2
|
Schmidt CC, Achilles EIS, Bolte K, Kleineberg NN, Richter MK, Schloss N, Fink GR, Weiss PH. Association of Circumscribed Subcortical Gray and White Matter Lesions With Apraxic Deficits in Patients With Left Hemisphere Stroke. Neurology 2023; 101:e1137-e1144. [PMID: 37463748 PMCID: PMC10513893 DOI: 10.1212/wnl.0000000000207598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 05/15/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Apraxia is commonly attributed to left hemisphere (LH) lesions of the cortical fronto-temporo-parietal praxis networks or white matter lesions causing disconnections between cortical nodes. By contrast, the contribution of lesions to the subcortical gray matter, that is, basal ganglia or thalamus, to apraxic deficits remains controversial. Here, we investigate whether damage to these subcortical gray matter structures (i.e., caudate nucleus, putamen, globus pallidus, and thalamus) or the adjacent white matter tracts was associated with apraxic deficits. METHODS We identified patients with distinct subcortical lesions with and without apraxia from a large retrospective sample of subacute LH ischemic stroke patients (n = 194). To test which subcortical structures (caudate nucleus, putamen, globus pallidus, thalamus, and adjacent white matter tracts), when lesioned, contributed to apraxic deficits, we statistically compared the proportion of lesioned voxels within subcortical gray and white matter structures between the apraxic and nonapraxic patients. RESULTS Of the 194 stroke patients screened, 39 (median age = 65 years, range 30-82 years; median time poststroke at the apraxia assessment = 7 days, range 1-44 days) had lesions confined to subcortical regions (gray and white matter). Eleven patients showed apraxic deficits when imitating gestures or pantomiming object use. Region-wise statistical lesion comparison (controlled for lesion size) revealed a more significant proportion of damage ('lesion load') in the caudate nucleus in apraxic stroke patients (mean difference = 6.9%, 95% CI 0.4-13.3, p = 0.038, η p 2 = 0.11). By contrast, apraxic patients had lower lesion load in the globus pallidus (mean difference = 9.9%, 95% CI 0.1-19.8, p = 0.048, η p 2 = 0.10), whereas the lesion load in other subcortical structures (putamen, thalamus, and adjacent white matter tracts) did not differ significantly between the apraxic and nonapraxic patients. DISCUSSION These findings provide new insights into the subcortical anatomy of apraxia after LH stroke, suggesting a specific contribution of caudate nucleus lesions to apraxic deficits.
Collapse
Affiliation(s)
- Claudia C Schmidt
- From the Cognitive Neuroscience (C.C.S., E.I.S.A., N.N.K., M.K.R., G.R.F., P.H.W.), Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Germany; and Department of Neurology (E.I.S.A., K.B., N.N.K., M.K.R., N.S., G.R.F., P.H.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany.
| | - Elisabeth I S Achilles
- From the Cognitive Neuroscience (C.C.S., E.I.S.A., N.N.K., M.K.R., G.R.F., P.H.W.), Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Germany; and Department of Neurology (E.I.S.A., K.B., N.N.K., M.K.R., N.S., G.R.F., P.H.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Katharina Bolte
- From the Cognitive Neuroscience (C.C.S., E.I.S.A., N.N.K., M.K.R., G.R.F., P.H.W.), Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Germany; and Department of Neurology (E.I.S.A., K.B., N.N.K., M.K.R., N.S., G.R.F., P.H.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Nina N Kleineberg
- From the Cognitive Neuroscience (C.C.S., E.I.S.A., N.N.K., M.K.R., G.R.F., P.H.W.), Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Germany; and Department of Neurology (E.I.S.A., K.B., N.N.K., M.K.R., N.S., G.R.F., P.H.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Monika K Richter
- From the Cognitive Neuroscience (C.C.S., E.I.S.A., N.N.K., M.K.R., G.R.F., P.H.W.), Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Germany; and Department of Neurology (E.I.S.A., K.B., N.N.K., M.K.R., N.S., G.R.F., P.H.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Natalie Schloss
- From the Cognitive Neuroscience (C.C.S., E.I.S.A., N.N.K., M.K.R., G.R.F., P.H.W.), Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Germany; and Department of Neurology (E.I.S.A., K.B., N.N.K., M.K.R., N.S., G.R.F., P.H.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Gereon R Fink
- From the Cognitive Neuroscience (C.C.S., E.I.S.A., N.N.K., M.K.R., G.R.F., P.H.W.), Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Germany; and Department of Neurology (E.I.S.A., K.B., N.N.K., M.K.R., N.S., G.R.F., P.H.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Peter H Weiss
- From the Cognitive Neuroscience (C.C.S., E.I.S.A., N.N.K., M.K.R., G.R.F., P.H.W.), Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Germany; and Department of Neurology (E.I.S.A., K.B., N.N.K., M.K.R., N.S., G.R.F., P.H.W.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| |
Collapse
|
3
|
Heilman KM. Upper Limb Apraxia. Continuum (Minneap Minn) 2021; 27:1602-1623. [PMID: 34881728 DOI: 10.1212/con.0000000000001014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Limb apraxia is one of the most common and most disabling disorders caused by brain damage. However, apraxia is one of the least recognized disorders associated with cerebral disease. This article discusses the signs and symptoms of, means of testing for, the pathophysiology of, and possible management of upper limb apraxia. RECENT FINDINGS Upper limb apraxia has four major forms: ideomotor, limb-kinetic, conceptual, and ideational. Although recent findings are included in this article, a full understanding of these disorders, including the means of testing, their possible pathophysiology, and the diseases that may cause these disorders, requires that some older literature is also discussed. SUMMARY This article guides clinicians in testing for and diagnosing the different forms of upper limb apraxia, identifying the underlying diseases that may cause apraxia, managing the different forms of the disorder, and possible forms of rehabilitation.
