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Pan R, Ye C, Zhang Z, Kwapong WR, Wang R, Lu K, Liao L, Yan Y, Yang T, Cao L, Jiang S, Zhang X, Liu J, Tao W, Wu B. Distinct alterations of retinal structure between thalamic and extra-thalamic subcortical infarction patients: A cross-sectional and longitudinal study. CNS Neurosci Ther 2024; 30:e14543. [PMID: 38018655 PMCID: PMC11017429 DOI: 10.1111/cns.14543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/25/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023] Open
Abstract
AIMS Cerebrovascular lesions in the primary visual cortex, the lateral geniculate nucleus, and the optic tract have been associated with retinal neurodegeneration via the retrograde degeneration (RD) mechanism. We aimed to use optical coherence tomography (OCT) to assess the effects of the strategic single subcortical infarction (SSI) location on retinal neurodegeneration and its longitudinal impacts. METHODS Patients with SSI were enrolled and stratified by lesion location on cerebral MRI into the thalamic infarction group and extra-thalamic infarction group. Healthy controls from the native communities were also recruited. Retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) were quantified using OCT. Generalized estimating equation (GEE) models were used for cross-sectional analyses and linear mixed models for longitudinal analyses. P < 0.05 was considered statistically significant. RESULTS We included a total of 283 eyes from 149 SSI patients. Of these, 115 eyes of 60 patients with follow-up were included in the longitudinal analyses. Cross-sectionally, thalamic-infarction patients had reduced retinal thickness compared with extra-thalamic infarction patients after adjustment for age, gender, disease duration, and vascular risk factors (p = 0.026 for RNFL, and p = 0.026 for GCIPL). Longitudinally, SSI patients showed greater retinal thinning compared with healthy controls over time (p = 0.040 for RNFL, and p < 0.001 for GCIPL), and thalamic infarction patients exhibited faster rates of GCIPL thinning in comparison with extra-thalamic infarction patients (p < 0.001). CONCLUSION Our study demonstrates a distinct effect of subcortical infarction lesion site on the retina both at the early stage of disease and at the 1-year follow-up time. These results present evidence of significant associations between strategic infarction locations and retinal neurodegeneration. It may provide novel insights for further research on RD in stroke patients and ultimately facilitate individualized recovery therapeutic strategy.
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Affiliation(s)
- Ruosu Pan
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Chen Ye
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Zhimeng Zhang
- West China School of MedicineSichuan UniversityChengduChina
| | | | - Ruilin Wang
- Department of OphthalmologyWest China Hospital, Sichuan UniversityChengduChina
| | - Kun Lu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Lanhua Liao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Yuying Yan
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Tang Yang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Le Cao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Shuai Jiang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Xuening Zhang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Junfeng Liu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Wendan Tao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Bo Wu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
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Dangare MS, Sasun AR, Harjpal P. Vestibular Rehabilitation Considerations in an Uncommon Optic Neuritis: A Case Report. Cureus 2024; 16:e53423. [PMID: 38435174 PMCID: PMC10908412 DOI: 10.7759/cureus.53423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
Optic neuritis is an inflammatory condition that leads to inflammation and damage to the optic nerve, causing visual disturbances and pain. It is commonly associated with disorders such as multiple sclerosis and often manifests as sudden, unilateral loss of vision or blurred vision. This disorder can affect individuals of any age and may lead to decreased binocular vision, potentially resulting in difficulties with depth perception and visual coordination. Physiotherapy plays a crucial role in treating optic neuritis by addressing various aspects of the illness. We report the case of a 14-year-old male with diminution in both eyes, which was sudden in onset and painless in nature, with no history of falls, trauma, or diabetes. Magnetic resonance imaging reveals hyperintensity on short-tau inversion recovery (STIR) with mild contrast enhancement in the posterior aspects of the bilateral optic nerves (intracranial part), extending to the optic chiasm in optic neuritis. Physiotherapists employ a range of techniques to enhance the patient's overall well-being, including gaze stability exercises, eye-hand coordination exercises, and habituation exercises aimed at improving visual tracking and coordination. Additionally, physiotherapy can help reduce related symptoms such as muscle weakness, balance issues, and posture problems caused by impaired visual perception. Physical therapists endeavor to improve the quality of life for patients with optic neuritis by enhancing functional independence and contributing to a more effective approach to treatment. Notably, there was an improvement in visual scanning, spatial awareness, and eye movement control in this case.
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Affiliation(s)
- Mansee S Dangare
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anam R Sasun
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pallavi Harjpal
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Fahrenthold BK, Cavanaugh MR, Tamhankar M, Lam BL, Feldon SE, Johnson BA, Huxlin KR. Training in cortically-blind fields confers patient-specific benefit against retinal thinning after occipital stroke. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.19.23298260. [PMID: 38196617 PMCID: PMC10775322 DOI: 10.1101/2023.12.19.23298260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Purpose Damage to the adult primary visual cortex (V1) causes vision loss in the contralateral hemifield, initiating a process of trans-synaptic retrograde degeneration (TRD). Here, we examined retinal correlates of TRD using a new metric to account for global changes in inner retinal thickness, and asked if perceptual training in the intact or blind field impacts its progression. Methods We performed a meta-analysis of optical coherence tomography (OCT) data in 48 participants with unilateral V1 stroke and homonymous visual defects, who completed clinical trial NCT03350919. After measuring the thickness of the macular ganglion cell and inner plexiform layers (GCL-IPL), and the peripapillary retinal nerve fiber layer (RNFL), we computed individual laterality indices (LI) at baseline and after ~6 months of daily motion discrimination training in the intact- or blind-field. Increasingly positive LI denoted greater layer thinning in retinal regions affected versus unaffected by the cortical damage. Results Pre-training, the affected GCL-IPL and RNFL were thinner than their unaffected counterparts, generating LI values positively correlated with time since stroke. Participants trained in their intact-field exhibited increased LIGCL-IPL. Those trained in their blind-field had no significant change in LIGCL-IPL. LIRNFL did not change in either group. Conclusions Relative shrinkage of the affected versus unaffected macular GCL-IPL can be reliably measured at an individual level and increases with time post-V1 stroke. Relative thinning progressed during intact-field training, but appeared to be halted by training within the blind field, suggesting a potentially neuroprotective effect of this simple behavioral intervention.
