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Nyquist P. Editorial for "Diaschisis Profiles in the Cerebellar Response to Hemodynamic Stimuli: Insights From Dynamic Measurement of Cerebrovascular Reactivity to Identify Occult and Transient Maxima". J Magn Reson Imaging 2023; 58:1470-1471. [PMID: 36786660 DOI: 10.1002/jmri.28646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/15/2023] Open
Affiliation(s)
- Paul Nyquist
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Anesthesia/Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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2
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Guder S, Sadeghi F, Zittel S, Quandt F, Choe C, Bönstrup M, Cheng B, Thomalla G, Gerloff C, Schulz R. Disability and persistent motor deficits are linked to structural crossed cerebellar diaschisis in chronic stroke. Hum Brain Mapp 2023; 44:5336-5345. [PMID: 37471691 PMCID: PMC10543354 DOI: 10.1002/hbm.26434] [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: 04/23/2023] [Revised: 06/15/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023] Open
Abstract
Brain imaging has significantly contributed to our understanding of the cerebellum being involved in recovery after non-cerebellar stroke. Due to its connections with supratentorial brain networks, acute stroke can alter the function and structure of the contralesional cerebellum, known as crossed cerebellar diaschisis (CCD). Data on the spatially precise distribution of structural CCD and their implications for persistent deficits after stroke are notably limited. In this cross-sectional study, structural MRI and clinical data were analyzed from 32 chronic stroke patients, at least 6 months after the event. We quantified lobule-specific contralesional atrophy, as a surrogate of structural CCD, in patients and healthy controls. Volumetric data were integrated with clinical scores of disability and motor deficits. Diaschisis-outcome models were adjusted for the covariables age, lesion volume, and damage to the corticospinal tract. We found that structural CCD was evident for the whole cerebellum, and particularly for lobules V and VI. Lobule VI diaschisis was significantly correlated with clinical scores, that is, volume reductions in contralesional lobule VI were associated with higher levels of disability and motor deficits. Lobule V and the whole cerebellum did not show similar diaschisis-outcome relationships across the spectrum of the clinical scores. These results provide novel insights into stroke-related cerebellar plasticity and might thereby promote lobule VI as a key area prone to structural CCD and potentially involved in recovery and residual motor functioning.
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Affiliation(s)
- Stephanie Guder
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Fatemeh Sadeghi
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Simone Zittel
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Fanny Quandt
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Chi‐un Choe
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Marlene Bönstrup
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Department of NeurologyUniversity Medical Center LeipzigLeipzigGermany
| | - Bastian Cheng
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Götz Thomalla
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Christian Gerloff
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Robert Schulz
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
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3
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Abderrakib A, Ligot N, Torcida N, Sadeghi Meibodi N, Naeije G. Crossed Cerebellar Diaschisis Worsens the Clinical Presentation in Acute Large Vessel Occlusion. Cerebrovasc Dis 2023; 52:552-559. [PMID: 36716718 DOI: 10.1159/000528676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/02/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Initial NIHSS in anterior large vessel occlusion (LVO) correlates partially with the hypoperfusion volume. We aimed at assessing the contribution of crossed cerebellar diaschisis (CCD) from the hypoperfused territory on LVO initial clinical deficit. METHODS CCD was retrospectively identified by brain CT perfusion imaging (CTP) in patients with anterior LVO treated by mechanical thrombectomy from January 2017 to July 2021. CCD was defined by CTP parameter alteration in the contralateral cerebellar hemisphere to the LVO. NIHSS, clinical/perfusion variables, and CCD were included in regression models to assess their interrelationships. RESULTS 206 patients were included. CCD was present in 90 patients (69%). NIHSS scores were higher on admission and at stroke discharge among patients with CCD (17.90 ± 6.1 vs. 11.4 ± 8.4, p < 0.001; 9.6 ± 7.7 vs. 6.6 ± 7.9, p = 0.049; respectively). Patients with a CCD had higher stroke volumes (118.2 ± 60.3 vs. 69.3 ± 59.7, p < 0.001) and lower rate of known atrial fibrillation (22% vs. 41%, p = 0.021). On multivariable logistic regression, CCD independently worsened the initial NIHSS (OR 4.85 [2.37-7.33]; p < 0.001). CONCLUSION CCD is found in 69% of LVO on admission CTP, correlates with stroke volumes, and independently worsens initial NIHSS.
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Affiliation(s)
- Anissa Abderrakib
- Neurology Department, Université Libre de Bruxelles - Cliniques Universitaires de Bruxelles - Hôpital Erasme, Bruxelles, Belgium
| | - Noémie Ligot
- Neurology Department, Université Libre de Bruxelles - Cliniques Universitaires de Bruxelles - Hôpital Erasme, Bruxelles, Belgium
| | - Nathan Torcida
- Neurology Department, Université Libre de Bruxelles - Cliniques Universitaires de Bruxelles - Hôpital Erasme, Bruxelles, Belgium
| | - Niloufar Sadeghi Meibodi
- Radiology Department, Université Libre de Bruxelles - Cliniques Universitaires de Bruxelles - Hôpital Erasme, Bruxelles, Belgium
| | - Gilles Naeije
- Neurology Department, Université Libre de Bruxelles - Cliniques Universitaires de Bruxelles - Hôpital Erasme, Bruxelles, Belgium
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4
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A subtle connection between crossed cerebellar diaschisis and supratentorial collateral circulation in subacute and chronic ischemic stroke. J Stroke Cerebrovasc Dis 2022; 31:106856. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/02/2022] [Accepted: 10/20/2022] [Indexed: 11/21/2022] Open
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5
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Chen W, He S, Song H, Sun H, Wang F, Tan Z, Yu Y. Quantitative Ischemic Characteristics and Prognostic Analysis of Crossed Cerebellar Diaschisis in Hyperacute Ischemic Stroke. J Stroke Cerebrovasc Dis 2022; 31:106344. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/24/2022] Open
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6
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Provost K, La Joie R, Strom A, Iaccarino L, Edwards L, Mellinger TJ, Pham J, Baker SL, Miller BL, Jagust WJ, Rabinovici GD. Crossed cerebellar diaschisis on 18F-FDG PET: Frequency across neurodegenerative syndromes and association with 11C-PIB and 18F-Flortaucipir. J Cereb Blood Flow Metab 2021; 41:2329-2343. [PMID: 33691512 PMCID: PMC8393295 DOI: 10.1177/0271678x211001216] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/08/2021] [Accepted: 02/15/2021] [Indexed: 11/16/2022]
Abstract
We used 18F-FDG-PET to investigate the frequency of crossed cerebellar diaschisis (CCD) in 197 patients with various syndromes associated with neurodegenerative diseases. In a subset of 117 patients, we studied relationships between CCD and cortical asymmetry of Alzheimer's pathology (β-amyloid (11C-PIB) and tau (18F-Flortaucipir)). PET images were processed using MRIs to derive parametric SUVR images and define regions of interest. Indices of asymmetry were calculated in the cerebral cortex, basal ganglia and cerebellar cortex. Across all patients, cerebellar 18F-FDG asymmetry was associated with reverse asymmetry of 18F-FDG in the cerebral cortex (especially frontal and parietal areas) and basal ganglia. Based on our operational definition (cerebellar asymmetry >3% with contralateral supratentorial hypometabolism), significant CCD was present in 47/197 (24%) patients and was most frequent in corticobasal syndrome and semantic and logopenic variants of primary progressive aphasia. In β-amyloid-positive patients, mediation analyses showed that 18F-Flortaucipir cortical asymmetry was associated with cerebellar 18F-FDG asymmetry, but that cortical 18F-FDG asymmetry mediated this relationship. Analysis of 18F-FDG-SUVR values suggested that CCD might also occur in the absence of frank cerebellar 18F-FDG asymmetry due to symmetrical supratentorial degeneration resulting in a bilateral diaschisis process.
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Affiliation(s)
- Karine Provost
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Amelia Strom
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Leonardo Iaccarino
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Lauren Edwards
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Taylor J Mellinger
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Julie Pham
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | | | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - William J Jagust
- Lawrence Berkeley National Laboratory, Berkeley, USA
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, USA
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
- Lawrence Berkeley National Laboratory, Berkeley, USA
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, USA
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
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7
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Guder S, Frey BM, Backhaus W, Braass H, Timmermann JE, Gerloff C, Schulz R. The Influence of Cortico-Cerebellar Structural Connectivity on Cortical Excitability in Chronic Stroke. Cereb Cortex 2021; 30:1330-1344. [PMID: 31647536 DOI: 10.1093/cercor/bhz169] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/17/2019] [Accepted: 06/22/2019] [Indexed: 12/11/2022] Open
Abstract
Brain imaging has recently evidenced that the structural state of distinct reciprocal cortico-cerebellar fiber tracts, the dentato-thalamo-cortical tract (DTCT), and the cortico-ponto-cerebellar tract (CPCeT), significantly influences residual motor output in chronic stroke patients, independent from the level of damage to the corticospinal tract (CST). Whether such structural information might also directly relate to measures of cortical excitability is an open question. Eighteen chronic stroke patients with supratentorial ischemic lesions and 17 healthy controls underwent transcranial magnetic stimulation to assess recruitment curves of motor evoked potentials of both hemispheres. Diffusion-weighted imaging and probabilistic tractography were applied to reconstruct reciprocal cortico-cerebellar motor tracts between the primary motor cortex and the cerebellum. Tract-related microstructure was estimated by means of fractional anisotropy, and linear regression modeling was used to relate it to cortical excitability. The main finding was a significant association between cortical excitability and the structural integrity of the DTCT, the main cerebellar outflow tract, independent from the level of damage to the CST. A comparable relationship was neither detectable for the CPCeT nor for the healthy controls. This finding contributes to a mechanistic understanding of the putative supportive role of the cerebellum for residual motor output by facilitating cortical excitability after stroke.
