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Liu CF, Hsu J, Xu X, Kim G, Sheppard SM, Meier EL, Miller MI, Hillis AE, Faria AV. Digital 3D Brain MRI Arterial Territories Atlas. Sci Data 2023; 10:74. [PMID: 36739282 PMCID: PMC9899211 DOI: 10.1038/s41597-022-01923-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 12/21/2022] [Indexed: 02/06/2023] Open
Abstract
The locus and extent of brain damage in the event of vascular insult can be quantitatively established quickly and easily with vascular atlases. Although highly anticipated by clinicians and clinical researchers, no digital MRI arterial atlas is readily available for automated data analyses. We created a digital arterial territory atlas based on lesion distributions in 1,298 patients with acute stroke. The lesions were manually traced in the diffusion-weighted MRIs, binary stroke masks were mapped to a common space, probability maps of lesions were generated and the boundaries for each arterial territory was defined based on the ratio between probabilistic maps. The atlas contains the definition of four major supra- and infra-tentorial arterial territories: Anterior, Middle, Posterior Cerebral Arteries and Vertebro-Basilar, and sub-territories (thalamoperforating, lenticulostriate, basilar and cerebellar arterial territories), in two hierarchical levels. This study provides the first publicly-available, digital, 3D deformable atlas of arterial brain territories, which may serve as a valuable resource for large-scale, reproducible processing and analysis of brain MRIs of patients with stroke and other conditions.
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Affiliation(s)
- Chin-Fu Liu
- Center for Imaging Science, Johns Hopkins University, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Johnny Hsu
- Department of Radiology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Xin Xu
- Department of Radiology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ganghyun Kim
- Center for Imaging Science, Johns Hopkins University, Baltimore, MD, USA
- Department of Neuroscience, Johns Hopkins University, Baltimore, MD, USA
| | - Shannon M Sheppard
- Department of Communication Sciences & Disorders, Chapman University, Orange, CA, USA
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Erin L Meier
- Department of Communication Sciences & Disorders, Northeastern University, Boston, MA, USA
| | - Michael I Miller
- Center for Imaging Science, Johns Hopkins University, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Kavli Neuroscience Discovery Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Argye E Hillis
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Physical Medicine & Rehabilitation, and Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
| | - Andreia V Faria
- Department of Radiology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
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Integrity of the Left Arcuate Fasciculus Segments Significantly Affects Language Performance in Individuals with Acute/Subacute Post-Stroke Aphasia: A Cross-Sectional Diffusion Tensor Imaging Study. Brain Sci 2022; 12:brainsci12070907. [PMID: 35884714 PMCID: PMC9313217 DOI: 10.3390/brainsci12070907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 01/05/2023] Open
Abstract
Objective: To investigate the correlation between the left arcuate fasciculus (AF) segments and acute/subacute post-stroke aphasia (PSA). Methods: Twenty-six patients underwent language assessment and MRI scanning. The integrity of the AF based on a three-segment model was evaluated using diffusion tensor imaging. All patients were classified into three groups according to the reconstruction of the left AF: completely reconstructed (group A, 8 cases), non-reconstructed (group B, 6 cases), and partially reconstructed (group C, 12 cases). The correlations and intergroup differences in language performance and diffusion indices were comprehensively estimated. Results: A correlation analyses showed that the lesion load of the language areas and diffusion indices on the left AF posterior and long segments was significantly related to some language subsets, respectively. When controlled lesion load was variable, significant correlations between diffusion indices on the posterior and long segments and comprehension, repetition, naming, and aphasia quotient were retained. Multiple comparison tests revealed intergroup differences in diffusion indices on the left AF posterior and long segments, as well as these language subsets. No significant correlation was found between the anterior segment and language performance. Conclusions: The integrity of the left AF segments, particularly the posterior segment, is crucial for the residual comprehension and repetition abilities in individuals with acute/subacute PSA, and lesion load in cortical language areas is an important factor that should be taken into account when illustrating the contributions of damage to special fiber tracts to language impairments.
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Meier EL, Kelly CR, Goldberg EB, Hillis AE. Executive control deficits and lesion correlates in acute left hemisphere stroke survivors with and without aphasia. Brain Imaging Behav 2022; 16:868-877. [PMID: 34647269 PMCID: PMC8514281 DOI: 10.1007/s11682-021-00580-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2021] [Indexed: 01/18/2023]
Abstract
In contrast to the traditional definition of the disorder, many individuals with aphasia exhibit non-linguistic cognitive impairments, including executive control deficits. Classic lesion studies cite frontal lobe damage in executive dysfunction, but more recent lesion symptom-mapping studies in chronic aphasia present mixed results. In this study, we compared executive control abilities of acute stroke survivors with and without aphasia and investigated lesion correlates of linguistic and non-linguistic cognitive tasks. Twenty-nine participants with acute left hemisphere stroke resulting in aphasia (n = 14) or no aphasia (n = 15) completed clinical MRI and testing, including three NIH Toolbox Cognition Batteries (Pattern Comparison Processing Speed, Flanker Inhibitory Control and Attention, and Dimensional Change Card Sort Tests) and the Boston Naming Test. We compared performance between groups using Wilcoxon rank sum tests. We used Least Absolute Shrinkage and Selection Operator Regression to identify neural markers (percent regional damage, hypoperfusion within vascular territories, and total lesion volume) of executive control deficits and anomia. Group performance was comparable on the Pattern Comparison Processing Speed Test, but people with aphasia had poorer standard scores, lower accuracy, and slower response times on the Dimensional Change Card Sort Test than people without aphasia. Damage to extrasylvian regions (dorsolateral prefrontal cortex, intraparietal sulcus) was related to executive control deficits, whereas language network damage (to inferior frontal and superior and posterior middle temporal gyri) was linked to naming impairments. These results suggest people with aphasia can exhibit comorbid executive control impairments linked to damage outside classic language network areas.