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Affiliation(s)
- Berkeley K. Fahrenthold
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, NY, USA
| | - Matthew R. Cavanaugh
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, NY, USA
| | - Madhura Tamhankar
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Byron L. Lam
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Steven E. Feldon
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, NY, USA
| | - Brent A. Johnson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Krystel R. Huxlin
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, NY, USA
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Kollai S, Bereczki D, Glasz T, Hortobágyi T, Kovács T. Early histopathological changes of secondary degeneration in the spinal cord after total MCA territory stroke. Sci Rep 2023; 13:21934. [PMID: 38082027 PMCID: PMC10713562 DOI: 10.1038/s41598-023-49230-x] [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: 09/25/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
Previous research has not demonstrated secondary degeneration of the spinal cord (SpC) motoneurons after cerebral infarct. The aim of the present study is to investigate the involvement of the anterior horn cells (AHC) in the early post-stroke period using histomorphological and immunohistochemical methods. Post-mortem analysis of the 6th cervical segment was performed in 7 patients who had total MCA stroke within 1 month before death. Nissl-stained sections were used for morphometry, while CD68 and synaptophysin (SYP) immunohistochemistry to monitor microglial activation and synaptic changes in the anterior horn (AH), respectively. Contralateral to the cerebral lesion (contralesional side), cells were smaller after 3 days and larger after 1 week of stroke, especially regarding the large alpha motoneurons. CD68 density increased mainly on the contralesional Rexed's IX lamina of the SpC. SYP coverage of the large motoneurons was reduced on the contralesional side. Early microglial activation in the AH and electrophysiological signs has suggested the possibility of impairment of anterior horn cells (AHC-s). Our study supported that early microglial activation in the contralesional side of the SpC may primarily affect the area corresponding to the location of large motoneurons, and is accompanied by a transient shrinkage followed by increase in size of the large AHC-s with a reduction of their synaptic coverage. After MCA stroke, early involvement of the SpC motoneurons may be suspected by their morphological and synaptic changes and by the pattern of microglial activation.
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Affiliation(s)
- Sarolta Kollai
- Department of Neurology, Semmelweis University, Balassa U. 6, Budapest, 1083, Hungary
- Károly Schaffer Laboratory of Neuropathology, Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Dániel Bereczki
- Department of Neurology, Semmelweis University, Balassa U. 6, Budapest, 1083, Hungary
- HUN-REN-SU Neuroepidemiological Research Group, Budapest, Hungary
| | - Tibor Glasz
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - Tibor Hortobágyi
- Institute of Neuropathology, University Hospital Zurich, Zurich, Switzerland
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Department of Old Age Psychiatry, Psychology and Neuroscience, Institute of Psychiatry, King's College London, London, UK
| | - Tibor Kovács
- Department of Neurology, Semmelweis University, Balassa U. 6, Budapest, 1083, Hungary.
- Károly Schaffer Laboratory of Neuropathology, Department of Neurology, Semmelweis University, Budapest, Hungary.
- HUN-REN-SU Neuroepidemiological Research Group, Budapest, Hungary.
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Effects of visual scanning exercises in addition to task specific approach on balance and activities of daily livings in post stroke patients with eye movement disorders: a randomized controlled trial. BMC Neurol 2022; 22:312. [PMID: 36002795 PMCID: PMC9400241 DOI: 10.1186/s12883-022-02843-7] [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: 05/16/2022] [Accepted: 08/16/2022] [Indexed: 11/11/2022] Open
Abstract
Background Impaired vision is one of the commonest and most disabling consequence following stroke. Among all visual impairments, eye movement disorders are found in 70% of stroke patients which include nystagmus, strabismus, gaze palsies, disconjugate eye movements and cranial nerve palsies. They have a wide ranging impact on balance and activities of daily livings by creating difficulties in maintaining normal alignment and appropriate movement of eyes. The purpose of this study was to examine the effects of visual scanning exercises in addition to task specific approach on balance and activities of daily livings in post stroke patients with eye movement disorders. Methods This study is a randomized controlled trial and was conducted in the University of Lahore Teaching Hospital from May 2019 to October 2020. A sample of 64 patients was recruited and randomly allocated into experimental and control group. 32 patients in experimental group were treated with visual scanning exercises along with task specific approach and 32 patients in control group were treated with task specific approach alone. Pre and post assessment of balance and activities of daily livings was assessed on BERG BALANCE SCALE and BARTHEL INDEX SCALE at baseline and at 4th week. Results Intra-group analysis of BERG BALANCE SCALE in experimental group showed statistically significant result (p < 0.05) in all items except in items 4, 13 and 14 respectively. Intra-group analysis of BERG BALANCE SCALE in control group showed statistically significant result (p < 0.05) in items 3, 5, 8 and 12 respectively, whereas remaining all items showed statistically insignificant result. Intra-group analysis of BARTHEL INDEX SCALE in experimental group showed statistically significant result in all items (p < 0.05) except in items 9 and 10 respectively. Intra-group analysis of BARTHEL INDEX in control group showed statistically significant result (p < 0.05) in items 1, 3, 4 and 8 respectively whereas remaining all items showed statistically insignificant result. Inter-group analysis showed statistically significant result in total scores of BERG BALANCE SCALE (p = 0.000) and BARTHEL INEX SCALE (p = 0.033). Conclusion Visual scanning exercises along with task specific approach were found to be more effective in comparison to task specific approach alone. Trial registration Trial registration number: [IRCT20190717044237N1], trial registration date: 10/11/2019, Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02843-7.
