouver, Canada
| | - Jason Chew
- From the Department of Neurology (L.W.Z., T.S.F.), University of British Columbia; and Department of Radiology (J.C.), University of British Columbia, Vancouver, Canada
| | - Thalia S Field
- From the Department of Neurology (L.W.Z., T.S.F.), University of British Columbia; and Department of Radiology (J.C.), University of British Columbia, Vancouver, Canada.
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Reddy YM, Parida S, Murthy JMK. Teaching NeuroImages: All Hemiparesis Are Not Contralateral. Neurology 2020; 96:e478-e479. [PMID: 32887785 DOI: 10.1212/wnl.0000000000010755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Y Muralidhar Reddy
- From the Department of Neurology, Care Hospital, Hyderabad, Telangana, India.
| | - Subhendu Parida
- From the Department of Neurology, Care Hospital, Hyderabad, Telangana, India
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Tan ZR, Zhang C, Tian FF. Spectrum of clinical features and neuroimaging findings in acute cerebral infarction patients with unusual ipsilateral motor impairment- a series of 22 cases. BMC Neurol 2019; 19:279. [PMID: 31718589 PMCID: PMC6849325 DOI: 10.1186/s12883-019-1516-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/28/2019] [Indexed: 01/15/2023] Open
Abstract
Background Cerebral infarction occurs when the arteries to brain are obstructed, and motor impairment contralateral to responsible lesion is commonly recognized. Few studies have profiled the characteristics of cases with ipsilateral motor impairment. We sought to characterize clinical features of patients with motor dysfunction caused by ipsilateral ischemic stroke. Methods We retrieved and analyzed the medical data for patients with ipsilateral cerebral infarction. Patients were regarded as having ipsilateral cerebral infarction if motor impairment is ipsilateral to recent stroke lesions. Results Only 22 patients with unusual ipsilateral cerebral infarction were included in this study. Ipsilateral limb paralysis was observed in all cases, and one case showed central facioplegia. Majority of patients with limb paralysis (90.9%, 20/22) presented with mild muscle strength deficits (MRC grading of 4 or more). Most of the patients (72.7%, 16/22) had a past history of stroke, and previous strokes were contralateral to the side of the recent stroke in 14 out of 16 patients (87.5%). No history of stroke or cerebral injury was identified in seven patients. With aspect of MRI findings, recent infarct lesions of all cases were located along the corticospinal tract. Conclusions History of stroke plays an important role in the pathogenesis of ipsilateral motor impairment, and cortical reorganization in the unaffected hemisphere may contribute to the compensation of motor function after stroke. Besides that, some cases with first stroke may be due to impairment of ipsilateral uncrossed corticospinal fibers.
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Affiliation(s)
- Zhe-Ren Tan
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - Chen Zhang
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - Fa-Fa Tian
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China.
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Patra DP, Narayan V, Savardekar A, Dossani RH, Cajavilca C, Javalkar V, Gonzalez-Toledo E, Cuellar HH. Acute Supratentorial Ischemic Stroke with Ipsilateral Hemiparesis: Pathomechanism and Management Challenges. World Neurosurg 2018; 119:1-5. [PMID: 30071337 DOI: 10.1016/j.wneu.2018.07.172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Supratentorial stroke manifesting as ipsilateral hemiparesis is rare. Multiple pathophysiologic mechanisms are possible for this unusual phenomenon and has been previously described. Its implication in therapeutic decision making in a patient with an acute emergent condition has never been discussed. We describe our experience with a patient with this unusual presentation. CASE DESCRIPTION A 44-year-old woman presented with acute-onset right hemiparesis and left facial weakness. Evaluation with computed tomography angiography showed right M3 segment occlusion. Her National Institutes of Health Stroke Scale score on arrival was 9. Urgent magnetic resonance imaging was performed, which showed ongoing ischemia in the right frontotemporal cortex. She underwent endovascular thrombectomy, and complete revascularization was achieved. Postoperatively, the patient experience complete neurologic recovery. Further diffusion tractography imaging showed near-complete nondecussation of corticospinal fibers. CONCLUSIONS Discordance between clinical and initial computed tomography angiography findings in a patient with acute ischemic stroke poses a management challenge. Additional imaging to correlate clinical findings in equivocal cases may help in decision making but may significantly delay intervention, and therefore its utility during the short therapeutic window period needs careful consideration. Considering the risks and benefits, timely intervention should be balanced judiciously against appropriate intervention to achieve a positive patient outcome.
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Affiliation(s)
- Devi Prasad Patra
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Vinayak Narayan
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Amey Savardekar
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Rimal Hanif Dossani
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Christian Cajavilca
- Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Vijaykumar Javalkar
- Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Eduardo Gonzalez-Toledo
- Department of Radiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Hugo H Cuellar
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA; Department of Radiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
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