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Affiliation(s)
- Erin L Meier
- Department of Communication Sciences and Disorders, Northeastern University, 360 Huntington Avenue, 228C FR, Boston, MA, 02215, USA.
| | - Catherine R Kelly
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Emily B Goldberg
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA
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4
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Wawrzyniak M, Schneider HR, Klingbeil J, Stockert A, Hartwigsen G, Weiller C, Saur D. Resolution of diaschisis contributes to early recovery from post-stroke aphasia. Neuroimage 2022; 251:119001. [PMID: 35172200 DOI: 10.1016/j.neuroimage.2022.119001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 01/31/2022] [Accepted: 02/12/2022] [Indexed: 11/15/2022] Open
Abstract
Diaschisis is a phenomenon observed in stroke that is defined as neuronal dysfunction in regions spared by the infarction but connected to the lesion site. We combined lesion network mapping and task-based functional MRI in 71 patients with post-stroke aphasia to investigate, whether diaschisis and its resolution contribute to early loss and recovery of language functions. Language activation acquired in the acute, subacute and chronic phase was analyzed in compartments with high and low normative resting-state functional connectivity to the lesion site on an individual basis. Regions with high compared to regions with low lesion connectivity showed a steeper increase in language reactivation from the acute to the subacute phase. This finding is compatible with the assumption of resolution of diaschisis. Additionally, language performance in the subacute phase and improvement from the subacute to the chronic phase significantly correlated with the diaschisis effect and its resolution, respectively, suggesting a behavioral relevance of this effect. We therefore assume that undamaged but functionally connected regions become dysfunctional due to missing input from the lesion contributing to the aphasic deficit. Since these regions are structurally intact, dysfunction resolves over time contributing to the rapid early behavioral improvement observed in aphasic stroke patients. Our results demonstrate that diaschisis and its resolution might be a relevant mechanism of early loss and recovery of language function in acute stroke patients.
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Affiliation(s)
- Max Wawrzyniak
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany.
| | - Hans R Schneider
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Julian Klingbeil
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Anika Stockert
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Gesa Hartwigsen
- Lise Meitner Research Group 'Cognition and Plasticity', Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Cornelius Weiller
- Freiburg Brain Imaging Center, Department of Neurology, University of Freiburg, Freiburg, Germany
| | - Dorothee Saur
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
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Meier EL, Sheppard SM, Goldberg EB, Kelly CR, Walker A, Ubellacker DM, Vitti E, Ruch K, Hillis AE. Dysfunctional Tissue Correlates of Unrelated Naming Errors in Acute Left Hemisphere Stroke. LANGUAGE, COGNITION AND NEUROSCIENCE 2021; 37:330-347. [PMID: 35665076 PMCID: PMC9159539 DOI: 10.1080/23273798.2021.1980593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 08/31/2021] [Indexed: 06/15/2023]
Abstract
Most naming error lesion-symptom mapping (LSM) studies have focused on semantic and/or phonological errors. Anomic individuals also produce unrelated word errors, which may be linked to semantic or modality-independent lexical deficits. To investigate the neural underpinnings of rarely-studied unrelated errors, we conducted LSM analyses in 100 individuals hospitalized with a left hemisphere stroke who completed imaging protocols and language assessments. We used least absolute shrinkage and selection operator regression to capture relationships between naming errors and dysfunctional brain tissue metrics (regional damage or hypoperfusion in vascular territories) in two groups: participants with and without impaired single-word auditory comprehension. Hypoperfusion-particularly within the parietal lobe-was an important error predictor, especially for the unimpaired group. In both groups, higher unrelated error proportions were associated with primarily ventral stream damage, the language route critical for processing meaning. Nonetheless, brain metrics implicated in unrelated errors were distinct from semantic error correlates.
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Affiliation(s)
- Erin L. Meier
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shannon M. Sheppard
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Communication Sciences and Disorders, Chapman University, Irvine, CA
| | - Emily B. Goldberg
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Catherine R. Kelly
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alexandra Walker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Emilia Vitti
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kristina Ruch
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD
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6
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Fregni F, El-Hagrassy MM, Pacheco-Barrios K, Carvalho S, Leite J, Simis M, Brunelin J, Nakamura-Palacios EM, Marangolo P, Venkatasubramanian G, San-Juan D, Caumo W, Bikson M, Brunoni AR. Evidence-Based Guidelines and Secondary Meta-Analysis for the Use of Transcranial Direct Current Stimulation in Neurological and Psychiatric Disorders. Int J Neuropsychopharmacol 2021; 24:256-313. [PMID: 32710772 PMCID: PMC8059493 DOI: 10.1093/ijnp/pyaa051] [Citation(s) in RCA: 226] [Impact Index Per Article: 75.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation has shown promising clinical results, leading to increased demand for an evidence-based review on its clinical effects. OBJECTIVE We convened a team of transcranial direct current stimulation experts to conduct a systematic review of clinical trials with more than 1 session of stimulation testing: pain, Parkinson's disease motor function and cognition, stroke motor function and language, epilepsy, major depressive disorder, obsessive compulsive disorder, Tourette syndrome, schizophrenia, and drug addiction. METHODS Experts were asked to conduct this systematic review according to the search methodology from PRISMA guidelines. Recommendations on efficacy were categorized into Levels A (definitely effective), B (probably effective), C (possibly effective), or no recommendation. We assessed risk of bias for all included studies to confirm whether results were driven by potentially biased studies. RESULTS Although most of the clinical trials have been designed as proof-of-concept trials, some of the indications analyzed in this review can be considered as definitely effective (Level A), such as depression, and probably effective (Level B), such as neuropathic pain, fibromyalgia, migraine, post-operative patient-controlled analgesia and pain, Parkinson's disease (motor and cognition), stroke (motor), epilepsy, schizophrenia, and alcohol addiction. Assessment of bias showed that most of the studies had low risk of biases, and sensitivity analysis for bias did not change these results. Effect sizes vary from 0.01 to 0.70 and were significant in about 8 conditions, with the largest effect size being in postoperative acute pain and smaller in stroke motor recovery (nonsignificant when combined with robotic therapy). CONCLUSION All recommendations listed here are based on current published PubMed-indexed data. Despite high levels of evidence in some conditions, it must be underscored that effect sizes and duration of effects are often limited; thus, real clinical impact needs to be further determined with different study designs.