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Ye C, Kwapong WR, Tao W, Lu K, Pan R, Wang A, Liu J, Liu M, Wu B. Alterations of optic tract and retinal structure in patients after thalamic stroke. Front Aging Neurosci 2022; 14:942438. [PMID: 35966790 PMCID: PMC9363922 DOI: 10.3389/fnagi.2022.942438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesTo investigate the association between degeneration of retinal structure and shrinkage of the optic tract in patients after thalamic stroke.Materials and methodsPatients with unilateral thalamic stroke were included. Structural magnetic resonance imaging (MRI) and optical coherence tomography (OCT) were performed to obtain parameters of optic tract shrinkage (lateral index) and retina structural thickness (retinal nerve fiber layer, RNFL; peripapillary retinal nerve fiber layer, pRNFL; ganglion cell-inner plexiform layer, GCIP), respectively. Visual acuity (VA) examination under illumination was conducted using Snellen charts and then converted to the logarithm of the minimum angle of resolution (LogMAR). We investigated the association between LI and OCT parameters and their relationships with VA.ResultsA total of 33 patients and 23 age-sex matched stroke-free healthy controls were enrolled. Patients with thalamic stroke showed altered LI compared with control participants (P = 0.011) and a significantly increased value of LI in the subgroup of disease duration more than 6 months (P = 0.004). In these patients, LI were significantly associated with pRNFL thickness (β = 0.349, 95% confidence interval [CI]: 0.134–0.564, P = 0.002) after adjusting for confounders (age, sex, hypertension, diabetes, dyslipidemia, and lesion volume). LI and pRNFL were both significantly associated with VA in all patients (LI: β = −0.275, 95% CI: −0.539 to −0.011, P = 0.041; pRNFL: β = −0.023, 95% CI: −0.046 to −0.001, P = 0.040) and in subgroup of disease duration more than 6 months (LI: β = −0.290, 95% CI: −0.469 to −0.111, P = 0.002; pRNFL: β = −0.041, 95% CI: −0.065 to −0.017, P = 0.003).ConclusionShrinkage of the optic tract can be detected in patients with thalamic stroke, especially after 6 months of stroke onset. In these patients, the extent of optic tract atrophy is associated with pRNFL thickness, and they are both related to visual acuity changes.
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Characterization of Macular Structural and Microvascular Changes in Thalamic Infarction Patients: A Swept-Source Optical Coherence Tomography-Angiography Study. Brain Sci 2022; 12:brainsci12050518. [PMID: 35624906 PMCID: PMC9139152 DOI: 10.3390/brainsci12050518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/02/2022] [Accepted: 04/17/2022] [Indexed: 02/05/2023] Open
Abstract
Background: The retina and brain share similar neuronal and microvascular features. We aimed to investigate the retinal thickness and microvasculature in patients with thalamic infarcts compared with control participants. Material and methods: Swept-source optical coherence tomography (SS-OCT) was used to image the macular thickness (retinal nerve fiber layer, RNFL; ganglion cell-inner plexiform layer, GCIP), while OCT angiography was used to image the microvasculature (superficial vascular plexus, SVP; intermediate capillary plexus, ICP; deep capillary plexus, DCP). Inbuilt software was used to measure the macular thickness (µm) and microvascular density (%). Lesion volumes were quantitively assessed based on structural magnetic resonance images. Results: A total of 35 patients with unilateral thalamic infarction and 31 age−sex-matched controls were enrolled. Compared with control participants, thalamic infarction patients showed a significantly thinner thickness of RNFL (p < 0.01) and GCIP (p = 0.02), and a lower density of SVP (p = 0.001) and ICP (p = 0.022). In the group of patients, ipsilateral eyes showed significant reductions in SVP (p = 0.033), RNFL (p = 0.01) and GCIP (p = 0.043). When divided into three groups based on disease duration (<1 month, 1−6 months, and >6 months), no significant differences were found among these groups. After adjusting for confounders, SVP, ICP, DCP, RNFL, and GCIP were significantly correlated with lesion volume in patients. Conclusions: Thalamic infarction patients showed significant macular structure and microvasculature changes. Lesion size was significantly correlated with these alterations. These findings may be useful for further research into the clinical utility of retinal imaging in stroke patients, especially those with damage to the visual pathway.
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Sims JR, Chen AM, Sun Z, Deng W, Colwell NA, Colbert MK, Zhu J, Sainulabdeen A, Faiq MA, Bang JW, Chan KC. Role of Structural, Metabolic, and Functional MRI in Monitoring Visual System Impairment and Recovery. J Magn Reson Imaging 2021; 54:1706-1729. [PMID: 33009710 PMCID: PMC8099039 DOI: 10.1002/jmri.27367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 12/13/2022] Open
Abstract
The visual system, consisting of the eyes and the visual pathways of the brain, receives and interprets light from the environment so that we can perceive the world around us. A wide variety of disorders can affect human vision, ranging from ocular to neurologic to systemic in nature. While other noninvasive imaging techniques such as optical coherence tomography and ultrasound can image particular sections of the visual system, magnetic resonance imaging (MRI) offers high resolution without depth limitations. MRI also gives superior soft-tissue contrast throughout the entire pathway compared to computed tomography. By leveraging different imaging sequences, MRI is uniquely capable of unveiling the intricate processes of ocular anatomy, tissue physiology, and neurological function in the human visual system from the microscopic to macroscopic levels. In this review we discuss how structural, metabolic, and functional MRI can be used in the clinical assessment of normal and pathologic states in the anatomic structures of the visual system, including the eyes, optic nerves, optic chiasm, optic tracts, visual brain nuclei, optic radiations, and visual cortical areas. We detail a selection of recent clinical applications of MRI at each position along the visual pathways, including the evaluation of pathology, plasticity, and the potential for restoration, as well as its limitations and key areas of ongoing exploration. Our discussion of the current and future developments in MR ocular and neuroimaging highlights its potential impact on our ability to understand visual function in new detail and to improve our protection and treatment of anatomic structures that are integral to this fundamental sensory system. LEVEL OF EVIDENCE 3: TECHNICAL EFFICACY STAGE 3: .