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Affiliation(s)
- Stephanie Guder
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Benedikt M Frey
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Winifried Backhaus
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Hanna Braass
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Jan E Timmermann
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Robert Schulz
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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8
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Nyquist PA. Editorial for "Crossed Cerebellar Diaschisis in Patients With Symptomatic Unilateral Anterior Circulation Stroke Is Associated With Hemodynamic Impairment in the Ipsilateral MCA Territory". J Magn Reson Imaging 2020; 53:1198-1199. [PMID: 33128418 DOI: 10.1002/jmri.27418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Paul A Nyquist
- Department of Neurology, Anesthesia/Critical Care Medicine, Neurosurgery, and General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Baek H, Sariev A, Lee S, Dong SY, Royer S, Kim H. Deep Cerebellar Low-Intensity Focused Ultrasound Stimulation Restores Interhemispheric Balance after Ischemic Stroke in Mice. IEEE Trans Neural Syst Rehabil Eng 2020; 28:2073-2079. [PMID: 32746292 DOI: 10.1109/tnsre.2020.3002207] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Ischemic damage after stroke disrupts the complex balance of inhibitory and excitatory activity within cortical network causing brain functional asymmetry. Cerebellar deep nuclei with its extensive projections to cortical regions could be a prospective target for stimulation to restore inter-hemispheric balance and enhance neural plasticity after stroke. In our study, we repeatedly stimulated the lateral cerebellar nucleus (LCN) by low-intensity focused ultrasound (LIFU) for 3 days to enhance rehabilitation after middle cerebral artery occlusion (MCAO) in a mouse stroke model. The neural activity of the mice sensorimotor cortex was measured using epidural electrodes and analyzed with quantified electroencephalography (qEEG). Pairwise derived Brain Symmetry Index (pdBSI) and delta power were used to assess the neurorehabilitative effect of LIFU stimulation. Compared to the Stroke (non-treated) group, the LIFU group exhibited a decrease in cortical pathological delta activity, significant recovery in pdBSI and enhanced performance on the balance beam walking test. These results suggest that cerebellar LIFU stimulation could be a non-invasive method for stroke rehabilitation through the restoration of interhemispheric balance.
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10
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Uchino H, Kazumata K, Ito M, Nakayama N, Kuroda S, Houkin K. Crossed cerebellar diaschisis as an indicator of severe cerebral hyperperfusion after direct bypass for moyamoya disease. Neurosurg Rev 2020; 44:599-605. [PMID: 32076897 DOI: 10.1007/s10143-020-01265-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/21/2020] [Accepted: 02/10/2020] [Indexed: 10/25/2022]
Abstract
Cerebral hyperperfusion (HP) complicates the postoperative course of patients with moyamoya disease (MMD) after direct revascularization surgery. Crossed cerebellar diaschisis (CCD) has been considered to be rarely associated with HP after revascularization surgery. This study aimed to describe the clinical features and factors associated with CCD secondary to cerebral HP after revascularization surgery for MMD. We analyzed 150 consecutive hemispheres including 101 in adults and 49 in pediatric patients who underwent combined direct and indirect bypass for MMD. Using single-photon emission computed tomography (SPECT), serial cerebral blood flow (CBF) was measured immediately after the surgery and on postoperative days 2 and 7. Pre- and postoperative voxel-based analysis of SPECT findings was performed to compare the changes in regional CBF. Multivariate logistic regression analysis was performed to test the effect of multiple variables on CCD. Asymptomatic and symptomatic HP was observed in 41.3% (62/150) and 16.7% (25/150) of the operated hemispheres, respectively. CCD was observed in 18.4% (16/87) of these hemispheres with radiological HP. Multivariate analysis revealed that the occurrence of CCD was significantly associated with symptomatic HP (p = 0.0015). Voxel-based analysis showed that the CBF increase in the operated frontal cortex, and the CBF reduction in the contralateral cerebellar hemisphere on day 7 were significantly larger in symptomatic HP than in asymptomatic HP (median 11.3% vs 7.5%; - 6.0% vs - 1.7%, respectively). CCD secondary to postoperative HP is more common than anticipated in MMD. CCD could potentially be used as an indicator of severe postoperative HP in patients with MMD.
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Affiliation(s)
- Haruto Uchino
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Ken Kazumata
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masaki Ito
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Naoki Nakayama
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Kuroda
- Department of Neurosurgery, University of Toyama, Toyama, Japan
| | - Kiyohiro Houkin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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11
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Kim Y, Lim SH, Park GY. Crossed Cerebellar Diaschisis Has an Adverse Effect on Functional Outcome in the Subacute Rehabilitation Phase of Stroke: A Case-Control Study. Arch Phys Med Rehabil 2019; 100:1308-1316. [PMID: 30876843 DOI: 10.1016/j.apmr.2019.01.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 01/25/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate whether crossed cerebellar diaschisis (CCD) is associated with functional outcome in the subacute rehabilitation phase of stroke. DESIGN Retrospective case-control study. SETTING Hospital-based cohort. PARTICIPANTS The study enrolled participants who underwent brain single-photon emission computed tomography (N=48). Patients with CCD were identified (n=24). Twenty-four controls were selected for each case-patient by matching age, stroke type (ischemic or hemorrhagic), lesion laterality, and lesion location. INTERVENTION Not applicable. MAIN OUTCOME MEASURES The functional ambulation category (FAC), modified Barthel Index (MBI), and Mini-Mental State Examination (MMSE) were administered at the initial (initiation of rehabilitation therapy) and the follow-up (4wk after rehabilitation therapy) assessments. RESULTS The CCD group had lower MMSE, FAC, MBI, and MMSE scores at the initial assessment (P=.032, .016, and .001, respectively) and lower FAC and MBI scores at the follow-up assessment, than the non-CCD group (P=.001 and .036, respectively). Although CCD was not associated with cognitive impairment, nonambulatory status, and dependent activities of daily living (ADL) at the initial assessment (P=.538, .083, and >.99, respectively), the CCD group had a higher risk of cognitive impairment (adjusted odds ratio [aOR]=4.044; 95% confidence interval [CI], 1.071-15.270; P=.039), nonambulatory status (aOR=7.000; 95% CI, 1.641-29.854; P=.009) and dependent ADL (aOR=13.500; 95% CI, 1.535-118.692; P=.019) at the follow-up assessment. CONCLUSIONS CCD is associated with severe functional impairment and may have an adverse effect on functional outcomes related to cognition, ambulatory function, and ADL during the subacute rehabilitation phase of stroke. This suggests that CCD may be a valuable predictor of functional outcome in the subacute rehabilitation phase of stroke.
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Affiliation(s)
- Youngkook Kim
- Department of Rehabilitation Medicine, Graduate School, The Catholic University of Korea, Seoul, Republic of Korea; Department of Rehabilitation Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - Geun-Young Park
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea.
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Craig BT, Carlson HL, Kirton A. Thalamic diaschisis following perinatal stroke is associated with clinical disability. Neuroimage Clin 2019; 21:101660. [PMID: 30639178 PMCID: PMC6412070 DOI: 10.1016/j.nicl.2019.101660] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/26/2018] [Accepted: 01/04/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Perinatal stroke causes most hemiparetic cerebral palsy and leads to lifelong disability. Understanding developmental neuroplasticity following early stroke is increasingly translated into novel therapies. Diaschisis refers to alterations brain structures remote from, but connected to, stroke lesions. Ipsilesional thalamic diaschisis has been described following adult stroke but has not been investigated in perinatal stroke. We hypothesized that thalamic diaschisis occurs in perinatal stroke and its degree would be inversely correlated with clinical motor function. METHODS Population-based, controlled cohort study. Participants were children (<19 years) with unilateral perinatal stroke (arterial ischemic stroke [AIS] or periventricular venous infarction [PVI]), anatomical magnetic resonance imaging (MRI) >6 months of age, symptomatic hemiparetic cerebral palsy, and no additional neurologic disorders. Typically developing controls had comparable age and gender proportions. T1-weighted anatomical scans were parcellated into 99 regions of interest followed by generation of regional volumes. The primary outcome was thalamic volume expressed as ipsilesional (ILTV), contralesional (CLTV) and thalamic ratio (CLTV/ILTV). Standardized clinical motor assessments were correlated with thalamic volume metrics. RESULTS Fifty-nine participants (12.9 years old ±4.0 years, 46% female) included 20 AIS, 11 PVI, and 28 controls. ILTV was reduced in both AIS and PVI compared to controls (p < .001, p = .029, respectively). Ipsilesional thalamic diaschisis was not associated with clinical motor function. However, CLTV was significantly larger in AIS compared to both controls and PVI (p = .005, p < .001, respectively). CLTV was inversely correlated with all four clinical motor assessments (all p < .003). CONCLUSION Bilateral thalamic volume changes occur after perinatal stroke. Ipsilesional volume loss is not associated with clinical motor function. Contralesional volume is inversely correlated with clinical motor function, suggesting the thalamus is involved in the known developmental plasticity that occurs in the contralesional hemisphere after early unilateral injury.
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Affiliation(s)
- Brandon T Craig
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Calgary Pediatric Stroke Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Helen L Carlson
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Calgary Pediatric Stroke Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Calgary Pediatric Stroke Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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13
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PET Imaging of Crossed Cerebellar Diaschisis after Long-Term Cerebral Ischemia in Rats. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:2483078. [PMID: 30627057 PMCID: PMC6305055 DOI: 10.1155/2018/2483078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/23/2018] [Indexed: 11/17/2022]
Abstract
Crossed cerebellar diaschisis (CCD) is a decrease of regional blood flow and metabolism in the cerebellar hemisphere contralateral to the injured brain hemisphere as a common consequence of stroke. Despite CCD has been detected in patients with stroke using neuroimaging modalities, the evaluation of this phenomenon in rodent models of cerebral ischemia has been scarcely evaluated so far. Here, we report the in vivo evaluation of CCD after long-term cerebral ischemia in rats using positron emission tomography (PET) imaging with 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG). Imaging studies were combined with neurological evaluation to assess functional recovery. In the ischemic territory, imaging studies showed a significant decrease in glucose metabolism followed by a progressive recovery later on. Conversely, the cerebellum showed a contralateral hypometabolism from days 7 to 14 after reperfusion. Neurological behavior showed major impaired outcome at day 1 after ischemia followed by a significant recovery of the sensorimotor function from days 7 to 28 after experimental stroke. Taken together, these results suggest that the degree of CCD after cerebral ischemia might be predictive of neurological recovery.
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14
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Sebök M, van Niftrik CH, Piccirelli M, Bozinov O, Wegener S, Esposito G, Pangalu A, Valavanis A, Buck A, Luft AR, Regli L, Fierstra J. BOLD cerebrovascular reactivity as a novel marker for crossed cerebellar diaschisis. Neurology 2018; 91:e1328-e1337. [DOI: 10.1212/wnl.0000000000006287] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 07/02/2018] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo study blood oxygen level–dependent cerebrovascular reactivity (BOLD-CVR) as a surrogate imaging marker for crossed cerebellar diaschisis (CCD).MethodsTwenty-five participants with symptomatic unilateral cerebrovascular steno-occlusive disease underwent a BOLD-CVR and an acetazolamide challenged (15O)-H2O-PET study. CCD and cerebellar asymmetry index were determined from PET and compared to BOLD-CVR quantitative values. Neurologic status at admission and outcome after 3 months were determined with NIH Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores.ResultsFor both the BOLD-CVR and PET examination, a significant cerebellar asymmetry index was found for participants exhibiting CCD (CCD+ vs CCD−: for BOLD-CVR 13.11 ± 9.46 vs 1.52 ± 4.97, p < 0.001; and for PET 7.31 ± 2.75 vs 1.68 ± 2.98, p < 0.001). The area under the curve for BOLD-CVR was 0.89 (95% confidence interval: 0.75–1.0) with 0.91 sensitivity and 0.81 specificity to detect CCD. Participants exhibiting CCD were in poorer clinical condition at baseline (CCD+ vs CCD−: NIHSS 7 vs 1, p = 0.003; mRS 3 vs 1, p = 0.001) and after 3-month follow-up (NIHSS 2 vs 0, p = 0.02; mRS 1 vs 0, p = 0.04). Worse performance on both scores showed an agreement with a larger BOLD-CVR cerebellar asymmetry index. This was not found for PET.ConclusionsBOLD-CVR demonstrates similar sensitivity to detect CCD as compared to (15O)-H2O-PET in patients with symptomatic unilateral cerebrovascular steno-occlusive disease. Furthermore, participants exhibiting CCD had a poorer baseline neurologic performance and neurologic outcome at 3 months.Classification of evidenceThis study provides Class II evidence that BOLD-CVR identifies CCD in patients with symptomatic unilateral cerebrovascular steno-occlusive disease.