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Affiliation(s)
- Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
| | - Mirret M El-Hagrassy
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Sandra Carvalho
- Neurotherapeutics and experimental Psychopathology Group (NEP), Psychological Neuroscience Laboratory, CIPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Jorge Leite
- I2P-Portucalense Institute for Psychology, Universidade Portucalense, Porto, Portugal
| | - Marcel Simis
- Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital, Sao Paulo, Brazil
| | - Jerome Brunelin
- CH Le Vinatier, PSYR2 team, Lyon Neuroscience Research Center, UCB Lyon 1, Bron, France
| | - Ester Miyuki Nakamura-Palacios
- Laboratory of Cognitive Sciences and Neuropsychopharmacology, Department of Physiological Sciences, Federal University of Espírito Santo, Espírito Santo, Brasil (Dr Nakamura-Palacios)
| | - Paola Marangolo
- Dipartimento di Studi Umanistici, Università Federico II, Naples, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Ganesan Venkatasubramanian
- Translational Psychiatry Laboratory, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Daniel San-Juan
- Neurophysiology Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
| | - Wolnei Caumo
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS) Surgery Department, School of Medicine, UFRGS; Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre (HCPA) Laboratory of Pain and Neuromodulation at HCPA, Porto Alegre, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, New York
| | - André R Brunoni
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry & Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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7
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Cramer SC, Wolf SL, Saver JL, Johnston KC, Mocco J, Lansberg MG, Savitz SI, Liebeskind DS, Smith W, Wintermark M, Elm JJ, Khatri P, Broderick JP, Janis S. The Utility of Domain-Specific End Points in Acute Stroke Trials. Stroke 2021; 52:1154-1161. [PMID: 33563009 DOI: 10.1161/strokeaha.120.031939] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Steven C Cramer
- Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles (S.C.C., J.L.S., D.S.L.).,California Rehabilitation Institute, Los Angeles (S.C.C.)
| | - Steven L Wolf
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA (S.L.W.)
| | - Jeffrey L Saver
- Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles (S.C.C., J.L.S., D.S.L.)
| | - Karen C Johnston
- Department of Neurology, University of Virginia, Charlottesville (K.C.J.)
| | - J Mocco
- Department of Neurosurgery, Mt. Sinai, New York (J.M.)
| | | | - Sean I Savitz
- Institute for Stroke and Cerebrovascular Disease, University of Texas Health Science Center, Houston (S.I.S.)
| | - David S Liebeskind
- Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles (S.C.C., J.L.S., D.S.L.)
| | - Wade Smith
- Department Neurology, University of California, San Francisco (W.S.)
| | | | - Jordan J Elm
- Department of Public Health Sciences, Medical University of South Carolina, Charleston (J.J.E.)
| | - Pooja Khatri
- Department of Neurology, University of Cincinnati (P.K.)
| | - Joseph P Broderick
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, University of Cincinnati Academic Health Center, OH (J.P.B.)
| | - Scott Janis
- Division of Clinical Research, The National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (S.J.)
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8
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Meier EL, Sheppard SM, Goldberg EB, Head CR, Ubellacker DM, Walker A, Hillis AE. Naming errors and dysfunctional tissue metrics predict language recovery after acute left hemisphere stroke. Neuropsychologia 2020; 148:107651. [PMID: 33045231 PMCID: PMC7546715 DOI: 10.1016/j.neuropsychologia.2020.107651] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 12/11/2022]
Abstract
Language recovery following acute left hemisphere (LH) stroke is notoriously difficult to predict. Global language measures (e.g., overall aphasia severity) and gross lesion metrics (e.g., size) provide incomplete recovery predictions. In this study, we test the hypothesis that the types of naming errors patients produce, combined with dysfunctional brain tissue metrics, can provide additional insight into recovery following acute LH stroke. One hundred forty-eight individuals who were hospitalized with a new LH stroke completed clinical neuroimaging and assessments of naming and global language skills. A subset of participants again completed language testing at subacute, early (5-7 months post-stroke), and late (≥11 months post-stroke) chronic phases. At each time point, we coded naming errors into four types (semantic, phonological, mixed and unrelated) and determined error type totals and proportions. Dysfunctional tissue measures included the percentage of damage to language network regions and hypoperfusion in vascular territories. A higher proportion of semantic errors was associated with better acute naming, but higher proportions of other error types was related to poorer accuracy. Naming and global language skills significantly improved over time , but naming error profiles did not change. Fewer acute unrelated errors and less damage to left angular gyrus resulted in optimal naming and language recovery by the final testing time point, yet patients with more acute errors and damage to left middle temporal gyrus demonstrated the greatest increases in language over time. These results illustrate that naming error profiles, particularly unrelated errors, add power to predictions of language recovery after stroke.
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Affiliation(s)
- Erin L Meier
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Shannon M Sheppard
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Communication Sciences and Disorders, Chapman University, Irvine, CA, USA
| | - Emily B Goldberg
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Catherine R Head
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Delaney M Ubellacker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexandra Walker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
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9
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Abstract
Acute ischemic stroke represents a major cause of long-term adult disability. Accurate prognostication of post-stroke functional outcomes is invaluable in guiding patient care, targeting early rehabilitation efforts, selecting patients for clinical research, and conveying realistic expectations to families. The involvement of specific brain regions by acute ischemia can alter post-stroke recovery potential. Understanding the influences of infarct topography on neurologic outcomes holds significant promise in prognosis of functional recovery. In this review, we discuss the recent evidence of the contribution of infarct location to patient management decisions and functional outcomes after acute ischemic stroke.
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Affiliation(s)
- Mark R Etherton
- 1 Harvard Medical School, Boston, MA, USA.,2 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Natalia S Rost
- 1 Harvard Medical School, Boston, MA, USA.,2 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Ona Wu
- 1 Harvard Medical School, Boston, MA, USA.,3 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
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10
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Shuster LI. Considerations for the Use of Neuroimaging Technologies for Predicting Recovery of Speech and Language in Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:291-305. [PMID: 29497745 DOI: 10.1044/2018_ajslp-16-0180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/16/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE The number of research articles aimed at identifying neuroimaging biomarkers for predicting recovery from aphasia continues to grow. Although the clinical use of these biomarkers to determine prognosis has been proposed, there has been little discussion of how this would be accomplished. This is an important issue because the best translational science occurs when translation is considered early in the research process. The purpose of this clinical focus article is to present a framework to guide the discussion of how neuroimaging biomarkers for recovery from aphasia could be implemented clinically. METHOD The genomics literature reveals that implementing genetic testing in the real-world poses both opportunities and challenges. There is much similarity between these opportunities and challenges and those related to implementing neuroimaging testing to predict recovery in aphasia. Therefore, the Center for Disease Control's model list of questions aimed at guiding the review of genetic testing has been adapted to guide the discussion of using neuroimaging biomarkers as predictors of recovery in aphasia. CONCLUSION The adapted model list presented here is a first and useful step toward initiating a discussion of how neuroimaging biomarkers of recovery could be employed clinically to provide improved quality of care for individuals with aphasia.