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Affiliation(s)
- Jeffrey R. Sims
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
| | - Anna M. Chen
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
- Sackler Institute of Graduate Biomedical Sciences, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
| | - Zhe Sun
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
- Sackler Institute of Graduate Biomedical Sciences, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
| | - Wenyu Deng
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
| | - Nicole A. Colwell
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
| | - Max K. Colbert
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
| | - Jingyuan Zhu
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Anoop Sainulabdeen
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
- Department of Surgery and Radiology, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Thrissur, India
| | - Muneeb A. Faiq
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
| | - Ji Won Bang
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
| | - Kevin C. Chan
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
- Sackler Institute of Graduate Biomedical Sciences, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
- Neuroscience Institute, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
- Center for Neural Science, College of Arts and Science, New York University, New York, New York, USA
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Mapping degeneration of the visual system in long-term follow-up after childhood hemispherectomy - A series of four cases. Epilepsy Res 2021; 178:106808. [PMID: 34801940 DOI: 10.1016/j.eplepsyres.2021.106808] [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: 06/03/2021] [Revised: 10/18/2021] [Accepted: 11/02/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Although hemidisconnection surgery may eliminate or reduce seizure activity in patients with epilepsy, there are visual, cognitive and motor deficits which affect patients' function post-operatively, with varying severity and according to pathology. Consequently, there is a need to map microstructural changes over long time periods and develop/apply methods that work with legacy data. METHODS In this study, we applied the novel single shell 3-Tissue method to data from a cohort of 4 patients who were scanned 20-years following childhood hemidisconnection surgery and presented with variable clinical outcomes. We have successfully reconstructed tractography of the whole visual pathway from single shell diffusion data with reduced number of gradient directions. RESULTS All patients presented with degeneration of the visual system characterised by low fractional anisotropy and high mean diffusivity. There were no apparent microstructural differences between both optic nerves that could explain the different level of visual function across patients. However, we provide evidence suggesting an association between the level of visual function and DTI metrics within the remaining components of the visual system, particularly the optic tract, of the contralateral hemisphere post-surgery. SIGNIFICANCE We believe this study suggests that diffusion MRI can be used to monitor the integrity of the visual system following hemispherectomy and if extended to larger cohorts and a greater number of time-points, including pre-surgically, can provide a clearer picture of the natural history of visual system degeneration. This knowledge may in turn help to identify patients at greatest risk of poor visual outcomes that might benefit from rehabilitation therapies.
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Hayakawa K, Tanda K, Nishimura A, Kinoshita D, Kizaki Z, Ohno K. Diffusion Restriction in the Optic Radiation of Term Neonates With Hypoxic-Ischemic Encephalopathy Demonstrated by Magnetic Resonance Imaging (MRI). J Child Neurol 2021; 36:950-957. [PMID: 34547931 DOI: 10.1177/08830738211015019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There has been no previous report of diffusion restriction in the optic radiation of term neonates with hypoxic-ischemic encephalopathy. Here, using diffusion-weighted magnetic resonance imaging (MRI), we assessed diffusion restriction in the optic radiation within the first 2 weeks of life and estimated signal changes and the apparent diffusion coefficient in the optic radiation and lateral geniculate body using T1-weighted MRI. MATERIALS AND METHODS Forty-five term neonates with hypoxic-ischemic encephalopathy underwent MRI twice during the first 2 weeks of life. Diffusion-weighted imaging and apparent diffusion coefficient were used to evaluate the presence of diffusion restriction in the optic radiation and lateral geniculate body. Apparent diffusion coefficient and T1 signal changes in the optic radiation and lateral geniculate body were also compared with those in 11 control neonates showing a normal pattern on MRI. RESULTS Diffusion restriction in the optic radiation was observed in 29% (13/45) of the hypoxic-ischemic encephalopathy neonates at a median age of 3.5 days (range: 1-9 days). The apparent diffusion coefficient in the optic radiation of affected neonates was significantly reduced in comparison with the controls. In all neonates with optic radiation involvement, increased T1 signal intensity was observed in the optic radiation in the second week, and was also evident in in lateral geniculate body in 8 of those neonates. CONCLUSION Diffusion restriction in the optic radiation is not rare among term neonates with hypoxic-ischemic encephalopathy, being visualized by diffusion-weighted imaging in the first week of life and also high-intensity T1 signal changes in the second week. This diffusion restriction in the optic radiation might be due to transsynaptic neuronal degeneration.
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Affiliation(s)
- Katsumi Hayakawa
- Department of Radiology, Red Cross Kyoto Daiichi Hospital, Higashiyama-ku, Kyoto, Japan
| | - Koichi Tanda
- Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan.,Department of Pediatrics, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Akira Nishimura
- Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Daisuke Kinoshita
- Department of Neonatology, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Zenro Kizaki
- Department of Pediatrics, Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Koji Ohno
- Department of Radiology, Red Cross Kyoto Daiichi Hospital, Higashiyama-ku, Kyoto, Japan
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Rashid AS, Rashid D, Yang G, Link H, Gauffin H, Huang-Link Y. Homonymous visual field defect and retinal thinning after occipital stroke. Brain Behav 2021; 11:e2345. [PMID: 34487632 PMCID: PMC8553301 DOI: 10.1002/brb3.2345] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/11/2021] [Accepted: 08/18/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Stroke is the most common cause of homonymous visual field defects (VFD). About half of the stroke patients recover from VFD. However, relationship between VFD and retinal changes remains elusive. PURPOSE To investigate the association between occurrence of VFD, changes of macular ganglion cell and inner plexiform layer (GCIPL) and its axon retinal nerve fiber layer (RNFL) detected with optical coherence tomography (OCT). PATIENTS AND METHODS The study consists of retrospective review of medical records and follow-up examinations. Patients with acute occipital stroke were registered. VFD was identified with confrontation and/or perimetry tests at the onset. At follow-up, the patients were examined with visual field tests and OCT measurements. RESULTS Thirty-six patients met the inclusion criteria. At onset, 26 patients (72%) had VFD. At follow-up >1 year after stroke, 13 patients (36%) had remaining VFD: 5 had homonymous hemianopia, 5 had homonymous quadrantanopia, and 3 had homonymous scotomas. Average thickness of GCIPL and RNFL were significantly reduced in each eye in patients with VFD compared to non-VFD (NVFD) (p < .01 for all comparisons). Thickness of superior and inferior RNFL quadrants was significantly reduced in VFD compared to NVFD (p < .01 for both). Among these 13 patients, 4 had characteristic homonymous quadrant-GCIPL thinning, 2 had characteristic homonymous hemi-GCIPL thinning, and 7 had diffuse GCIPL thinning. CONCLUSION GCIPL and RNFL thinning were observed in the patients with VFD. GCIPL thinning appears in two forms: atypical diffuse thinning, or homonymous hemi-GCIPL thinning. Examining GCIPL and RNFL provides easy and reliable objective measures and is therefore proposed to be of predictive value on visual function.