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Wathen CA, Frizon LA, Maiti TK, Baker KB, Machado AG. Deep brain stimulation of the cerebellum for poststroke motor rehabilitation: from laboratory to clinical trial. Neurosurg Focus 2018; 45:E13. [PMID: 30064319 DOI: 10.3171/2018.5.focus18164] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Ischemic stroke is a leading cause of disability worldwide, with profound economic costs. Poststroke motor impairment is the most commonly encountered deficit resulting in significant disability and is the primary driver of stroke-associated healthcare expenditures. Although many patients derive some degree of benefit from physical rehabilitation, a significant proportion continue to suffer from persistent motor impairment. Noninvasive brain stimulation, vagal nerve stimulation, epidural cortical stimulation, and deep brain stimulation (DBS) have all been studied as potential modalities to improve upon the benefits derived from physical therapy alone. These neuromodulatory therapies aim primarily to augment neuroplasticity and drive functional reorganization of the surviving perilesional cortex. The authors have proposed a novel and emerging therapeutic approach based on cerebellar DBS targeted at the dentate nucleus. Their rationale is based on the extensive reciprocal connectivity between the dentate nucleus and wide swaths of cerebral cortex via the dentatothalamocortical and corticopontocerebellar tracts, as well as the known limitations to motor rehabilitation imposed by crossed cerebellar diaschisis. Preclinical studies in rodent models of ischemic stroke have shown that cerebellar DBS promotes functional recovery in a frequency-dependent manner, with the most substantial benefits of the therapy noted at 30-Hz stimulation. The improvements in motor function are paralleled by increased expression of markers of synaptic plasticity, synaptogenesis, and neurogenesis in the perilesional cortex. Given the findings of preclinical studies, a first-in-human trial, Electrical Stimulation of the Dentate Nucleus Area (EDEN) for Improvement of Upper Extremity Hemiparesis Due to Ischemic Stroke: A Safety and Feasibility Study, commenced in 2016. Although the existing preclinical evidence is promising, the results of this Phase I trial and subsequent clinical trials will be necessary to determine the future applicability of this therapy.
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Affiliation(s)
| | - Leonardo A Frizon
- 2Center for Neurological Restoration, Neurological Institute, Cleveland Clinic
| | - Tanmoy K Maiti
- 3Department of Neurosurgery, Neurological Institute, Cleveland Clinic; and
| | - Kenneth B Baker
- 4Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Andre G Machado
- 3Department of Neurosurgery, Neurological Institute, Cleveland Clinic; and
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Kim Y, Kim SH, Kim JS, Hong BY. Modification of Cerebellar Afferent Pathway in the Subacute Phase of Stroke. J Stroke Cerebrovasc Dis 2018; 27:2445-2452. [PMID: 29801815 DOI: 10.1016/j.jstrokecerebrovasdis.2018.04.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/22/2018] [Accepted: 04/28/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND This study aims to identify the relationship between corticopontocerebellar tract (CPCT) and corticospinal tract (CST) integrity as well as motor function after stroke. MATERIALS AND METHODS A total of 33 patients with stroke (18 left, 15 right hemispheric lesions) who underwent diffusion tensor imaging within 2 months of stroke onset and 17 age- and sex-matched healthy controls were retrospectively enrolled. Tract volume and the asymmetry index based on tract volume (AITV) of the CST and CPCT were used to identify structural changes in individual tracts and the correlation between those tracts. Motor function was assessed using the Medical Research Council (MRC) muscle scale, manual function test (MFT), functional ambulation category, and modified Barthel index. RESULTS The volume of the affected CPCT was lower, and that of the unaffected CPCT was higher than the volumes in the control group (P < .001, P = .001, respectively). The CPCT AITV showed a strong positive correlation with the CST AITV in patients with either left or right hemispheric lesions (rs = .779, P < .001; rs = .732, P = .003, respectively). The CPCT AITV negatively correlated with the MRC muscle scale of the shoulder, wrist, and ankle muscles (r = -.490, -.490, -.416; P = .004, .004, .016, respectively). A higher unaffected CPCT volume was indicative of less affected upper extremity function, as assessed by MFT (rs = -.546, P = .029). CONCLUSIONS Modification of the CPCT depended on CST integrity and was associated with the severity of hemiplegia and hemiplegic upper extremity function. The CPCT may complement the role of the CST and help to predict the motor function.
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Affiliation(s)
- Youngkook Kim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Paldal-gu, Suwon, Republic of Korea
| | - Se-Hong Kim
- Department of Family Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Paldal-gu, Suwon, Republic of Korea
| | - Joon-Sung Kim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Paldal-gu, Suwon, Republic of Korea
| | - Bo Young Hong
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Paldal-gu, Suwon, Republic of Korea.
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Sin DS, Kim MH, Park SA, Joo MC, Kim MS. Crossed Cerebellar Diaschisis: Risk Factors and Correlation to Functional Recovery in Intracerebral Hemorrhage. Ann Rehabil Med 2018; 42:8-17. [PMID: 29560319 PMCID: PMC5852233 DOI: 10.5535/arm.2018.42.1.8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/23/2017] [Indexed: 11/09/2022] Open
Abstract
Objective The purpose of this study is to investigate predictors of crossed cerebellar diaschisis (CCD), and the effects of CCD on functional outcomes including motor function, activities of daily living, cognitive function, and ambulation 6 months after onset in patients with intracerebral hemorrhage (ICH). Methods A total of 74 patients experiencing their first ICH were recruited. If the asymmetric index was more than 10% using single photon emission computed tomography (SPECT), a diagnosis of CCD was confirmed. Clinical factors were retrospectively assessed by reviewing medical records. Radiologic factors encompassed the concomitance of intraventricular hemorrhage, side and location of the lesion, and hemorrhage volume. Functional outcomes were evaluated using the Fugl-Meyer Assessment, the Korean version of the Mini-Mental State Examination, the Korean version of the Modified Barthel Index, and measurement of the Functional Ambulatory Category at the time of SPECT measurement and 6 months post-ICH. Results Lesion location, especially in the basal ganglia (odds ratio [OR]=6.138, p=0.011), and hemorrhagic volume (OR=1.055, p=0.046) were independent predictors for CCD according to multivariate logistic regression analysis. In addition, the presence of CCD was significantly related to the improvement in Fugl-Meyer Assessment score after 6 months (adjusted R2=0.152, p=0.036). Conclusion Lesion location and hemorrhagic volume were the predisposing factors for CCD, and the CCD was associated with poor motor recovery over 6 months in patients with hemorrhagic stroke.
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Affiliation(s)
- Deok Su Sin
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine & Hospital, Iksan, Korea
| | - Myoung Hyoun Kim
- Department of Nuclear Medicine, Wonkwang University School of Medicine & Hospital, Iksan, Korea
| | - Soon-Ah Park
- Department of Nuclear Medicine, Wonkwang University School of Medicine & Hospital, Iksan, Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine & Hospital, Iksan, Korea
| | - Min Su Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine & Hospital, Iksan, Korea
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Iwasa H, Murata Y, Nishimori M, Miyatake K, Tadokoro M, Kohsaki S, Nogami M, Ueba Y, Ueba T, Yamagami T. Remote effects in the ipsilateral thalamus and/or contralateral cerebellar hemisphere using FDG PET in patients with brain tumors. Jpn J Radiol 2018; 36:303-311. [PMID: 29372376 DOI: 10.1007/s11604-018-0721-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate reduced metabolism in the ipsilateral thalamus (TH) and/or contralateral cerebellum (CE) according to tumor localization and cortical metabolism around the tumor in patients with brain tumors based on FDG uptake. METHODS This study investigated 48 consecutive patients with solitary cerebral hemisphere parenchymal brain tumors who underwent PET/CT and MRI. Patients were divided into 4 groups (A: reduced uptake in ipsilateral TH and contralateral CE, B: reduced uptake in ipsilateral TH only, C: reduced uptake in contralateral CE only, and D: no reduced uptake in ipsilateral TH or contralateral CE). FDG uptake and MRI findings were compared among these groups. RESULTS Of 48 patients, group A included 24 (50%), group B included 10 (21%), group C included 0, and group D included 14 (29%). No significant tendencies were observed between the groups regarding tumor localization. However, reduced cortical metabolism around the tumor was observed in 22 patients in group A, 7 patients in group B, and 1 patient in group D. All patients in group B showed reduced metabolism from around the tumor up to the ipsilateral TH. CONCLUSION Reduced FDG uptake in ipsilateral TH and contralateral CE usually occur simultaneously in patients with solitary brain tumors.