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Affiliation(s)
- Linda I Shuster
- Department of Speech, Language, and Hearing Sciences, Western Michigan University, Kalamazoo
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11
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Kielar A, Deschamps T, Chu RKO, Jokel R, Khatamian YB, Chen JJ, Meltzer JA. Identifying Dysfunctional Cortex: Dissociable Effects of Stroke and Aging on Resting State Dynamics in MEG and fMRI. Front Aging Neurosci 2016; 8:40. [PMID: 26973515 PMCID: PMC4776400 DOI: 10.3389/fnagi.2016.00040] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/15/2016] [Indexed: 11/13/2022] Open
Abstract
Spontaneous signals in neuroimaging data may provide information on cortical health in disease and aging, but the relative sensitivity of different approaches is unknown. In the present study, we compared different but complementary indicators of neural dynamics in resting-state MEG and BOLD fMRI, and their relationship with blood flow. Participants included patients with post-stroke aphasia, age-matched controls, and young adults. The complexity of brain activity at rest was quantified in MEG using spectral analysis and multiscale entropy (MSE) measures, whereas BOLD variability was quantified as the standard deviation (SDBOLD), mean squared successive difference (MSSD), and sample entropy of the BOLD time series. We sought to assess the utility of signal variability and complexity measures as markers of age-related changes in healthy adults and perilesional dysfunction in chronic stroke. The results indicate that reduced BOLD variability is a robust finding in aging, whereas MEG measures are more sensitive to the cortical abnormalities associated with stroke. Furthermore, reduced complexity of MEG signals in perilesional tissue were correlated with hypoperfusion as assessed with arterial spin labeling (ASL), while no such relationship was apparent with BOLD variability. These findings suggest that MEG signal complexity offers a sensitive index of neural dysfunction in perilesional tissue in chronic stroke, and that these effects are clearly distinguishable from those associated with healthy aging.
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Affiliation(s)
- Aneta Kielar
- Rotman Research Institute, Baycrest Health SciencesToronto, ON, Canada
| | - Tiffany Deschamps
- Rotman Research Institute, Baycrest Health SciencesToronto, ON, Canada
| | - Ron K. O. Chu
- Rotman Research Institute, Baycrest Health SciencesToronto, ON, Canada
- Department of Psychology, University of TorontoToronto, ON, Canada
| | - Regina Jokel
- Rotman Research Institute, Baycrest Health SciencesToronto, ON, Canada
- Department of Speech-Language Pathology, University of TorontoToronto, ON, Canada
| | | | - Jean J. Chen
- Rotman Research Institute, Baycrest Health SciencesToronto, ON, Canada
- Department of Medical Biophysics, University of TorontoToronto, ON, Canada
- Canadian Partnership for Stroke RecoveryOttawa, ON, Canada
| | - Jed A. Meltzer
- Rotman Research Institute, Baycrest Health SciencesToronto, ON, Canada
- Department of Psychology, University of TorontoToronto, ON, Canada
- Department of Speech-Language Pathology, University of TorontoToronto, ON, Canada
- Canadian Partnership for Stroke RecoveryOttawa, ON, Canada
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12
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Sandars M, Cloutman L, Woollams AM. Taking Sides: An Integrative Review of the Impact of Laterality and Polarity on Efficacy of Therapeutic Transcranial Direct Current Stimulation for Anomia in Chronic Poststroke Aphasia. Neural Plast 2015; 2016:8428256. [PMID: 26819777 PMCID: PMC4706968 DOI: 10.1155/2016/8428256] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 08/10/2015] [Accepted: 08/24/2015] [Indexed: 11/18/2022] Open
Abstract
Anomia is a frequent and persistent symptom of poststroke aphasia, resulting from damage to areas of the brain involved in language production. Cortical neuroplasticity plays a significant role in language recovery following stroke and can be facilitated by behavioral speech and language therapy. Recent research suggests that complementing therapy with neurostimulation techniques may enhance functional gains, even amongst those with chronic aphasia. The current review focuses on the use of transcranial Direct Current Stimulation (tDCS) as an adjunct to naming therapy for individuals with chronic poststroke aphasia. Our survey of the literature indicates that combining therapy with anodal (excitatory) stimulation to the left hemisphere and/or cathodal (inhibitory) stimulation to the right hemisphere can increase both naming accuracy and speed when compared to the effects of therapy alone. However, the benefits of tDCS as a complement to therapy have not been yet systematically investigated with respect to site and polarity of stimulation. Recommendations for future research to help determine optimal protocols for combined therapy and tDCS are outlined.
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Affiliation(s)
- Margaret Sandars
- Neuroscience and Aphasia Research Unit, School of Psychological Sciences, 3rd Floor, Zochonis Building, University of Manchester, Brunswick Street, Manchester M13 9PL, UK
| | - Lauren Cloutman
- Neuroscience and Aphasia Research Unit, School of Psychological Sciences, 3rd Floor, Zochonis Building, University of Manchester, Brunswick Street, Manchester M13 9PL, UK
| | - Anna M. Woollams
- Neuroscience and Aphasia Research Unit, School of Psychological Sciences, 3rd Floor, Zochonis Building, University of Manchester, Brunswick Street, Manchester M13 9PL, UK
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Abstract
In acute stroke, the major factor for recovery is the early use of thrombolysis aimed at arterial recanalization and reperfusion of ischemic brain tissue. Subsequently, neurorehabilitative training critically improves clinical recovery due to augmention of postlesional plasticity. Neuroimaging and electrophysiology studies have revealed that the location and volume of the stroke lesion, the affection of nerve fiber tracts, as well as functional and structural changes in the perilesional tissue and in large-scale bihemispheric networks are relevant biomarkers of post-stroke recovery. However, associated disorders, such as mood disorders, epilepsy, and neurodegenerative diseases, may induce secondary cerebral changes or aggravate the functional deficits and, thereby, compromise the potential for recovery.