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Affiliation(s)
- Avan Sabir Rashid
- Division of Neurology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping City, Sweden
| | - Darian Rashid
- Division of Neurology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping City, Sweden
| | - Ge Yang
- Institute of Ophthalmology, University College London, London, UK
| | - Hans Link
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Helena Gauffin
- Division of Neurology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping City, Sweden
| | - Yumin Huang-Link
- Division of Neurology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping City, Sweden
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He J, Zhang F, Xie G, Yao S, Feng Y, Bastos DCA, Rathi Y, Makris N, Kikinis R, Golby AJ, O'Donnell LJ. Comparison of multiple tractography methods for reconstruction of the retinogeniculate visual pathway using diffusion MRI. Hum Brain Mapp 2021; 42:3887-3904. [PMID: 33978265 PMCID: PMC8288095 DOI: 10.1002/hbm.25472] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/24/2021] [Accepted: 04/25/2021] [Indexed: 12/31/2022] Open
Abstract
The retinogeniculate visual pathway (RGVP) conveys visual information from the retina to the lateral geniculate nucleus. The RGVP has four subdivisions, including two decussating and two nondecussating pathways that cannot be identified on conventional structural magnetic resonance imaging (MRI). Diffusion MRI tractography has the potential to trace these subdivisions and is increasingly used to study the RGVP. However, it is not yet known which fiber tracking strategy is most suitable for RGVP reconstruction. In this study, four tractography methods are compared, including constrained spherical deconvolution (CSD) based probabilistic (iFOD1) and deterministic (SD-Stream) methods, and multi-fiber (UKF-2T) and single-fiber (UKF-1T) unscented Kalman filter (UKF) methods. Experiments use diffusion MRI data from 57 subjects in the Human Connectome Project. The RGVP is identified using regions of interest created by two clinical experts. Quantitative anatomical measurements and expert anatomical judgment are used to assess the advantages and limitations of the four tractography methods. Overall, we conclude that UKF-2T and iFOD1 produce the best RGVP reconstruction results. The iFOD1 method can better quantitatively estimate the percentage of decussating fibers, while the UKF-2T method produces reconstructed RGVPs that are judged to better correspond to the known anatomy and have the highest spatial overlap across subjects. Overall, we find that it is challenging for current tractography methods to both accurately track RGVP fibers that correspond to known anatomy and produce an approximately correct percentage of decussating fibers. We suggest that future algorithm development for RGVP tractography should take consideration of both of these two points.
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Affiliation(s)
- Jianzhong He
- Institute of Information Processing and Automation, College of Information Engineering, Zhejiang University of TechnologyHangzhouChina
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Fan Zhang
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Guoqiang Xie
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Department of NeurosurgeryNuclear Industry 215 Hospital of Shaanxi ProvinceXianyangChina
| | - Shun Yao
- Department of Neurosurgery, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Center for Pituitary Tumor Surgery, Department of NeurosurgeryThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Yuanjing Feng
- Institute of Information Processing and Automation, College of Information Engineering, Zhejiang University of TechnologyHangzhouChina
| | - Dhiego C. A. Bastos
- Department of Neurosurgery, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Yogesh Rathi
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Department of Psychiatry, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Nikos Makris
- Department of Psychiatry, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Departments of Psychiatry, Neurology and Radiology, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Ron Kikinis
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Alexandra J. Golby
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Department of Neurosurgery, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Lauren J. O'Donnell
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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Fahrenthold BK, Cavanaugh MR, Jang S, Murphy AJ, Ajina S, Bridge H, Huxlin KR. Optic Tract Shrinkage Limits Visual Restoration After Occipital Stroke. Stroke 2021; 52:3642-3650. [PMID: 34266305 PMCID: PMC8545836 DOI: 10.1161/strokeaha.121.034738] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose: Damage to the adult primary visual cortex (V1) causes vision loss in the contralateral visual hemifield, initiating a process of trans-synaptic retrograde degeneration. The present study examined functional implications of this process, asking if degeneration impacted the amount of visual recovery attainable from visual restoration training in chronic patients, and if restoration training impacted optic tract (OT) shrinkage. Methods: Magnetic resonance imaging was used to measure OT volumes bilaterally in 36 patients with unilateral occipital stroke. From OT volumes, we computed laterality indices (LI), estimating the stroke-induced OT shrinkage in each case. A subset of these chronic patients (n=14, 13±6 months poststroke) underwent an average of nearly 1 year of daily visual restoration training, which repeatedly stimulated vision in their blind field. The amount of visual field recovery was quantified using Humphrey perimetry, and post training magnetic resonance imaging was used to assess the impact of training on OT shrinkage. Results: OT LI was correlated with time since stroke: it was close to 0 (no measurable OT shrinkage) in subacute participants (<6 months poststroke) while chronic participants (>6 months poststroke) exhibited LI >0, but with significant variability. Visual training did not systematically alter LI, but chronic patients with baseline LI≈0 (no OT shrinkage) exhibited greater visual field recovery than those with LI>0. Conclusions: Unilateral OT shrinkage becomes detectable with magnetic resonance imaging by ≈7 months poststroke, albeit with significant interindividual variability. Although visual restoration training did not alter the amount of degeneration already sustained, OT shrinkage appeared to serve as a biomarker of the potential for training-induced visual recovery in chronic cortically blind patients.