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Affiliation(s)
- Hitomi Iwasa
- Department of Radiology, Kochi Medical School, Kochi University, Kohasu, Okocho, Nankoku, Kochi, 783-8505, Japan.
| | - Yoriko Murata
- Department of Radiology, Kochi Medical School, Kochi University, Kohasu, Okocho, Nankoku, Kochi, 783-8505, Japan
| | - Miki Nishimori
- Department of Radiology, Kochi Medical School, Kochi University, Kohasu, Okocho, Nankoku, Kochi, 783-8505, Japan
| | - Kana Miyatake
- Department of Radiology, Kochi Medical School, Kochi University, Kohasu, Okocho, Nankoku, Kochi, 783-8505, Japan
| | - Michiko Tadokoro
- Department of Radiology, Kochi Medical School, Kochi University, Kohasu, Okocho, Nankoku, Kochi, 783-8505, Japan
| | - Shino Kohsaki
- Department of Radiology, Health care system JINSEI-KAI Hosogi Hospital, Daizencho, Kochi, Kochi, 780-0926, Japan
| | - Munenobu Nogami
- Department of Radiology, Kobe University Hospital, Kusunokicho Chuoku, Kobe, Hyogo, 650-0017, Japan
| | - Yusuke Ueba
- Department of Neurosurgery, Kochi Medical School, Kochi University, Kohasu, Okocho, Nankoku, Kochi, 783-8505, Japan
| | - Tetsuya Ueba
- Department of Neurosurgery, Kochi Medical School, Kochi University, Kohasu, Okocho, Nankoku, Kochi, 783-8505, Japan
| | - Takuji Yamagami
- Department of Radiology, Kochi Medical School, Kochi University, Kohasu, Okocho, Nankoku, Kochi, 783-8505, Japan
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Yin L, Cheng S, Xiao J, Zhu Y, Bu S, Zhang X, Liu R, Huang Y, Xie S. 3D pseudocontinuous arterial spin-labeling perfusion imaging detected crossed cerebellar diaschisis in acute, subacute and chronic intracerebral hemorrhage. Clin Imaging 2017; 50:37-42. [PMID: 29258030 DOI: 10.1016/j.clinimag.2017.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/07/2017] [Accepted: 12/11/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to evaluate the value of 3D pseudocontinuous arterial spin-labeling (pCASL) perfusion imaging detected crossed cerebellar diaschisis (CCD) at different stages of intracerebral hemorrhage (ICH). MATERIALS AND METHODS We assessed bilateral cerebral blood flow (CBF) values of different brain regions and the relationships between the CCD and clinical status of 16 ICH patients. RESULTS The ICH patients had significantly lower CBF values in the contralateral cerebellum in acute, subacute and chronic stages. The subacute CCD had a significant correlation with clinical status. CONCLUSIONS 3D pCASL may be an ideal tool to study the phenomenon and clinical consequences of ICH with CCD.
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Affiliation(s)
- Liang Yin
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Shuangjuan Cheng
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Jiangxi Xiao
- Department of Radiology, Peking University First Hospital, Beijing, China.
| | - Ying Zhu
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Shanshan Bu
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Xiaodong Zhang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Ran Liu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yining Huang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Sheng Xie
- Department of Radiology, China-Japanese Friendship Hospital, Beijing, China
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Kunz WG, Sommer WH, Höhne C, Fabritius MP, Schuler F, Dorn F, Othman AE, Meinel FG, von Baumgarten L, Reiser MF, Ertl-Wagner B, Thierfelder KM. Crossed cerebellar diaschisis in acute ischemic stroke: Impact on morphologic and functional outcome. J Cereb Blood Flow Metab 2017; 37:3615-3624. [PMID: 28084869 PMCID: PMC5669343 DOI: 10.1177/0271678x16686594] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Crossed cerebellar diaschisis (CCD) is the phenomenon of hypoperfusion and hypometabolism of the contralateral cerebellar hemisphere caused by dysfunction of the related supratentorial region. Our aim was to analyze its influence on morphologic and functional outcome in acute ischemic stroke. Subjects with stroke caused by a large vessel occlusion of the anterior circulation were selected from an initial cohort of 1644 consecutive patients who underwent multiparametric CT including whole-brain CT perfusion. Two experienced readers evaluated the posterior fossa in terms of CCD absence (CCD-) or presence (CCD+). A total of 156 patients formed the study cohort with 102 patients (65.4%) categorized as CCD- and 54 (34.6%) as CCD+. In linear and logistic regression analyses, no significant association between CCD and final infarction volume (β = -0.440, p = 0.972), discharge mRS ≤ 2 (OR = 1.897, p = 0.320), or 90-day mRS ≤ 2 (OR = 0.531, p = 0.492) was detected. CCD+ patients had larger supratentorial cerebral blood flow deficits (median: 164 ml vs. 115 ml; p = 0.001) compared to CCD-patients. Regarding complications, CCD was associated with a higher rate of parenchymal hematomas (OR = 4.793, p = 0.035). In conclusion, CCD is frequently encountered in acute ischemic stroke caused by large vessel occlusion of the anterior circulation. CCD was associated with the occurrence of parenchymal hematoma in the ipsilateral cerebral infarction but did not prove to significantly influence patient outcome.
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Affiliation(s)
- Wolfgang G Kunz
- 1 Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Wieland H Sommer
- 1 Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Christopher Höhne
- 2 Department of Neurology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Matthias P Fabritius
- 1 Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Felix Schuler
- 1 Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Franziska Dorn
- 3 Department of Neuroradiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Ahmed E Othman
- 4 Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen, Germany
| | - Felix G Meinel
- 1 Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Louisa von Baumgarten
- 2 Department of Neurology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Maximilian F Reiser
- 1 Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Birgit Ertl-Wagner
- 1 Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Kolja M Thierfelder
- 1 Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
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Is Dynamic Cerebral Autoregulation Bilaterally Impaired after Unilateral Acute Ischemic Stroke? J Stroke Cerebrovasc Dis 2017; 26:1081-1087. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.12.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/16/2016] [Accepted: 12/24/2016] [Indexed: 11/20/2022] Open
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Xiong L, Lin W, Han J, Chen X, Leung T, Soo Y, Wong KS. Enhancing cerebral perfusion with external counterpulsation after ischaemic stroke: how long does it last? J Neurol Neurosurg Psychiatry 2016; 87:531-6. [PMID: 25934015 DOI: 10.1136/jnnp-2014-309842] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 04/13/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE External counterpulsation (ECP) is a non-invasive method used to augment cerebral perfusion in ischaemic stroke. We aimed to investigate time-course effects on blood pressure elevation and cerebral blood flow augmentation induced by ECP in ischaemic stroke. METHODS Patients with acute unilateral ischaemic stroke and large artery occlusive disease were recruited to receive 35 daily 1 h ECP treatment sessions. Serial transcranial Doppler monitoring of bilateral middle cerebral arteries was performed on days 3, 5, 7, 10, 14, 21, 28 and 35 after stroke onset. Flow velocity changes before, during and after ECP and continuous beat-to-beat blood pressure data were recorded. The cerebral augmentation index (CAI) is the increase in the percentage of the middle cerebral artery mean flow velocity during ECP compared with baseline. RESULTS The CAI in patients with stroke was significantly higher on the ipsilateral side and on the contralateral side on day 3 (ipsilateral CAI, 9.3%; contralateral CAI, 7.2%), day 5 (7.0%; 6.7%), day 7 (6.8%; 6.0%), day 10 (6.0%; 5.1%), day 14 (4.7%; 2.6%) and day 21 (4.1%; 2.2%) after stroke onset than that in controls (-2.0%) (all p<0.05). There was a significant trend of decreasing CAI on the ipsilateral and contralateral sides over time after a stroke. Differences in the percentage increase in the mean blood pressure did not change significantly over time in patients with stroke. CONCLUSIONS Blood pressure elevation persists throughout ECP treatment, which consists of 35 sessions. However, cerebral blood flow augmentation may last at least 3 weeks and then appears to return to baseline 1 month after acute stroke onset.
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Affiliation(s)
- Li Xiong
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Wenhua Lin
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jinghao Han
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Xiangyan Chen
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Thomas Leung
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yannie Soo
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Ka Sing Wong
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, Hong Kong
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Sommer WH, Bollwein C, Thierfelder KM, Baumann A, Janssen H, Ertl-Wagner B, Reiser MF, Plate A, Straube A, von Baumgarten L. Crossed cerebellar diaschisis in patients with acute middle cerebral artery infarction: Occurrence and perfusion characteristics. J Cereb Blood Flow Metab 2016; 36:743-54. [PMID: 26661242 PMCID: PMC4821023 DOI: 10.1177/0271678x15617953] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 10/12/2015] [Indexed: 01/22/2023]
Abstract
We aimed to investigate the overall prevalence and possible factors influencing the occurrence of crossed cerebellar diaschisis after acute middle cerebral artery infarction using whole-brain CT perfusion. A total of 156 patients with unilateral hypoperfusion of the middle cerebral artery territory formed the study cohort; 352 patients without hypoperfusion served as controls. We performed blinded reading of different perfusion maps for the presence of crossed cerebellar diaschisis and determined the relative supratentorial and cerebellar perfusion reduction. Moreover, imaging patterns (location and volume of hypoperfusion) and clinical factors (age, sex, time from symptom onset) resulting in crossed cerebellar diaschisis were analysed. Crossed cerebellar diaschisis was detected in 35.3% of the patients with middle cerebral artery infarction. Crossed cerebellar diaschisis was significantly associated with hypoperfusion involving the left hemisphere, the frontal lobe and the thalamus. The degree of the relative supratentorial perfusion reduction was significantly more pronounced in crossed cerebellar diaschisis-positive patients but did not correlate with the relative cerebellar perfusion reduction. Our data suggest that (i) crossed cerebellar diaschisis is a common feature after middle cerebral artery infarction which can robustly be detected using whole-brain CT perfusion, (ii) its occurrence is influenced by location and degree of the supratentorial perfusion reduction rather than infarct volume (iii) other clinical factors (age, sex and time from symptom onset) did not affect the occurrence of crossed cerebellar diaschisis.
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Affiliation(s)
- Wieland H Sommer
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Christine Bollwein
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Kolja M Thierfelder
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Alena Baumann
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Hendrik Janssen
- Department of Neuroradiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Birgit Ertl-Wagner
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Maximilian F Reiser
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Annika Plate
- Department of Neurology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Andreas Straube
- Department of Neurology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Louisa von Baumgarten
- Department of Neurology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
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Garbuzova-Davis S, Haller E, Williams SN, Haim ED, Tajiri N, Hernandez-Ontiveros DG, Frisina-Deyo A, Boffeli SM, Sanberg PR, Borlongan CV. Compromised blood-brain barrier competence in remote brain areas in ischemic stroke rats at the chronic stage. J Comp Neurol 2015; 522:3120-37. [PMID: 24610730 DOI: 10.1002/cne.23582] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 01/28/2014] [Accepted: 03/05/2014] [Indexed: 12/14/2022]
Abstract
Stroke is a life-threatening disease leading to long-term disability in stroke survivors. Cerebral functional insufficiency in chronic stroke might be due to pathological changes in brain areas remote from the initial ischemic lesion, i.e., diaschisis. Previously, we showed that the damaged blood-brain barrier (BBB) was involved in subacute diaschisis. The present study investigated BBB competence in chronic diaschisis by using a transient middle cerebral artery occlusion (tMCAO) rat model. Our results demonstrated significant BBB damage mostly in the ipsilateral striatum and motor cortex in rats at 30 days after tMCAO. The BBB alterations were also determined in the contralateral hemisphere via ultrastructural and immunohistochemical analyses. Major BBB pathological changes in contralateral remote striatum and motor cortex areas included 1) vacuolated endothelial cells containing large autophagosomes, 2) degenerated pericytes displaying mitochondria with cristae disruption, 3) degenerated astrocytes and perivascular edema, 4) Evans blue extravasation, and 5) appearance of parenchymal astrogliosis. Discrete analyses of striatal and motor cortex areas revealed significantly higher autophagosome accumulation in capillaries of ventral striatum and astrogliosis in dorsal striatum in both cerebral hemispheres. These widespread microvascular alterations in ipsilateral and contralateral brain hemispheres suggest persistent and/or continued BBB damage in chronic ischemia. The pathological changes in remote brain areas likely indicate chronic ischemic diaschisis, which should be considered in the development of treatment strategies for stroke.