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Affiliation(s)
- Rüdiger J Seitz
- Department of Neurology, Centre of Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Heinrich-Heine-University Düsseldorf , Düsseldorf , Germany ; Biomedical Research Centre, Heinrich-Heine-University Düsseldorf , Düsseldorf , Germany ; Florey Institute of Neuroscience and Mental Health, University of Melbourne , Parkville, VIC , Australia
| | - Geoffrey A Donnan
- Florey Institute of Neuroscience and Mental Health, University of Melbourne , Parkville, VIC , Australia
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Garrison KA, Rogalsky C, Sheng T, Liu B, Damasio H, Winstein CJ, Aziz-Zadeh LS. Functional MRI Preprocessing in Lesioned Brains: Manual Versus Automated Region of Interest Analysis. Front Neurol 2015; 6:196. [PMID: 26441816 PMCID: PMC4585177 DOI: 10.3389/fneur.2015.00196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 08/21/2015] [Indexed: 11/13/2022] Open
Abstract
Functional magnetic resonance imaging (fMRI) has significant potential in the study and treatment of neurological disorders and stroke. Region of interest (ROI) analysis in such studies allows for testing of strong a priori clinical hypotheses with improved statistical power. A commonly used automated approach to ROI analysis is to spatially normalize each participant's structural brain image to a template brain image and define ROIs using an atlas. However, in studies of individuals with structural brain lesions, such as stroke, the gold standard approach may be to manually hand-draw ROIs on each participant's non-normalized structural brain image. Automated approaches to ROI analysis are faster and more standardized, yet are susceptible to preprocessing error (e.g., normalization error) that can be greater in lesioned brains. The manual approach to ROI analysis has high demand for time and expertise, but may provide a more accurate estimate of brain response. In this study, commonly used automated and manual approaches to ROI analysis were directly compared by reanalyzing data from a previously published hypothesis-driven cognitive fMRI study, involving individuals with stroke. The ROI evaluated is the pars opercularis of the inferior frontal gyrus. Significant differences were identified in task-related effect size and percent-activated voxels in this ROI between the automated and manual approaches to ROI analysis. Task interactions, however, were consistent across ROI analysis approaches. These findings support the use of automated approaches to ROI analysis in studies of lesioned brains, provided they employ a task interaction design.
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Affiliation(s)
- Kathleen A Garrison
- Department of Psychiatry, Yale School of Medicine , New Haven, CT , USA ; Division of Biokinesiology and Physical Therapy, University of Southern California , Los Angeles, CA , USA ; Brain and Creativity Institute, University of Southern California , Los Angeles, CA , USA
| | - Corianne Rogalsky
- Brain and Creativity Institute, University of Southern California , Los Angeles, CA , USA ; Department of Speech and Hearing Science, Arizona State University , Tempe, AZ , USA
| | - Tong Sheng
- Brain and Creativity Institute, University of Southern California , Los Angeles, CA , USA ; Palo Alto VA Medical Center , Palo Alto, CA , USA ; Stanford University School of Medicine , Palo Alto, CA , USA
| | - Brent Liu
- Department of Biomedical Engineering, University of Southern California , Los Angeles, CA , USA
| | - Hanna Damasio
- Brain and Creativity Institute, University of Southern California , Los Angeles, CA , USA ; Department of Psychology, University of Southern California , Los Angeles, CA , USA
| | - Carolee J Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California , Los Angeles, CA , USA
| | - Lisa S Aziz-Zadeh
- Brain and Creativity Institute, University of Southern California , Los Angeles, CA , USA ; Department of Psychology, University of Southern California , Los Angeles, CA , USA ; Division of Occupational Science and Occupational Therapy, University of Southern California , Los Angeles, CA , USA
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Clarke S, Bindschaedler C, Crottaz-Herbette S. Impact of Cognitive Neuroscience on Stroke Rehabilitation. Stroke 2015; 46:1408-13. [DOI: 10.1161/strokeaha.115.007435] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 02/11/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Stephanie Clarke
- From the Service de Neuropsychologie et de Neuroréhabilitation, CHUV, Lausanne, Switzerland
| | - Claire Bindschaedler
- From the Service de Neuropsychologie et de Neuroréhabilitation, CHUV, Lausanne, Switzerland
| | - Sonia Crottaz-Herbette
- From the Service de Neuropsychologie et de Neuroréhabilitation, CHUV, Lausanne, Switzerland
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Ardila A, Bernal B, Rosselli M. Language and visual perception associations: meta-analytic connectivity modeling of Brodmann area 37. Behav Neurol 2015; 2015:565871. [PMID: 25648869 PMCID: PMC4306224 DOI: 10.1155/2015/565871] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 12/09/2014] [Accepted: 12/17/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Understanding the functions of different brain areas has represented a major endeavor of neurosciences. Historically, brain functions have been associated with specific cortical brain areas; however, modern neuroimaging developments suggest cognitive functions are associated to networks rather than to areas. OBJECTIVE The purpose of this paper was to analyze the connectivity of Brodmann area (BA) 37 (posterior, inferior, and temporal/fusiform gyrus) in relation to (1) language and (2) visual processing. METHODS Two meta-analyses were initially conducted (first level analysis). The first one was intended to assess the language network in which BA37 is involved. The second one was intended to assess the visual perception network. A third meta-analysis (second level analysis) was then performed to assess contrasts and convergence between the two cognitive domains (language and visual perception). The DataBase of Brainmap was used. RESULTS Our results support the role of BA37 in language but by means of a distinct network from the network that supports its second most important function: visual perception. CONCLUSION It was concluded that left BA37 is a common node of two distinct networks-visual recognition (perception) and semantic language functions.
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Affiliation(s)
- Alfredo Ardila
- Department of Communication Sciences and Disorders, Florida International University, Miami, FL 33199, USA
| | - Byron Bernal
- Radiology Department and Research Institute, Miami Children's Hospital, Miami, FL 33155, USA
| | - Monica Rosselli
- Department of Psychology, Florida Atlantic University, Davie, FL 33314, USA
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Rosso C, Vargas P, Valabregue R, Arbizu C, Henry-Amar F, Leger A, Lehéricy S, Samson Y. Aphasia severity in chronic stroke patients: a combined disconnection in the dorsal and ventral language pathways. Neurorehabil Neural Repair 2014; 29:287-95. [PMID: 25096274 DOI: 10.1177/1545968314543926] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The contribution of lesion size and location in poststroke aphasia is debated, especially the extent to which aphasia severity is affected by damage to specific white matter areas. OBJECTIVE To identify specific white matter areas critical for poststroke aphasia global severity and to determine whether injury to these areas had more impact on aphasia severity than the infarct volume. METHODS Twenty-three chronic poststroke aphasic patients were assessed with the Aphasia Rapid Test (ART) and the Boston Diagnosis Aphasia Examination (BDAE) global severity scales and underwent diffusion tensor and structural imaging. Voxel-based diffusion tensor imaging regression analysis was used to determine in which areas fractional anisotropy (FA) abnormalities were correlated with ART and BDAE severity scales. The relationships between aphasia severity, FA values, and infarct volumes were investigated using global and partial correlations. RESULTS We found a critical area associated with aphasia severity overlapping with the arcuate and the inferior fronto-occipital fasciculi, resulting in a combined disconnection of the dorsal and ventral pathways. ART scores were inversely correlated with FA values in this region, with greater severity present with lower FA values (correlation coefficient = -0.833, P < .0001). The proportion of variance explained by the FA value was higher than the proportion of variance explained by the infarct volume (R (2) = 68% vs 27%, P = .01). The impact of infarct volume on aphasia severity disappeared when damage to this critical white matter area was taken into account (P = .38). CONCLUSION The assessment of the integrity of this region may potentially have a clinical impact in neurorehabilitation and acute decision making.