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Affiliation(s)
- Berkeley K. Fahrenthold
- Flaum Eye Institute (B.K.F., M.R.C., S.J., K.R.H.), University of Rochester, NY. Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom. Department of Neurorehabilitation and Therapy Services, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Matthew R. Cavanaugh
- Flaum Eye Institute (B.K.F., M.R.C., S.J., K.R.H.), University of Rochester, NY. Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom. Department of Neurorehabilitation and Therapy Services, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Subin Jang
- Flaum Eye Institute (B.K.F., M.R.C., S.J., K.R.H.), University of Rochester, NY. Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom. Department of Neurorehabilitation and Therapy Services, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Allison J. Murphy
- Neuroscience Graduate Program (A.J.M.), University of Rochester, NY. Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom. Department of Neurorehabilitation and Therapy Services, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | | | | | - Krystel R. Huxlin
- Flaum Eye Institute (B.K.F., M.R.C., S.J., K.R.H.), University of Rochester, NY. Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom. Department of Neurorehabilitation and Therapy Services, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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14
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Efficacy of Visual Retraining in the Hemianopic Field after Stroke: Results of a Randomized Clinical Trial. Ophthalmology 2020; 128:1091-1101. [PMID: 33242498 DOI: 10.1016/j.ophtha.2020.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate the efficacy of motion discrimination training as a potential therapy for stroke-induced hemianopic visual field defects. DESIGN Clinical trial. PARTICIPANTS Forty-eight patients with stroke-induced homonymous hemianopia (HH) were randomized into 2 training arms: intervention and control. Patients were between 21 and 75 years of age and showed no ocular issues at presentation. METHODS Patients were trained on a motion discrimination task previously evidenced to reduce visual field deficits, but not in a randomized clinical trial. Patients were randomized with equal allocation to receive training in either their sighted or deficit visual fields. Training was performed at home for 6 months, consisting of repeated visual discriminations at a single location for 20 to 30 minutes daily. Study staff and patients were masked to training type. Testing before and after training was identical, consisting of Humphrey visual fields (Carl Zeiss Meditech), macular integrity assessment perimetry, OCT, motion discrimination performance, and visual quality-of-life questionnaires. MAIN OUTCOME MEASURES Primary outcome measures were changes in perimetric mean deviation (PMD) on Humphrey Visual Field Analyzer in both eyes. RESULTS Mean PMDs improved over 6 months in deficit-trained patients (mean change in the right eye, 0.58 dB; 95% confidence interval, 0.07-1.08 dB; mean change in the left eye 0.84 dB; 95% confidence interval, 0.22-1.47 dB). No improvement was observed in sighted-trained patients (mean change in the right eye, 0.12 dB; 95% confidence interval, -0.38 to 0.62 dB; mean change in the left eye, 0.10 dB; 95% confidence interval, -0.52 to 0.72 dB). However, no significant differences were found between the alternative training methods (right eye, P = 0.19; left eye, P = 0.10). CONCLUSIONS To date, no widely accepted therapy is available to treat HH. This study evaluated the efficacy of a promising potential treatment, visual perceptual training. We failed to find a difference between treatment training within the deficit field and control training within the sighted field when performed in a home environment.
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15
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Lacerda LM, Clayden JD, Handley SE, Winston GP, Kaden E, Tisdall M, Cross JH, Liasis A, Clark CA. Microstructural Investigations of the Visual Pathways in Pediatric Epilepsy Neurosurgery: Insights From Multi-Shell Diffusion Magnetic Resonance Imaging. Front Neurosci 2020; 14:269. [PMID: 32322185 PMCID: PMC7158873 DOI: 10.3389/fnins.2020.00269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/10/2020] [Indexed: 01/12/2023] Open
Abstract
Background Surgery is a key approach for achieving seizure freedom in children with focal onset epilepsy. However, the resection can affect or be in the vicinity of the optic radiations. Multi-shell diffusion MRI and tractography can better characterize tissue structure and provide guidance to help minimize surgical related deficits. Whilst in adults tractography has been used to demonstrate that damage to the optic radiations leads to postoperative visual field deficits, this approach has yet to be properly explored in children. Objective To demonstrate the capabilities of multi-shell diffusion MRI and tractography in characterizing microstructural changes in children with epilepsy pre- and post-surgery affecting the occipital, parietal or temporal lobes. Methods Diffusion Tensor Imaging and the Spherical Mean Technique were used to investigate the microstructure of the optic radiations. Furthermore, tractography was used to evaluate whether pre-surgical reconstructions of the optic radiations overlap with the resection margin as measured using anatomical post-surgical T1-weighted MRI. Results Increased diffusivity in patients compared to controls at baseline was observed with evidence of decreased diffusivity, anisotropy, and neurite orientation distribution in contralateral hemisphere after surgery. Pre-surgical optic radiation tractography overlapped with post-surgical resection margins in 20/43 (46%) children, and where visual data was available before and after surgery, the presence of overlap indicated a visual field deficit. Conclusion This is the first report in a pediatric series which highlights the relevance of tractography for future pre-surgical evaluation in children undergoing epilepsy surgery and the usefulness of multi-shell diffusion MRI to characterize brain microstructure in these patients.