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Affiliation(s)
- Svitlana Garbuzova-Davis
- Center of Excellence for Aging and Brain Repair, University of South Florida, Morsani College of Medicine, Tampa, Florida, 33612; Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College of Medicine, Tampa, Florida, 33612; Department of Molecular Pharmacology and Physiology, University of South Florida, Morsani College of Medicine, Tampa, Florida, 33612; Department of Pathology and Cell Biology, University of South Florida, Morsani College of Medicine, Tampa, Florida, 33612
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Kang KM, Sohn CH, Kim BS, Kim YI, Choi SH, Yun TJ, Kim JH, Park SW, Cheon GJ, Han MH. Correlation of Asymmetry Indices Measured by Arterial Spin-Labeling MR Imaging and SPECT in Patients with Crossed Cerebellar Diaschisis. AJNR Am J Neuroradiol 2015; 36:1662-8. [PMID: 26228883 DOI: 10.3174/ajnr.a4366] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 02/20/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Crossed cerebellar diaschisis, not only a secondary result of supratentorial infarction but also an indicator of clinical outcomes, has frequently been reported on PET and SPECT but has been rarely described with arterial spin-labeling MR imaging. The purpose of this study was to determine the ability of arterial spin-labeling MR imaging to evaluate crossed cerebellar diaschisis compared with that of SPECT. To our knowledge, this is the first study to validate arterial spin-labeling in crossed cerebellar diaschisis by using SPECT as a reference standard. MATERIALS AND METHODS This study included 16 patients in whom crossed cerebellar diaschisis was shown on SPECT and 10 control subjects in whom crossed cerebellar diaschisis was not shown on SPECT. During the qualitative analysis, asymmetric cerebellar perfusion on arterial spin-labeling was divided into 1 of the following 3 grades by 2 blinded observers: the affected cerebellum was isointense compared with the unaffected cerebellum (grade I), it was slightly hypointense (grade II), or it was markedly hypointense (grade III). In the quantitative analysis, asymmetry indices were calculated by using SPECT and arterial spin-labeling images. For statistical analysis, κ statistics, the interobserver correlation coefficient, the independent t test, Pearson correlation, and linear regression analysis were used. RESULTS Almost all the diagnoses of crossed cerebellar diaschisis on SPECT were noted on arterial spin-labeling in both qualitative and quantitative analyses with good interobserver agreement (κ = 0.961; interobserver correlation coefficient, 0.806). The mean asymmetry index of arterial spin-labeling (26.06 ± 9.00) was significantly larger than that for SPECT (15.28 ± 5.34; P < .001). There was a significant positive correlation between the asymmetry indices obtained for SPECT and those for arterial spin-labeling (r = 0.77 [95% CI, 0.443-0.916]; P < .001). The relationship of asymmetry indices between SPECT and arterial spin-labeling (x, y) was calculated as y = 6.2131 + 1.2986x (R(2) = 0.592; P < .001). CONCLUSIONS Arterial spin-labeling can be a noninvasive alternative to SPECT for evaluating crossed cerebellar diaschisis.
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Affiliation(s)
- K M Kang
- From the Departments of Radiology (K.M.K., C.-H.S., B.S.K., S.H.C., T.J.Y., J.-h.K., M.H.H.) Department of Radiology (K.M.K., C.-H.S., B.S.K., S.H.C., T.J.Y., J.-h.K., S.-W.P., M.H.H.), Seoul National University College of Medicine, Seoul, Republic of Korea
| | - C-H Sohn
- From the Departments of Radiology (K.M.K., C.-H.S., B.S.K., S.H.C., T.J.Y., J.-h.K., M.H.H.) Department of Radiology (K.M.K., C.-H.S., B.S.K., S.H.C., T.J.Y., J.-h.K., S.-W.P., M.H.H.), Seoul National University College of Medicine, Seoul, Republic of Korea Institute of Radiation Medicine (C.-H.S., S.H.C., M.H.H.), Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - B S Kim
- From the Departments of Radiology (K.M.K., C.-H.S., B.S.K., S.H.C., T.J.Y., J.-h.K., M.H.H.) Department of Radiology (K.M.K., C.-H.S., B.S.K., S.H.C., T.J.Y., J.-h.K., S.-W.P., M.H.H.), Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Y I Kim
- Nuclear Medicine (Y.I.K., G.J.C.), Seoul National University Hospital, Seoul, Republic of Korea
| | - S H Choi
- From the Departments of Radiology (K.M.K., C.-H.S., B.S.K., S.H.C., T.J.Y., J.-h.K., M.H.H.) Department of Radiology (K.M.K., C.-H.S., B.S.K., S.H.C., T.J.Y., J.-h.K., S.-W.P., M.H.H.), Seoul National University College of Medicine, Seoul, Republic of Korea Institute of Radiation Medicine (C.-H.S., S.H.C., M.H.H.), Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - T J Yun
- From the Departments of Radiology (K.M.K., C.-H.S., B.S.K., S.H.C., T.J.Y., J.-h.K., M.H.H.) Department of Radiology (K.M.K., C.-H.S., B.S.K., S.H.C., T.J.Y., J.-h.K., S.-W.P., M.H.H.), Seoul National University College of Medicine, Seoul, Republic of Korea
| | - J-h Kim
- From the Departments of Radiology (K.M.K., C.-H.S., B.S.K., S.H.C., T.J.Y., J.-h.K., M.H.H.) Department of Radiology (K.M.K., C.-H.S., B.S.K., S.H.C., T.J.Y., J.-h.K., S.-W.P., M.H.H.), Seoul National University College of Medicine, Seoul, Republic of Korea
| | - S-W Park
- Department of Radiology (K.M.K., C.-H.S., B.S.K., S.H.C., T.J.Y., J.-h.K., S.-W.P., M.H.H.), Seoul National University College of Medicine, Seoul, Republic of Korea Department of Radiology (S.-W.P.), Seoul National University Boramae Hospital, Seoul, Republic of Korea
| | - G J Cheon
- Nuclear Medicine (Y.I.K., G.J.C.), Seoul National University Hospital, Seoul, Republic of Korea
| | - M H Han
- From the Departments of Radiology (K.M.K., C.-H.S., B.S.K., S.H.C., T.J.Y., J.-h.K., M.H.H.) Department of Radiology (K.M.K., C.-H.S., B.S.K., S.H.C., T.J.Y., J.-h.K., S.-W.P., M.H.H.), Seoul National University College of Medicine, Seoul, Republic of Korea Institute of Radiation Medicine (C.-H.S., S.H.C., M.H.H.), Seoul National University Medical Research Center, Seoul, Republic of Korea
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Abstract
During learning, performance changes often involve a transition from controlled processing in which performance is flexible and responsive to ongoing error feedback, but effortful and slow, to a state in which processing becomes swift and automatic. In this state, performance is unencumbered by the requirement to process feedback, but its insensitivity to feedback reduces its flexibility. Many properties of automatic processing are similar to those that one would expect of forward models, and many have suggested that these may be instantiated in cerebellar circuitry. Since hierarchically organized frontal lobe areas can both send and receive commands, I discuss the possibility that they can act both as controllers and controlled objects and that their behaviors can be independently modeled by forward models in cerebellar circuits. Since areas of the prefrontal cortex contribute to this hierarchically organized system and send outputs to the cerebellar cortex, I suggest that the cerebellum is likely to contribute to the automation of cognitive skills, and to the formation of habitual behavior which is resistant to error feedback. An important prerequisite to these ideas is that cerebellar circuitry should have access to higher order error feedback that signals the success or failure of cognitive processing. I have discussed the pathways through which such feedback could arrive via the inferior olive and the dopamine system. Cerebellar outputs inhibit both the inferior olive and the dopamine system. It is possible that learned representations in the cerebellum use this as a mechanism to suppress the processing of feedback in other parts of the nervous system. Thus, cerebellar processes that control automatic performance may be completed without triggering the engagement of controlled processes by prefrontal mechanisms.
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Affiliation(s)
- Narender Ramnani
- Department of Psychology, Royal Holloway, University of London, Egham, UK.
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Yassi N, Malpas CB, Campbell BC, Moffat B, Steward C, Parsons MW, Desmond PM, Donnan GA, Davis SM, Bivard A. Contralesional Thalamic Surface Atrophy and Functional Disconnection 3 Months after Ischemic Stroke. Cerebrovasc Dis 2015; 39:232-41. [DOI: 10.1159/000381105] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 02/18/2015] [Indexed: 11/19/2022] Open
Abstract
Background: Remote structural and functional changes have been previously described after stroke and may have an impact on clinical outcome. We aimed to use multimodal MRI to investigate contralesional subcortical structural and functional changes 3 months after anterior circulation ischemic stroke. Methods: Fifteen patients with acute ischemic stroke had multimodal MRI imaging (including high resolution structural T1-MPRAGE and resting state fMRI) within 1 week of onset and at 1 and 3 months. Seven healthy controls of similar age group were also imaged at a single time point. Contralesional subcortical structural volume was assessed using an automated segmentation algorithm in FMRIB's Integrated Registration and Segmentation Tool (FIRST). Functional connectivity changes were assessed using the intrinsic connectivity contrast (ICC), which was calculated using the functional connectivity toolbox for correlated and anticorrelated networks (Conn). Results: Contralesional thalamic volume in the stroke patients was significantly reduced at 3 months compared to baseline (median change -2.1%, interquartile range [IQR] -3.4-0.4, p = 0.047), with the predominant areas demonstrating atrophy geometrically appearing to be the superior and inferior surface. The difference in volume between the contralesional thalamus at baseline (mean 6.41 ml, standard deviation [SD] 0.6 ml) and the mean volume of the 2 thalami in controls (mean 7.22 ml, SD 1.1 ml) was not statistically significant. The degree of longitudinal thalamic atrophy in patients was correlated with baseline stroke severity with more severe strokes being associated with a greater degree of atrophy (Spearman's rho -0.54, p = 0.037). There was no significant difference between baseline contralesional thalamic ICC in patients and control thalamic ICC. However, in patients, there was a significant linear reduction in the mean ICC of the contralesional thalamus over the imaging time points (p = 0.041), indicating reduced connectivity to the remainder of the brain. Conclusions: These findings highlight the importance of remote brain areas, such as the contralesional thalamus, in stroke recovery. Similar methods have the potential to be used in the prediction of stroke outcome or as imaging biomarkers of stroke recovery.