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Affiliation(s)
- Charlotte Rosso
- CRICM-Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France INSERM, U1127; CNRS, UMR 7225, Paris, France COGIMAGE, Paris, France APHP, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France Univ Paris 11, IFR49, DSV/I2BM/NeuroSpin, Bat 145, Gif-sur-Yvette, France INSERM, AP-HP, Centre d'Investigation Clinique CIC9503, Département des Maladies du Système Nerveux, Hôpital Pitié-Salpêtrière, Paris, France
| | - Patricia Vargas
- CRICM-Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France INSERM, U1127; CNRS, UMR 7225, Paris, France COGIMAGE, Paris, France
| | - Romain Valabregue
- CRICM-Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France INSERM, U1127; CNRS, UMR 7225, Paris, France COGIMAGE, Paris, France Institut du Cerveau et de la Moelle épinière, Centre de Neuro-Imagerie de Recherche (CENIR), Paris, France
| | - Céline Arbizu
- APHP, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France Centre des maladies cognitives et comportementales, IM2A, Hôpital Pitié-Salpêtrière, Paris, France
| | - François Henry-Amar
- APHP, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France Centre des maladies cognitives et comportementales, IM2A, Hôpital Pitié-Salpêtrière, Paris, France
| | - Anne Leger
- APHP, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
| | - Stéphane Lehéricy
- CRICM-Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France INSERM, U1127; CNRS, UMR 7225, Paris, France COGIMAGE, Paris, France APHP, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France Institut du Cerveau et de la Moelle épinière, Centre de Neuro-Imagerie de Recherche (CENIR), Paris, France APHP, Service de Neuroradiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Yves Samson
- CRICM-Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris, France INSERM, U1127; CNRS, UMR 7225, Paris, France COGIMAGE, Paris, France APHP, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Paris, France
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18
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Stability of ischemic core volume during the initial hours of acute large vessel ischemic stroke in a subgroup of mechanically revascularized patients. Neuroradiology 2014; 56:325-32. [DOI: 10.1007/s00234-014-1329-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
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Longitudinal effects of lesions on functional networks after stroke. J Cereb Blood Flow Metab 2013; 33:1279-85. [PMID: 23715061 PMCID: PMC3734780 DOI: 10.1038/jcbfm.2013.80] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 03/19/2013] [Accepted: 04/26/2013] [Indexed: 11/08/2022]
Abstract
While ischemic stroke reflects focal damage determined by the affected vascular territory, clinical symptoms are often more complex and may be better explained by additional indirect effects of the focal lesion. Assumed to be structurally underpinned by anatomical connections, supporting evidence has been found using alterations in the functional connectivity of resting-state functional magnetic resonance imaging (fMRI) data in both sensorimotor and attention networks. To assess the generalizability of this phenomenon in a stroke population with heterogeneous lesions, we investigated the distal effects of lesions on a global level. Longitudinal resting-state fMRI scans were acquired at three consecutive time points, beginning during the acute phase (days 1, 7, and 90 post-stroke) in 12 patients after ischemic stroke. We found a preferential functional change in affected networks (i.e., networks containing lesions changed more during recovery when compared with unaffected networks). This change in connectivity was significantly correlated with clinical changes assessed with the National Institute of Health Stroke Scale. Our results provide evidence that the functional architecture of large-scale networks is critical to understanding the clinical effect and trajectory of post-stroke recovery.
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20
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Kiran S. What is the nature of poststroke language recovery and reorganization? ISRN NEUROLOGY 2012; 2012:786872. [PMID: 23320190 PMCID: PMC3540797 DOI: 10.5402/2012/786872] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 11/05/2012] [Indexed: 12/16/2022]
Abstract
This review focuses on three main topics related to the nature of poststroke language recovery and reorganization. The first topic pertains to the nature of anatomical and physiological substrates in the infarcted hemisphere in poststroke aphasia, including the nature of the hemodynamic response in patients with poststroke aphasia, the nature of the peri-infarct tissue, and the neuronal plasticity potential in the infarcted hemisphere. The second section of the paper reviews the current neuroimaging evidence for language recovery in the acute, subacute, and chronic stages of recovery. The third and final section examines changes in connectivity as a function of recovery in poststroke aphasia, specifically in terms of changes in white matter connectivity, changes in functional effective connectivity, and changes in resting state connectivity after stroke. While much progress has been made in our understanding of language recovery, more work needs to be done. Future studies will need to examine whether reorganization of language in poststroke aphasia corresponds to a tighter, more coherent, and efficient network of residual and new regions in the brain. Answering these questions will go a long way towards being able to predict which patients are likely to recover and may benefit from future rehabilitation.
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Affiliation(s)
- Swathi Kiran
- Department of Speech, Language, and Hearing Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Boston, MA 02215, USA ; Massachusetts General Hospital, Boston, MA, USA
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Allendorfer JB, Kissela BM, Holland SK, Szaflarski JP. Different patterns of language activation in post-stroke aphasia are detected by overt and covert versions of the verb generation fMRI task. Med Sci Monit 2012; 18:CR135-7. [PMID: 22367124 PMCID: PMC3319663 DOI: 10.12659/msm.882518] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Post-stroke language functions depend on the relative contributions of the dominant and non-dominant hemispheres. Thus, we aimed to identify the neural correlates of overt and covert verb generation in adult post-stroke aphasia. Material/Methods Sixteen aphasic LMCA stroke patients (SPs) and 32 healthy controls (HCs) underwent language testing followed by fMRI while performing an overt event-related verb generation task (ER-VGT) isolating activations related to noun-verb semantic processing or to articulation and auditory processing, and a covert block design verb generation task (BD-VGT). Results BD-VGT activation patterns were consistent with previous studies, while ER-VGT showed different patterns in SPs relative to HCs including less left-hemispheric involvement during semantic processing and predominantly right-sided activation related to articulation and auditory processing. ER-VGT intra-scanner performance was positively associated with activation during semantic associations in the left middle temporal gyrus for HCs (p=0.031) and left middle frontal gyrus for SPs (p=0.042). Increased activation in superior frontal/cingulate gyri was associated with better intra-scanner performance (p=0.020). Lesion size negatively impacted verbal fluency tested with Controlled Oral Word Association Test (p=0.0092) and the Semantic Fluency Test (p=0.033) and trended towards a negative association with verb generation performance on the event-related verb generation task (p=0.081). Conclusions Greater retention of pre-stroke language skills is associated with greater involvement of the left hemisphere with different cortical recruitment patterns observed in SPs versus HCs. Post-stroke verbal fluency may depend more upon the structural and functional integrity of the dominant left hemisphere language network rather than the shift to contralateral homologues.