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Affiliation(s)
- Luís M Lacerda
- Developmental Imaging and Biophysics Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jonathan D Clayden
- Developmental Imaging and Biophysics Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Sian E Handley
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom.,Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Enrico Kaden
- Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Martin Tisdall
- Department of Neurosurgery, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - J Helen Cross
- Clinical Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Alki Liasis
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Children's Hospital of Pittsburgh, University of Pittsburgh Medical Centre, Pittsburgh, PA, United States
| | - Chris A Clark
- Developmental Imaging and Biophysics Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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Kinoshita F, Kinoshita T, Toyoshima H, Shinohara Y. Ipsilateral atrophy of the mammillary body and fornix after thalamic stroke: evaluation by MRI. Acta Radiol 2019; 60:1512-1522. [PMID: 30909707 DOI: 10.1177/0284185119839166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Fumiko Kinoshita
- Research Institute for Brain and Blood Vessels-Akita, Akita, Japan
| | | | - Hideto Toyoshima
- Research Institute for Brain and Blood Vessels-Akita, Akita, Japan
| | - Yuki Shinohara
- Research Institute for Brain and Blood Vessels-Akita, Akita, Japan
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17
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Buisset A, Leruez S. Hémianopsie latérale homonyme post-traumatique et atteinte des cellules ganglionnaires : à propos de 3 cas. J Fr Ophtalmol 2018; 41:910-915. [DOI: 10.1016/j.jfo.2018.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 05/21/2018] [Accepted: 06/18/2018] [Indexed: 11/30/2022]
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18
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Pula JH, Yuen CA. Eyes and stroke: the visual aspects of cerebrovascular disease. Stroke Vasc Neurol 2017; 2:210-220. [PMID: 29507782 PMCID: PMC5829892 DOI: 10.1136/svn-2017-000079] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 05/30/2017] [Accepted: 06/02/2017] [Indexed: 01/05/2023] Open
Abstract
A large portion of the central nervous system is dedicated to vision and therefore strokes have a high likelihood of involving vision in some way. Vision loss can be the most disabling residual effect after a cerebral infarction. Transient vision problems can likewise be a harbinger of stroke and prompt evaluation after recognition of visual symptoms can prevent future vascular injury. In this review, we discuss the visual aspects of stroke. First, anatomy and the vascular supply of the visual system are considered. Then, the different stroke syndromes which involve vision are discussed. Finally, topics involving the assessment, prognosis, treatment and therapeutic intervention of vision-specific stroke topics are reviewed.
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Affiliation(s)
- John H Pula
- Department of Neurology, NorthShore University HealthSystem, Chicago, Illinois, USA
| | - Carlen A Yuen
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
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Cavanaugh MR, Huxlin KR. Visual discrimination training improves Humphrey perimetry in chronic cortically induced blindness. Neurology 2017; 88:1856-1864. [PMID: 28404802 PMCID: PMC5419988 DOI: 10.1212/wnl.0000000000003921] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/01/2017] [Indexed: 11/25/2022] Open
Abstract
Objective: To assess if visual discrimination training improves performance on visual perimetry tests in chronic stroke patients with visual cortex involvement. Methods: 24-2 and 10-2 Humphrey visual fields were analyzed for 17 chronic cortically blind stroke patients prior to and following visual discrimination training, as well as in 5 untrained, cortically blind controls. Trained patients practiced direction discrimination, orientation discrimination, or both, at nonoverlapping, blind field locations. All pretraining and posttraining discrimination performance and Humphrey fields were collected with online eye tracking, ensuring gaze-contingent stimulus presentation. Results: Trained patients recovered ∼108 degrees2 of vision on average, while untrained patients spontaneously improved over an area of ∼16 degrees2. Improvement was not affected by patient age, time since lesion, size of initial deficit, or training type, but was proportional to the amount of training performed. Untrained patients counterbalanced their improvements with worsening of sensitivity over ∼9 degrees2 of their visual field. Worsening was minimal in trained patients. Finally, although discrimination performance improved at all trained locations, changes in Humphrey sensitivity occurred both within trained regions and beyond, extending over a larger area along the blind field border. Conclusions: In adults with chronic cortical visual impairment, the blind field border appears to have enhanced plastic potential, which can be recruited by gaze-controlled visual discrimination training to expand the visible field. Our findings underscore a critical need for future studies to measure the effects of vision restoration approaches on perimetry in larger cohorts of patients.
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Dinkin M. Trans-synaptic Retrograde Degeneration in the Human Visual System: Slow, Silent, and Real. Curr Neurol Neurosci Rep 2017; 17:16. [DOI: 10.1007/s11910-017-0725-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Handley SE, Panteli VS, Liasis A. Trans-synaptic Retrograde Degeneration Following Hemispherectomy in Childhood. Neuroophthalmology 2017; 41:103-107. [PMID: 28348634 DOI: 10.1080/01658107.2016.1276935] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022] Open
Abstract
Trans-synaptic retrograde degeneration (TRD) in the human visual system has been established. However there are few studies demonstrating macular thinning of the Retinal Ganglion cell Layer and/or Inner Plexiform layer (RGCL-IPL), corresponding to an acquired homonymous hemianopia. We report a 17 year old with a homonymous hemianopia, secondary to a hemispherectomy for intractable epilepsy. Three years following hemispherectomy, Optical Coherence Tomography (OCT) revealed evidence of TRD, corresponding to his complete homonymous hemianopia. Macular maps of the RGCL-IPL thickness provides useful additional information to measurements of optic nerve Retinal Nerve Fibre Layer Thickness (RNFL) in identifying TRD in acquired homonymous hemianopia.
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Affiliation(s)
- Sian E Handley
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children , London, United Kingdom
| | - Vasiliki S Panteli
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children , London, United Kingdom
| | - Alki Liasis
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children , London, United Kingdom
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22
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Patel KR, Ramsey LE, Metcalf NV, Shulman GL, Corbetta M. Early diffusion evidence of retrograde transsynaptic degeneration in the human visual system. Neurology 2016; 87:198-205. [PMID: 27306632 DOI: 10.1212/wnl.0000000000002841] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 04/01/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We investigated whether diffusion tensor imaging (DTI) indices of white matter integrity would offer early markers of retrograde transsynaptic degeneration (RTD) in the visual system after stroke. METHODS We performed a prospective longitudinal analysis of the sensitivity of DTI markers of optic tract health in 12 patients with postsynaptic visual pathway stroke, 12 stroke controls, and 28 healthy controls. We examined group differences in (1) optic tract fractional anisotropy (FA-asymmetry), (2) perimetric measures of visual impairment, and (3) the relationship between FA-asymmetry and perimetric assessment. RESULTS FA-asymmetry was higher in patients with visual pathway lesions than in control groups. These differences were evident 3 months from the time of injury and did not change significantly at 12 months. Perimetric measures showed evidence of impairment in participants with visual pathway stroke but not in control groups. A significant association was observed between FA-asymmetry and perimetric measures at 3 months, which persisted at 12 months. CONCLUSIONS DTI markers of RTD are apparent 3 months from the time of injury. This represents the earliest noninvasive evidence of RTD in any species. Furthermore, these measures associate with measures of visual impairment. DTI measures offer a reproducible, noninvasive, and sensitive method of investigating RTD and its role in visual impairment.