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Fiori S, Pannek K, Pasquariello R, Ware RS, Cioni G, Rose SE, Boyd RN, Guzzetta A. Corticopontocerebellar Connectivity Disruption in Congenital Hemiplegia. Neurorehabil Neural Repair 2015; 29:858-66. [PMID: 25613985 DOI: 10.1177/1545968314568726] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Crossed cerebellar diaschisis is the disruption of functional connectivity between cerebrum and cerebellum after hemispheric unilateral brain lesions. In adults and to a lesser extent in children, crossed cerebellar diaschisis has been largely investigated by functional connectivity and demonstrated to influence paretic hand function. OBJECTIVE We aim to demonstrate a disruption in structural corticopontocerebellar (CPC) connectivity in children with congenital brain lesions and examine its correlation with paretic hand motor function. METHODS Thirty-six children (Manual Ability Classification System: I, n = 21; II, n = 15) with unilateral brain lesions and 18 controls were analyzed in a case-control study, and diffusion magnetic resonance imaging data were acquired at 3T. High angular resolution diffusion imaging probabilistic tractography was employed for the region of interest-based reconstruction of CPC tracts. To identify statistical differences in structural cerebrocerebellar connectivity between case and control groups, an asymmetry index based on the number of streamlines of CPC tracts was used. In the case group, the correlation between asymmetry index and hand function measures was also determined. RESULTS Projections through the middle cerebellar peduncle to the contralateral cerebral cortex showed greater asymmetry in children with congenital unilateral brain lesion compared to controls (P = .03), thus indicating a disruption of structural cerebrocerebellar connectivity. The degree of asymmetry index showed a correlation (P < .03; r = -0.31) with impaired hand abilities in bimanual tasks. CONCLUSIONS Disruption of structural cerebrocerebellar connectivity is present in patients with congenital unilateral brain injury and might be related to impaired hand function in bimanual skills, with potential implication in tailoring early intervention strategies.
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Affiliation(s)
- Simona Fiori
- Department of Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy
| | - Kerstin Pannek
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia The Australian e-Health Research Centre, CSIRO, Brisbane, Australia
| | - Rosa Pasquariello
- Department of Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy
| | - Robert S Ware
- School of Population Health, The University of Queensland, Brisbane, Queensland, Australia Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stephen E Rose
- The Australian e-Health Research Centre, CSIRO, Brisbane, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Andrea Guzzetta
- Department of Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Whole-brain 320-detector row dynamic volume CT perfusion detected crossed cerebellar diaschisis after spontaneous intracerebral hemorrhage. Neuroradiology 2014; 57:179-87. [PMID: 25381579 DOI: 10.1007/s00234-014-1456-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 10/17/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the value of 320-detector row CT used to detect crossed cerebellar diaschisis (CCD) in patients with unilateral supratentorial spontaneous intracerebral hemorrhage (SICH). METHODS We investigated 62 of 156 patients with unilateral supratentorial SICH using 320-detector row CT scanning. Regional cerebral blood flow (rCBF), cerebral blood volume (rCBV), mean transit time (rMTT), and time to peak (rTTP) levels were measured in different regions of interest (ROIs) that were manually outlined on computed tomography perfusion (CTP) for the cerebrum, including normal-appearing brain tissue that surrounded the perilesional low-density area (NA) and the perihematomal low-density area (PA) in all patients and the cerebellum (ipsilateral and contralateral) in CCD-positive patients. RESULTS Of 62 cases, a total of 14 met the criteria for CCD due to cerebellar perfusion asymmetry on CTP maps. In the quantitative analysis, significant differences were found in the perfusion parameters between the contralateral and ipsilateral cerebellum in CCD-positive cases. No significant differences were found between the CCD-positive group and the CCD-negative group according to the hematoma volume, NIHSS scores, and cerebral perfusion abnormality (each P > 0.05). The correlation analysis of the degree of NA, PA perfusion abnormality, and the degree of CCD severity showed negative and significant linear correlations (R, -0.66∼-0.56; P < 0.05). CONCLUSION 320-detector row CT is a robust and practicable method for the comprehensive primary imaging work-up of CCD in unilateral supratentorial SICH patients.
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Baron JC. The Johann Jacob Wepfer award 2014 of the European stroke conference to professors Stephen M. Davis and Geoffrey A. Donnan. Cerebrovasc Dis 2014; 38:55-8. [PMID: 25227156 DOI: 10.1159/000365557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Wiest R, Abela E, Missimer J, Schroth G, Hess CW, Sturzenegger M, Wang DJJ, Weder B, Federspiel A. Interhemispheric cerebral blood flow balance during recovery of motor hand function after ischemic stroke--a longitudinal MRI study using arterial spin labeling perfusion. PLoS One 2014; 9:e106327. [PMID: 25191858 PMCID: PMC4156327 DOI: 10.1371/journal.pone.0106327] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 07/30/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Unilateral ischemic stroke disrupts the well balanced interactions within bilateral cortical networks. Restitution of interhemispheric balance is thought to contribute to post-stroke recovery. Longitudinal measurements of cerebral blood flow (CBF) changes might act as surrogate marker for this process. OBJECTIVE To quantify longitudinal CBF changes using arterial spin labeling MRI (ASL) and interhemispheric balance within the cortical sensorimotor network and to assess their relationship with motor hand function recovery. METHODS Longitudinal CBF data were acquired in 23 patients at 3 and 9 months after cortical sensorimotor stroke and in 20 healthy controls using pulsed ASL. Recovery of grip force and manual dexterity was assessed with tasks requiring power and precision grips. Voxel-based analysis was performed to identify areas of significant CBF change. Region-of-interest analyses were used to quantify the interhemispheric balance across nodes of the cortical sensorimotor network. RESULTS Dexterity was more affected, and recovered at a slower pace than grip force. In patients with successful recovery of dexterous hand function, CBF decreased over time in the contralesional supplementary motor area, paralimbic anterior cingulate cortex and superior precuneus, and interhemispheric balance returned to healthy control levels. In contrast, patients with poor recovery presented with sustained hypoperfusion in the sensorimotor cortices encompassing the ischemic tissue, and CBF remained lateralized to the contralesional hemisphere. CONCLUSIONS Sustained perfusion imbalance within the cortical sensorimotor network, as measured with task-unrelated ASL, is associated with poor recovery of dexterous hand function after stroke. CBF at rest might be used to monitor recovery and gain prognostic information.
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Affiliation(s)
- Roland Wiest
- Support Center for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, University Hospital Inselspital and University of Bern, Bern, Switzerland
- * E-mail:
| | - Eugenio Abela
- Support Center for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, University Hospital Inselspital and University of Bern, Bern, Switzerland
- Department of Neurology, University Hospital Inselspital and University of Bern, Bern, Switzerland
| | - John Missimer
- Paul Scherrer Institute, Laboratory of Biomolecular Research, Villigen, Switzerland
| | - Gerhard Schroth
- Support Center for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, University Hospital Inselspital and University of Bern, Bern, Switzerland
| | - Christian W. Hess
- Department of Neurology, University Hospital Inselspital and University of Bern, Bern, Switzerland
| | - Matthias Sturzenegger
- Department of Neurology, University Hospital Inselspital and University of Bern, Bern, Switzerland
| | - Danny J. J. Wang
- Department of Neurology, Ahmanson-Lovelace Brain Mapping Center, University of California Los Angeles, Los Angeles, California, United States of America
| | - Bruno Weder
- Support Center for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, University Hospital Inselspital and University of Bern, Bern, Switzerland
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Department of Neurology, University Hospital Inselspital and University of Bern, Bern, Switzerland
| | - Andrea Federspiel
- Department of Psychiatric Neurophysiology, University Hospital of Psychiatry and University of Bern, Bern, Switzerland
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Coucha M, Li W, Johnson MH, Fagan SC, Ergul A. Protein nitration impairs the myogenic tone of rat middle cerebral arteries in both ischemic and nonischemic hemispheres after ischemic stroke. Am J Physiol Heart Circ Physiol 2013; 305:H1726-35. [PMID: 24097431 DOI: 10.1152/ajpheart.00535.2013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The myogenic response is crucial for maintaining vascular resistance to achieve constant perfusion during pressure fluctuations. Reduced cerebral blood flow has been reported in ischemic and nonischemic hemispheres after stroke. Ischemia-reperfusion injury and the resulting oxidative stress impair myogenic responses in the ischemic hemisphere. Yet, the mechanism by which ischemia-reperfusion affects the nonischemic side is still undetermined. The goal of the present study was to determine the effect of ischemia-reperfusion injury on the myogenic reactivity of cerebral vessels from both hemispheres and whether protein nitration due to excess peroxynitrite production is the underlying mechanism of loss of tone. Male Wistar rats were subjected to sham operation or 30-min middle cerebral artery occlusion/45-min reperfusion. Rats were administered saline, the peroxynitrite decomposition catalyst 5,10,15,20-tetrakis(4-sulfonatophenyl)prophyrinato iron (III), or the nitration inhibitor epicatechin at reperfusion. Middle cerebral arteries isolated from another set of control rats were exposed to ex vivo oxygen-glucose deprivation with and without glycoprotein 91 tat (NADPH oxidase inhibitor) or N(ω)-nitro-l-arginine methyl ester. Myogenic tone and nitrotyrosine levels were determined. Ischemia-reperfusion injury impaired the myogenic tone of vessels in both hemispheres compared with the sham group (P < 0.001). Vessels exposed to ex vivo oxygen-glucose deprivation experienced a similar loss of myogenic tone. Inhibition of peroxynitrite parent radicals significantly improved the myogenic tone. Peroxynitrite scavenging or inhibition of nitration improved the myogenic tone of vessels from ischemic (P < 0.001 and P < 0.05, respectively) and nonischemic (P < 0.01 and P < 0.05, respectively) hemispheres. Nitration was significantly increased in both hemispheres versus the sham group and was normalized with epicatechin treatment. In conclusion, ischemia-reperfusion injury impairs vessel reactivity in both hemispheres via nitration. We suggest that sham operation rather than the nonischemic side should be used as a control in preclinical stroke studies.
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Affiliation(s)
- Maha Coucha
- Department of Physiology, Georgia Regents University, Augusta, Georgia
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Abstract
Stroke and cerebrovascular diseases are major causes of mortality, morbidity, and disability. Nuclear Medicine, primarily via tomographic methods, has made significant contributions to the understanding of the hemodynamic and metabolic consequences of cerebrovascular diseases. In this review, the findings in acute, subacute, and chronic cerebrovascular diseases are described. Many of the pathophysiologic processes and consequences that follow stroke, including completed infarct core, adjacent penumbra, and diaschisis, have been investigated with Nuclear Medicine, and stroke outcome may be related to these phenomena. Additional topics included in this review are cerebrovascular reserve tests and multi-infarct dementia. Finally, Nuclear Medicine investigations of stroke recovery and cerebral plasticity appear to indicate that enhanced activity of preexisting networks, rather than substitution of function, represents the most important mechanism of improvement in chronic stroke rehabilitation.