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Affiliation(s)
- Jane B Allendorfer
- Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, OH 45267-0525, USA.
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Repair-Based Therapies After Stroke. Transl Stroke Res 2012. [DOI: 10.1007/978-1-4419-9530-8_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Seitz RJ, Donnan GA. Role of neuroimaging in promoting long-term recovery from ischemic stroke. J Magn Reson Imaging 2010; 32:756-72. [PMID: 20882606 DOI: 10.1002/jmri.22315] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Rüdiger J Seitz
- Department of Neurology, University Hospital Düsseldorf, and Biomedical Research Centre, Heinrich-Heine-University Düsseldorf, Germany.
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Payabvash S, Kamalian S, Fung S, Wang Y, Passanese J, Kamalian S, Souza LCS, Kemmling A, Harris GJ, Halpern EF, González RG, Furie KL, Lev MH. Predicting language improvement in acute stroke patients presenting with aphasia: a multivariate logistic model using location-weighted atlas-based analysis of admission CT perfusion scans. AJNR Am J Neuroradiol 2010; 31:1661-8. [PMID: 20488905 DOI: 10.3174/ajnr.a2125] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Prediction of functional outcome immediately after stroke onset can guide optimal management. Most prognostic grading scales to date, however, have been based on established global metrics such as total NIHSS score, admission infarct volume, or intracranial occlusion on CTA. Our purpose was to construct a more focused, location-weighted multivariate model for the prediction of early aphasia improvement, based not only on traditional clinical and imaging parameters, but also on atlas-based structure/function correlation specific to the clinical deficit, using CT perfusion imaging. MATERIALS AND METHODS Fifty-eight consecutive patients with aphasia due to first-time ischemic stroke of the left hemisphere were included. Language function was assessed on the basis of the patients admission and discharge NIHSS scores and clinical records. All patients had brain CTP and CTA within 9 hours of symptom onset. For image analysis, all CTPs were automatically co-registered to MNI-152 brain space and parcellated into mirrored cortical and subcortical regions. Multiple logistic regression analysis was used to find independent imaging and clinical predictors of language recovery. RESULTS By the time of discharge, 21 (36%) patients demonstrated improvement of language. Independent factors predicting improvement in language included rCBF of the angular gyrus GM (BA 39) and the lower third of the insular ribbon, proximal cerebral artery occlusion on admission CTA, and aphasia score on the admission NIHSS examination. Using these 4 variables, we developed a multivariate logistic regression model that could estimate the probability of early improvement in aphasia and predict functional outcome with 91% accuracy. CONCLUSIONS An imaging-based location-weighted multivariate model was developed to predict early language improvement of patients with aphasia by using admission data collected within 9 hours of stroke onset. This pilot model should be validated in a larger, prospective study; however, the semiautomated atlas-based analysis of brain CTP, along with the statistical approach, could be generalized for prediction of other outcome measures in patients with stroke.
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Affiliation(s)
- S Payabvash
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114-9657, USA
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Blood pressure treatment in acute ischemic stroke: a review of studies and recommendations. Curr Opin Neurol 2010; 23:46-52. [PMID: 20038827 DOI: 10.1097/wco.0b013e3283355694] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Elevated blood pressure (BP) is frequent in patients with acute ischemic stroke. Pathophysiological data support its usefulness to maintain adequate perfusion of the ischemic penumba. This review article aims to summarize the available evidence from clinical studies that examined the prognostic role of BP during the acute phase of ischemic stroke and intervention studies that assessed the efficacy of active BP alteration. RECENT FINDINGS We found 34 observational studies (33,470 patients), with results being inconsistent among the studies; most studies reported a negative association between increased levels of BP and clinical outcome, whereas a few studies showed clinical improvement with higher BP levels, clinical deterioration with decreased BP, or no association at all. Similarly, the conclusions drawn by the 18 intervention studies included in this review (1637 patients) were also heterogeneous. Very recent clinical data suggest a possible beneficial effect of early treatment with some antihypertensives on late clinical outcome. SUMMARY Observational and interventional studies of management of acute poststroke hypertension yield conflicting results. We discuss different explanations that may account for this and discuss the current guidelines and pathophysiological considerations for the management of acute poststroke hypertension.
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Cloutman L, Newhart M, Davis C, Heidler-Gary J, Hillis AE. Acute recovery of oral word production following stroke: patterns of performance as predictors of recovery. Behav Neurol 2010; 21:145-53. [PMID: 19996511 PMCID: PMC2828045 DOI: 10.3233/ben-2009-0245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Impairments in oral word production are common at the onset of stroke. The identification of factors that predict early recovery has important implications for identifying those at greater risk of continued impaired functioning, and the management of the patient's care following discharge. Aims: To identify patterns of performance that are predictors of acute recovery of oral word production abilities following stroke;
to identify any association between early and more chronic recovery. Method and procedures:Acute stroke patients were administered oral word production tasks within 1–2 days of hospital
admission, with repeat testing by 7 days; a subset of patients had repeat testing between three weeks to one year later. Performance
was examined for error rate and type to identify potential predictors of early recovery. Outcome and results: The proportion of circumlocution and no response errors at initial testing were associated with the magnitude
of recovery of language functioning within the first week following stroke. Patient characteristics of age and gender were found
to have no influence on the degree of early recovery observed. None of the examined factors predicted late recovery. The degree
of early recovery was not associated with the degree of later recovery. Conclusions: The current study identified patterns of task performance that increase our understanding of how oral word
production recovers following acute stroke. The finding that the degree of early recovery does not predict the degree of later
recovery is consistent with the hypothesis that early and late recovery are due to different mechanisms (restored blood flow in
acute stroke, and reorganization in later recovery).