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Affiliation(s)
- Kevin R Patel
- From the Athinoula A. Martinos Center for Biomedical Imaging (K.R.P.), Massachusetts General Hospital, Boston; Departments of Neurology (L.E.R., N.V.M., G.L.S., M.C.), Radiology (M.C.), and Anatomy and Neurobiology (M.C.), Washington University in St. Louis School of Medicine, MO; and Department of Neuroscience (M.C.), University of Padua, Italy.
| | - Lenny E Ramsey
- From the Athinoula A. Martinos Center for Biomedical Imaging (K.R.P.), Massachusetts General Hospital, Boston; Departments of Neurology (L.E.R., N.V.M., G.L.S., M.C.), Radiology (M.C.), and Anatomy and Neurobiology (M.C.), Washington University in St. Louis School of Medicine, MO; and Department of Neuroscience (M.C.), University of Padua, Italy
| | - Nicholas V Metcalf
- From the Athinoula A. Martinos Center for Biomedical Imaging (K.R.P.), Massachusetts General Hospital, Boston; Departments of Neurology (L.E.R., N.V.M., G.L.S., M.C.), Radiology (M.C.), and Anatomy and Neurobiology (M.C.), Washington University in St. Louis School of Medicine, MO; and Department of Neuroscience (M.C.), University of Padua, Italy
| | - Gordon L Shulman
- From the Athinoula A. Martinos Center for Biomedical Imaging (K.R.P.), Massachusetts General Hospital, Boston; Departments of Neurology (L.E.R., N.V.M., G.L.S., M.C.), Radiology (M.C.), and Anatomy and Neurobiology (M.C.), Washington University in St. Louis School of Medicine, MO; and Department of Neuroscience (M.C.), University of Padua, Italy
| | - Maurizio Corbetta
- From the Athinoula A. Martinos Center for Biomedical Imaging (K.R.P.), Massachusetts General Hospital, Boston; Departments of Neurology (L.E.R., N.V.M., G.L.S., M.C.), Radiology (M.C.), and Anatomy and Neurobiology (M.C.), Washington University in St. Louis School of Medicine, MO; and Department of Neuroscience (M.C.), University of Padua, Italy
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Retinal Ganglion Cell Atrophy in Homonymous Hemianopia due to Acquired Occipital Lesions Observed Using Cirrus High-Definition-OCT. J Ophthalmol 2016; 2016:2394957. [PMID: 27274865 PMCID: PMC4870342 DOI: 10.1155/2016/2394957] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 03/31/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose. To report a reduction in macular ganglion cell layer and inner plexiform layer (GCL+IPL) thickness and circumpapillary retinal nerve fiber layer (cpRNFL) thickness using spectral-domain optical coherence tomography in patients with homonymous hemianopia due to posterior cerebral artery (PCA) stroke. Methods. Seven patients with PCA stroke were examined using Cirrus high-definition-OCT. The GCL+IPL thicknesses were divided into the hemianopic and unaffected sides. The relationship between the time after stroke and the GCL+IPL thicknesses in the hemianopic side was evaluated. Results. The average thicknesses of the GCL+IPL were 64.6 and 82.0 μm on the hemianopic and unaffected sides, respectively, and the measurement was significantly thinner on the former side (p = 0.018). A regression analysis revealed a negative linear relationship (R2 = 0.574, p = 0.049) between the time after stoke and the GCL+IPL thicknesses on the hemianopic side. The supratemporal and inferotemporal cpRNFL thicknesses in the eyes ipsilateral to the stroke showed a significant reduction. Conclusion. Our findings confirmed our previous observations that the degeneration of retinal ganglion cells can occur after PCA stroke. GCL+IPL thinning was demonstrated in the hemiretinae corresponding to the affected hemifields. Also, it is suggested that the retinal changes observed are progressive.
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Abstract
The incidence of cortically induced blindness is increasing as our population ages. The major cause of cortically induced blindness is stroke affecting the primary visual cortex. While the impact of this form of vision loss is devastating to quality of life, the development of principled, effective rehabilitation strategies for this condition lags far behind those used to treat motor stroke victims. Here we summarize recent developments in the still emerging field of visual restitution therapy, and compare the relative effectiveness of different approaches. We also draw insights into the properties of recovered vision, its limitations and likely neural substrates. We hope that these insights will guide future research and bring us closer to the goal of providing much-needed rehabilitation solutions for this patient population.
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Affiliation(s)
- Michael D Melnick
- Department of Brain & Cognitive Sciences, University of Rochester, Rochester, NY, USA
| | - Duje Tadin
- Department of Brain & Cognitive Sciences, University of Rochester, Rochester, NY, USA The Flaum Eye Institute, University of Rochester, Rochester, NY, USA The Center for Visual Science, University of Rochester, Rochester, NY, USA
| | - Krystel R Huxlin
- Department of Brain & Cognitive Sciences, University of Rochester, Rochester, NY, USA The Flaum Eye Institute, University of Rochester, Rochester, NY, USA The Center for Visual Science, University of Rochester, Rochester, NY, USA
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Huang-Link YM, Al-Hawasi A, Eveman I. Retrograde degeneration of visual pathway: hemimacular thinning of retinal ganglion cell layer in progressive and active multiple sclerosis. J Neurol 2014; 261:2453-6. [PMID: 25311572 DOI: 10.1007/s00415-014-7538-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 09/24/2014] [Accepted: 09/29/2014] [Indexed: 11/24/2022]
Affiliation(s)
- Yu-Min Huang-Link
- Department of Neurology, Institute of Clinical and Experimental Medicine, Linköping University Hospital, 581 85, Linköping, Sweden,
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