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Affiliation(s)
- David H Lewis
- Division of Nuclear Medicine, Department of Radiology, University of Washington School of Medicine, Seattle, WA 98104, USA.
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Szilágyi G, Vas A, Kerényi L, Nagy Z, Csiba L, Gulyás B. Correlation between crossed cerebellar diaschisis and clinical neurological scales. Acta Neurol Scand 2012; 125:373-81. [PMID: 21781057 DOI: 10.1111/j.1600-0404.2011.01576.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND A common consequence of unilateral stroke is crossed cerebellar diaschisis (CCD), a decrease in regional blood flow (CBF) and metabolism (CMRglu) in the cerebellar hemisphere contralateral to the affected cerebral hemisphere. Former studies indicated a post-stroke time-dependent relationship between the degree of CCD and the clinical status of acute and sub-acute stroke patients, but no study has been performed in post-stroke patients. OBJECTIVES The objective of this investigation was to evaluate the quantitative correlation between the degree of CCD and the values of clinical stroke scales in post-stroke patients. MATERIALS AND METHODS We measured with positron emission tomography (PET) regional CBF and CMRglu values in the affected cortical regions and the contralateral cerebellum in ten ischaemic post-stroke patients. Based on these quantitative parameters, the degree of diaschisis (DoD) was calculated, and the DoD values were correlated with three clinical stroke scales [Barthel Index, Orgogozo Scale and Scandinavian Neurological Scale (SNS)]. RESULTS There were significant linear correlations between all clinical stroke scales and the CCD values (Barthel Index and Orgogozo Scale: P < 0.001, for both CBF and CMRglu; SNS: P = 0.007 and P = 0.044; CBF and CMRglu, respectively). CONCLUSIONS The findings indicate that DoD can be used as a quantitative indicator of the functional impairments following stroke, i.e. it can serve as a potential surrogate of the severity of the damage.
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Affiliation(s)
- G Szilágyi
- Department of Neurology, State Health Center, Budapest, Hungary
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Yoon CW, Seo SW, Park JS, Kwak KC, Yoon U, Suh MK, Kim GH, Shin JS, Kim CH, Noh Y, Cho H, Kim MJ, Kim JH, Roh JH, Lee JM, Na DL. Cerebellar Atrophy in Patients with Subcortical-Type Vascular Cognitive Impairment. THE CEREBELLUM 2012; 12:35-42. [DOI: 10.1007/s12311-012-0388-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Perinatal cerebellar injury in human and animal models. Neurol Res Int 2012; 2012:858929. [PMID: 22530126 PMCID: PMC3317029 DOI: 10.1155/2012/858929] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 11/29/2011] [Indexed: 12/20/2022] Open
Abstract
Cerebellar injury is increasingly recognized through advanced neonatal brain imaging as a complication of premature birth. Survivors of preterm birth demonstrate a constellation of long-term neurodevelopmental deficits, many of which are potentially referable to cerebellar injury, including impaired motor functions such as fine motor incoordination, impaired motor sequencing and also cognitive, behavioral dysfunction among older patients. This paper reviews the morphogenesis and histogenesis of the human and rodent developing cerebellum, and its more frequent injuries in preterm. Most cerebellar lesions are cerebellar hemorrhage and infarction usually leading to cerebellar abnormalities and/or atrophy, but the exact pathogenesis of lesions of the cerebellum is unknown. The different mechanisms involved have been investigated with animal models and are primarily hypoxia, ischemia, infection, and inflammation Exposure to drugs and undernutrition can also induce cerebellar abnormalities. Different models are detailed to analyze these various disturbances of cerebellar development around birth.
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Jeon YW, Kim SH, Lee JY, Whang K, Kim MS, Kim YJ, Lee MS. Dynamic CT perfusion imaging for the detection of crossed cerebellar diaschisis in acute ischemic stroke. Korean J Radiol 2011; 13:12-9. [PMID: 22247631 PMCID: PMC3253398 DOI: 10.3348/kjr.2012.13.1.12] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 09/09/2011] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Although the detection of crossed cerebellar diaschisis (CCD) by means of different imaging modalities is well described, little is known about its diagnosis by computed tomography perfusion (CTP) imaging. We investigated the detection rate of CCD by CTP imaging and the factors related to CCD on CTP images in patients with acute ischemic stroke. MATERIALS AND METHODS CT perfusion maps of cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and time-to-peak (TTP) obtained from 81 consecutive patients affected by an acute ischemic stroke were retrospectively reviewed. Whole-brain perfusion maps were obtained with a multichannel CT scanner using the toggling-table technique. The criteria for CCD was a unilateral supratentorial ischemic lesion and an accompanying decrease in perfusion of the contralateral cerebellar hemisphere on the basis of CTP maps by visual inspection without a set threshold. Maps were quantitatively analyzed in CCD positive cases. RESULTS The criteria for CCD were fulfilled in 25 of the 81 cases (31%). Detection rates per CTP map were as follows: MTT (31%) > TTP (21%) > CBF (9%) > CBV (6%). Supratentorial ischemic volume, degree of perfusion reduction, and infratentorial asymmetry index correlated strongly (R, 0.555-0.870) and significantly (p < 0.05) with each other in CCD-positive cases. CONCLUSION It is possible to detect CCD on all four of the CTP-based maps. Of these maps, MTT is most sensitive in detecting CCD. Our data indicate that CTP imaging is a valid tool for the diagnosis of CCD in patients affected by an acute hemispheric stroke.
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Affiliation(s)
- Young Wook Jeon
- Department of Radiology, Wonju Christian Hospital, Yonsei University Wonju College of Medicine, Gangwon-do 220-701, Korea
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Evaluation of methods for detecting perfusion abnormalities after stroke in dysfunctional brain regions. Brain Struct Funct 2011; 217:667-75. [DOI: 10.1007/s00429-011-0363-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 11/10/2011] [Indexed: 10/15/2022]
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O'Halloran CJ, Kinsella GJ, Storey E. The cerebellum and neuropsychological functioning: a critical review. J Clin Exp Neuropsychol 2011; 34:35-56. [PMID: 22047489 DOI: 10.1080/13803395.2011.614599] [Citation(s) in RCA: 158] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
The cerebellum, while once considered a brain region principally involved in motor control and coordination, is increasingly becoming associated with a range of neuropsychological and neuropsychiatric presentations. This paper reviews the dominant neuropsychological domains and neuropsychiatric conditions for which cerebellar involvement has been demonstrated, including visuospatial functioning, learning and memory, language, executive functioning, attention-deficit/hyperactivity disorder, autism spectrum disorders, and schizophrenia. The paper concludes with a discussion of a potential neuropsychological localization model within the cerebellum and a discussion of prognosis and rates of recovery that can be expected, following localized cerebellar lesions.
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Crossed cerebellar diaschisis after stroke: can perfusion-weighted MRI show functional inactivation? J Cereb Blood Flow Metab 2011; 31:1493-500. [PMID: 21386854 PMCID: PMC3130318 DOI: 10.1038/jcbfm.2011.15] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this study, we aimed to assess the detection of crossed cerebellar diaschisis (CCD) following stroke by perfusion-weighted magnetic resonance imaging (PW-MRI) in comparison with positron emission tomography (PET). Both PW-MRI and 15O-water-PET were performed in acute and subacute hemispheric stroke patients. The degree of CCD was defined by regions of interest placed in the cerebellar hemispheres ipsilateral (I) and contralateral (C) to the supratentorial lesion. An asymmetry index (AI=C/I) was calculated for PET-cerebral blood flow (CBF) and MRI-based maps of CBF, cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP). The resulting AI values were compared by Bland-Altman (BA) plots and receiver operating characteristic analysis to detect the degree and presence of CCD. A total of 26 imaging procedures were performed (median age 57 years, 20/26 imaged within 48 hours after stroke). In BA plots, all four PW-MRI maps could not reliably reflect the degree of CCD. In receiver operating characteristic analysis for detection of CCD, PW-CBF performed poorly (accuracy 0.61), whereas CBV, MTT, and TTP failed (accuracy <0.60). On the basis of our findings, PW-MRI at 1.5 T is not suited to depict CCD after stroke.
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Biran V, Heine VM, Verney C, Sheldon RA, Spadafora R, Vexler ZS, Rowitch DH, Ferriero DM. Cerebellar abnormalities following hypoxia alone compared to hypoxic-ischemic forebrain injury in the developing rat brain. Neurobiol Dis 2011; 41:138-46. [PMID: 20843479 PMCID: PMC3910430 DOI: 10.1016/j.nbd.2010.09.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 08/07/2010] [Accepted: 09/03/2010] [Indexed: 11/26/2022] Open
Abstract
Two-day-old (P2) rat pups were subjected to either a global hypoxia or to electrocoagulation of the right carotid artery followed by 2.5 h hypoxia. Cellular and regional injury in the cerebellum (CB) was studied at 1, 2 and 19 days using immunohistology. Following hypoxia and hypoxia-ischemia, all neuronal populations of the CB were damaged in a subset of Purkinje cells. The decrease in the number of interneurons, as well as the thickness of molecular and granular layers was significant following hypoxia. Diffuse white matter damage, with loss of preoligodendrocytes was more severe following hypoxia than hypoxia-ischemia. Global hypoxia in the rat at P2 produces extensive damage to many cell types in different areas of the CB. The addition of unilateral forebrain ischemia does not increase the severity of these changes. Our data provide insight into the mechanisms of the changes observed in the CB of premature newborns.
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Affiliation(s)
- Valerie Biran
- Department of Neurology and Pediatrics, University of California San Francisco, San Francisco, CA, USA.
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Zopf R, Fruhmann Berger M, Klose U, Karnath HO. Perfusion imaging of the right perisylvian neural network in acute spatial neglect. Front Hum Neurosci 2009; 3:15. [PMID: 19680470 PMCID: PMC2726039 DOI: 10.3389/neuro.09.015.2009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2009] [Accepted: 07/15/2009] [Indexed: 11/13/2022] Open
Abstract
Recent studies have suggested a tightly connected perisylvian neural network associated with spatial neglect. Here we investigated whether structural damage in one part of the network typically is accompanied with functional damage in other, structurally intact areas of this network. By combining normalized fluid-attenuated inversion-recovery (FLAIR) imaging, diffusion-weighted imaging (DWI), and perfusion-weighted imaging (PWI) we asked whether or not lesions centering on fronto-temporal regions co-occur with abnormal perfusion in structurally intact parietal cortex. With thresholds applied to delineate behaviourally relevant malperfusion of brain tissue, the analysis of normalized time-to-peak (TTP) and maximal signal reduction (MSR) perfusion maps did not reveal significant changes outside the area of structural damage. In particular, we found no abnormal perfusion in the structurally intact inferior parietal lobule (IPL) and/or the temporo-parietal junction (TPJ). The present results obtained in three consecutively admitted neglect patients with fronto-temporal lesions indicate that structural damage in one part of the right perisylvian network associated with spatial neglect does not necessarily require dysfunction by malperfusion in other, structurally intact parts of the network to provoke spatial neglect. The neural tissue in the fronto-temporal cortex appears to have an original role in processes of spatial orienting and exploration.