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Affiliation(s)
- Lauren Cloutman
- Departments of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
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Mishra NK, Albers GW, Davis SM, Donnan GA, Furlan AJ, Hacke W, Lees KR. Mismatch-based delayed thrombolysis: a meta-analysis. Stroke 2009; 41:e25-33. [PMID: 19926836 DOI: 10.1161/strokeaha.109.566869] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Clinical benefit from thrombolysis is reduced as stroke onset to treatment time increases. The use of "mismatch" imaging to identify patients for delayed treatment has face validity and has been used in case series and clinical trials. We undertook a meta-analysis of relevant trials to examine whether present evidence supports delayed thrombolysis among patients selected according to mismatch criteria. METHODS We collated outcome data for patients who were enrolled after 3 hours of stroke onset in thrombolysis trials and had mismatch on pretreatment imaging. We selected the trials on the basis of a systematic search of the Web of Knowledge. We compared favorable outcome, reperfusion and/or recanalization, mortality, and symptomatic intracerebral hemorrhage between the thrombolyzed and nonthrombolyzed groups of patients and the probability of a favorable outcome among patients with successful reperfusion and clinical findings for 3 to 6 versus 6 to 9 hours from poststroke onset. Results are expressed as adjusted odds ratios (a-ORs) with 95% CIs. Heterogeneity was explored by test statistics for clinical heterogeneity, I(2) (inconsistency), and L'Abbé plot. RESULTS We identified articles describing the DIAS, DIAS II, DEDAS, DEFUSE, and EPITHET trials, giving a total of 502 mismatch patients thrombolyzed beyond 3 hours. The combined a-ORs for favorable outcomes were greater for patients who had successful reperfusion (a-OR=5.2; 95% CI, 3 to 9; I(2)=0%). Favorable clinical outcome was not significantly improved by thrombolysis (a-OR=1.3; 95% CI, 0.8 to 2.0; I(2)=20.9%). Odds for reperfusion/recanalization were increased among patients who received thrombolytic therapy (a-OR=3.0; 95% CI, 1.6 to 5.8; I(2)=25.7%). The combined data showed a significant increase in mortality after thrombolysis (a-OR=2.4; 95% CI, 1.2 to 4.9; I(2)=0%), but this was not confirmed when we excluded data from desmoteplase doses that were abandoned in clinical development (a-OR=1.6; 95% CI, 0.7 to 3.7; I(2)=0%). Symptomatic intracerebral hemorrhage was significantly increased after thrombolysis (a-OR=6.5; 95% CI, 1.2 to 35.4; I(2)=0%) but not significant after exclusion of abandoned doses of desmoteplase (a-OR=5.4; 95% CI, 0.9 to 31.8; I(2)=0%). CONCLUSIONS Delayed thrombolysis amongst patients selected according to mismatch imaging is associated with increased reperfusion/recanalization. Recanalization/reperfusion is associated with improved outcomes. However, delayed thrombolysis in mismatch patients was not confirmed to improve clinical outcome, although a useful clinical benefit remains possible. Thrombolysis carries a significant risk of symptomatic intracerebral hemorrhage and possibly increased mortality. Criteria to diagnose mismatch are still evolving. Validation of the mismatch selection paradigm is required with a phase III trial. Pending these results, delayed treatment, even according to mismatch selection, cannot be recommended as part of routine care.
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Affiliation(s)
- Nishant K Mishra
- University Department of Medicine and Therapeutics, Gardiner Institute, Western Infirmary and Faculty of Medicine, University of Glasgow, Glasgow G116NT, UK
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Bang OY. Multimodal MRI for ischemic stroke: from acute therapy to preventive strategies. J Clin Neurol 2009; 5:107-19. [PMID: 19826561 PMCID: PMC2760715 DOI: 10.3988/jcn.2009.5.3.107] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 07/17/2009] [Accepted: 07/17/2009] [Indexed: 01/09/2023] Open
Abstract
Background and Purpose Conventional therapies for ischemic stroke include thrombolytic therapy, prevention of inappropriate coagulation and thrombosis, and surgery to repair vascular abnormalities. Over 10 years have passed since the US Food and Drug Administration approved intravenous tissue plasminogen activator for use in acute stroke patients, but most major clinical trials have failed during the last 2 decades, including large clinical trials for secondary prevention and neuroprotection. These results suggest the presence of heterogeneity among stroke patients. Neuroimaging techniques now allow changes to be observed in patients from the acute to the recovery phase. The role of MRI in stroke evaluation and treatment is discussed herein. Main Contents Three MRI strategies are discussed with relevant examples. First, the following MRI strategies for acute ischemic stroke are presented: diffusion-perfusion mismatch, deoxygenation (oxygen extraction and cerebral metabolic rate of oxygen), and blood-brain barrier permeability derangement in selected patients for recanalization therapy. Second, multimodal MRI for identifying stroke mechanisms and the specific causes of stroke (i.e., patent foramen ovale, infective endocarditis, and nonbacterial thrombotic endocarditis) are presented, followed by MRI strategies for prevention of recurrent stroke: plaque images and flow dynamics for carotid intervention. Expectations The studies reviewed herein suggest that using MRI to improve the understanding of individual pathophysiologies will further promote the development of rational stroke therapies tailored to the specifics of each case.
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Affiliation(s)
- Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Assessment of arcuate fasciculus with diffusion-tensor tractography may predict the prognosis of aphasia in patients with left middle cerebral artery infarcts. Neuroradiology 2009; 51:549-55. [PMID: 19434402 DOI: 10.1007/s00234-009-0534-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 04/28/2009] [Indexed: 01/07/2023]
Abstract
INTRODUCTION It is often clinically difficult to assess the severity of aphasia in the earliest stage of cerebral infarction. A method enabling objective assessment of verbal function is needed for this purpose. We examined whether diffusion tensor (DT) tractography is of clinical value in assessing aphasia. METHODS Thirteen right-handed patients with left middle cerebral artery infarcts who were scanned within 2 days after stroke onset were enrolled in this study. Magnetic resonance data of ten control subjects were also examined by DT tractography. Based on the severity of aphasia at discharge, patients were divided into two groups: six patients in the aphasic group and seven in the nonaphasic group. Fractional anisotropy (FA) and number of arcuate fasciculus fibers were evaluated. Asymmetry index was calculated for both FA and number of fibers. RESULTS FA values for the arcuate fasciculus fibers did not differ between hemispheres in either the patient groups or the controls. Number of arcuate fasciculus fibers exhibited a significant leftward asymmetry in the controls and the nonaphasic group but not in the aphasic group. Asymmetry index of number of fibers was significantly lower (rightward) in the aphasic group than in the nonaphasic (P = 0.015) and control (P = 0.005) groups. Loss of leftward asymmetry in number of AF fibers predicted aphasia at discharge with a sensitivity of 0.83 and specificity of 0.86. CONCLUSIONS Asymmetry of arcuate fasciculus fibers by DT tractography may deserve to be assessed in acute infarction for predicting the fate of vascular aphasia.
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