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Affiliation(s)
- Regine Zopf
- Section of Neuropsychology, Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen Tübingen, Germany.
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Lin DDM, Kleinman JT, Wityk RJ, Gottesman RF, Hillis AE, Lee AW, Barker PB. Crossed cerebellar diaschisis in acute stroke detected by dynamic susceptibility contrast MR perfusion imaging. AJNR Am J Neuroradiol 2009; 30:710-5. [PMID: 19193758 DOI: 10.3174/ajnr.a1435] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Crossed cerebellar diaschisis (CCD), the decrease in blood flow and metabolism in the cerebellar hemisphere contralateral to a supratentorial stroke, is frequently reported on positron-emission tomography (PET) and single-photon emission CT (SPECT) but is rarely described with MR perfusion techniques. This study was undertaken to determine the frequency of CCD observed in acute stroke by retrospective review of a research data base of patients with acute stroke evaluated by diffusion-weighted (DWI) and dynamic contrast susceptibility perfusion MR imaging (PWI). MATERIALS AND METHODS PWI scans of 301 consecutive patients with acute stroke and positive DWI abnormality from a research data base were reviewed. Contralateral cerebellar hypoperfusion was identified by inspection of time-to-peak (TTP) maps for asymmetry with an absence of cerebellar abnormalities on T2-weighted scans, DWI, or disease of the vertebrobasilar system on MR angiography. In a subset of the cases, quantitative analysis of perfusion scans was performed using an arterial input function and singular value decomposition (SVD) to generate cerebral blood flow (CBF) maps. RESULTS A total of 47 of 301 cases (15.61%) met the criteria of CCD by asymmetry of cerebellar perfusion on TTP maps. On quantitative analysis, there was corresponding reduction of CBF by 22.75 +/- 10.94% (range, 7.45% to 52.13%) of the unaffected cerebellar hemisphere). CONCLUSIONS MR perfusion techniques can be used to detect CCD, though the frequency presented in this series is lower than that commonly reported in the PET/SPECT literature. Nevertheless, with its role in acute stroke and noninvasive nature, MR perfusion may be a viable alternative to PET or SPECT to study the phenomenon and clinical consequences of supratentorial stroke with CCD.
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Affiliation(s)
- D D M Lin
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Ebinger M, De Silva DA, Christensen S, Parsons MW, Markus R, Donnan GA, Davis SM. Imaging the penumbra - strategies to detect tissue at risk after ischemic stroke. J Clin Neurosci 2008; 16:178-87. [PMID: 19097909 DOI: 10.1016/j.jocn.2008.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 03/05/2008] [Accepted: 04/06/2008] [Indexed: 10/21/2022]
Abstract
The aim of thrombolytic therapy after acute ischemic stroke is salvage of the ischemic penumbra. Several imaging techniques have been used to identify the penumbra in patients who may benefit from reperfusion beyond the currently narrow 3-hour time-window for thrombolysis. We discuss the advantages and disadvantages of positron emission tomography (PET), single photon emission computed tomography (SPECT), MRI and CT scans. We comment on concepts of clinical-imaging mismatch models and we explore the implications for clinical trials.
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Affiliation(s)
- M Ebinger
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria 3050, Australia
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Liu Y, Karonen JO, Nuutinen J, Vanninen E, Kuikka JT, Vanninen RL. Crossed cerebellar diaschisis in acute ischemic stroke: a study with serial SPECT and MRI. J Cereb Blood Flow Metab 2007; 27:1724-32. [PMID: 17311077 DOI: 10.1038/sj.jcbfm.9600467] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study evaluated the relationship between crossed cerebellar diaschisis (CCD) and (1) lesion volume and location in the acute phase and 1 week after stroke onset and (2) clinical outcome. Twenty-two patients with cerebral ischemic stroke underwent single-photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI) within 48 h and on day 8 from onset. Interhemispheric asymmetric indices (AI) on SPECT were calculated for medial, intermediate, and lateral zones of the cerebellum. Lesion volumes and locations were obtained from diffusion-weighted MRI. Neurological status and 3-month clinical outcome were evaluated. Within 48 h, lesion locations in the temporal association cortex and pyramidal tract of the corona radiata were independent determinants for the AI of the medial zone (R(2)=0.439). Lesion locations in the primary, premotor, and supplementary motor cortices, primary somatosensory cortex, and anterior part of the posterior limb of the internal capsule were determinants for the AI of the intermediate zone (R(2)=0.785). Lesions in the primary motor cortex, premotor, and supplementary motor cortices and in the genu of the internal capsule were determinants for the AI of the lateral zone (R(2)=0.746). On day 8, the associations were decreased. The AIs of the intermediate and lateral zones and lesion location in the parietal association cortex were independently associated with the 3-month clinical outcome (R(2)>0.555). Acute CCD is a result of functional deafference, while in the subacute phase, transneuronal degeneration might contribute to CCD. CCD in the intermediate and later zones is a better indicator than that in the medial zone.
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Affiliation(s)
- Yawu Liu
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio University, Kuopio, Finland.
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Ogasawara K, Kobayashi M, Suga Y, Chida K, Saito H, Komoribayashi N, Otawara Y, Ogawa A. Significance of postoperative crossed cerebellar hypoperfusion in patients with cerebral hyperperfusion following carotid endarterectomy: SPECT study. Eur J Nucl Med Mol Imaging 2007; 35:146-52. [PMID: 17899075 DOI: 10.1007/s00259-007-0588-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 08/20/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE Cerebral hyperperfusion after carotid endarterectomy (CEA) results in cerebral hyperperfusion syndrome and cognitive impairment. The goal of the present study was to clarify the clinical significance of postoperative crossed cerebellar hypoperfusion (CCH) in patients with cerebral hyperperfusion after CEA by assessing brain perfusion with single-photon emission computed tomography (SPECT). METHODS Brain perfusion was quantitatively measured using SPECT and the [(123)I]N-isopropyl-p-iodoamphetamine-autoradiography method before and immediately after CEA and on the third postoperative day in 80 patients with ipsilateral internal carotid artery stenosis (>or=70%). Postoperative CCH was determined by differences between asymmetry of perfusion in bilateral cerebellar hemispheres before and after CEA. Neuropsychological testing was also performed preoperatively and at the first postoperative month. RESULTS Eleven patients developed cerebral hyperperfusion (cerebral blood flow increase of >or=100% compared with preoperative values) on SPECT imaging performed immediately after CEA. In seven of these patients, CCH was observed on the third postoperative day. All three patients with hyperperfusion syndrome exhibited cerebral hyperperfusion and CCH on the third postoperative day and developed postoperative cognitive impairment. Of the eight patients with asymptomatic hyperperfusion, four exhibited CCH despite resolution of cerebral hyperperfusion on the third postoperative day, and three of these patients experienced postoperative cognitive impairment. In contrast, four patients without postoperative CCH did not experience postoperative cognitive impairment. CONCLUSIONS The presence of postoperative CCH with concomitant cerebral hyperperfusion reflects the development of hyperperfusion syndrome. Further, the presence of postoperative CCH in patients with cerebral hyperperfusion following CEA suggests development of postoperative cognitive impairment, even when asymptomatic.
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Affiliation(s)
- Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-8505, Japan.
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Hosoda K, Ishii K, Minoshima S, Kohmura E. Probabilistic cortical surface map of the middle cerebral artery territory for single-photon emission computed tomography studies. J Neurosurg 2007; 106:119-27. [PMID: 17236497 DOI: 10.3171/jns.2007.106.1.119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The middle cerebral artery (MCA) is the intracranial vessel most frequently affected by cerebrovascular diseases. A more accurate knowledge of the topography of this vessel may have an impact on treatment strategies for ischemic cerebrovascular diseases. The aim of this study was to construct a topographic map of the MCA territory for single-photon emission computed tomography (SPECT) using statistical brain mapping. METHODS The margin of the perfusion deficit associated with infarction due to arterial occlusion, as seen on SPECT imaging, is presumed to approximate the borders of the territory of the artery. Basing the study on this hypothesis, SPECT images obtained in 12 patients with large MCA infarctions due to angiographically confirmed MCA trunk occlusion were selected, anatomically standardized, and compared with SPECT images obtained in healthy volunteers to construct probabilistic cortical surface maps of the MCA territory. Crossed cerebellar diaschisis was used as a primary cutoff marker for creation of the map. This MCA map (Method C) was compared with the conventional region of interest (ROI) method (Method A) and previously reported predefined cortical templates (Method B) for preliminary clinical application. The probabilistic cortical surface map of the MCA territory showed that regions with the highest ratio of MCA territory included the transverse temporal gyrus (100%), supramarginal gyrus (100%), and inferior parietal lobule (91-92%). For preliminarily clinical application, this map (Method C) was compared with the conventional ROI method (Method A) in predicting hyperperfusion after carotid endarterectomy by performing a receiver operating characteristic (ROC) analysis, which demonstrated the statistically significant superiority of the MCA map (area under the ROC curve [Az] = 0.91) to the ROI method (Az = 0.75; p = 0.025). The ROC analysis also demonstrated a diagnostic value of the MCA map (Az = 0.95) that equaled predefined cortical templates (Method B) (Az = 0.93). CONCLUSIONS The probabilistic cortical surface map of the MCA territory used for SPECT, which was created using statistical brain mapping techniques, would be useful for an objective assessment of the cerebral perfusion status of patients with cerebrovascular diseases.
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Affiliation(s)
- Kohkichi Hosoda
- Department of Neurosurgery, Hyogo Emergency Medical Center/Kobe Red Cross Hospital, Kobe, Japan.
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Raymont V, Grafman J. Cognitive neural plasticity during learning and recovery from brain damage. PROGRESS IN BRAIN RESEARCH 2007; 157:199-206. [PMID: 17046672 DOI: 10.1016/s0079-6123(06)57013-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The process of neuroplasticity is the ability of the brain to change, either in response to experience or injury. It is a vital process both during normal development and for the recovery after brain injury. Recent research has emphasized that this takes place via both local restitution as well as reorganization and compensatory reassignment. The fact that the brain can undergo such plastic changes has provided evidence for what underlies developmental brain disorders, as well as the variable response to injury at different points in the lifespan. The factors affecting plasticity and its long-term consequences may have increasing importance in exposing the pattern of changes that occur in the normal brain with aging.
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Affiliation(s)
- Vanessa Raymont
- Vietnam Head Injury Study, National Naval Medical Center, Bethesda, MD, USA
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