Collapse
|
4
|
Watson CE, Gotts SJ, Martin A, Buxbaum LJ. Bilateral functional connectivity at rest predicts apraxic symptoms after left hemisphere stroke. Neuroimage Clin 2018; 21:101526. [PMID: 30612063 PMCID: PMC6319198 DOI: 10.1016/j.nicl.2018.08.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/22/2018] [Accepted: 08/31/2018] [Indexed: 12/11/2022]
Abstract
Increasing evidence indicates that focal lesions following stroke cause alterations in connectivity among functional brain networks. Functional connectivity between hemispheres has been shown to be particularly critical for predicting stroke-related behavioral deficits and recovery of motor function and attention. Much less is known, however, about the relevance of interhemispheric functional connectivity for cognitive abilities like praxis that rely on strongly lateralized brain networks. In the current study, we examine correlations between symptoms of apraxia-a disorder of skilled action that cannot be attributed to lower-level sensory or motor impairments-and spontaneous, resting brain activity in functional MRI in chronic left hemisphere stroke patients and neurologically-intact control participants. Using a data-driven approach, we identified 32 regions-of-interest in which pairwise functional connectivity correlated with two distinct measures of apraxia, even when controlling for age, head motion, lesion volume, and other artifacts: overall ability to pantomime the typical use of a tool, and disproportionate difficulty pantomiming the use of tools associated with different, competing use and grasp-to-move actions (e.g., setting a kitchen timer versus picking it up). Better performance on both measures correlated with stronger interhemispheric functional connectivity. Relevant regions in the right hemisphere were often homologous to left hemisphere areas associated with tool use and action. Additionally, relative to overall pantomime accuracy, disproportionate difficulty pantomiming the use of tools associated with competing use and grasp actions was associated with weakened functional connectivity among a more strongly left-lateralized and peri-Sylvian set of brain regions. Finally, patient performance on both measures of apraxia was best predicted by a model that incorporated information about lesion location and functional connectivity, and functional connectivity continued to explain unique variance in behavior even after accounting for lesion loci. These results indicate that interhemispheric functional connectivity is relevant even for a strongly lateralized cognitive ability like praxis and emphasize the importance of the right hemisphere in skilled action.
Collapse
Affiliation(s)
| | - Stephen J Gotts
- Laboratory of Brain and Cognition, National Institute of Mental Health, NIH, Bethesda, MD 20892, USA
| | - Alex Martin
- Laboratory of Brain and Cognition, National Institute of Mental Health, NIH, Bethesda, MD 20892, USA
| | - Laurel J Buxbaum
- Moss Rehabilitation Research Institute, Elkins Park, PA 19027, USA.
| |
Collapse
|
5
|
Kumral E, Deveci EE, Çolak AY, Çağında AD, Erdoğan C. Multiple variant type thalamic infarcts: pure and combined types. Acta Neurol Scand 2015; 131:102-10. [PMID: 25109495 DOI: 10.1111/ane.12290] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Variant topographic patterns of thalamic infarction with distinct manifestations have been classified into three territories: anteromedian, central, and posterolateral. The purpose of this study was to determine clinical, etiological, and radiological features of multiple variant thalamic infarcts. METHODS We reviewed 8400 patients with a first clinical stroke included in the Ege Stroke Registry between 2000 and 2013. Among 80 patients with an acute multiple thalamic infarcts confirmed by MRI, we selected all patients with lesions outside the classical territories and studied their clinical, etiological, and radiological features. RESULTS Among 8400 patients with first-ever stroke in our registry, 21 patients (26% of all multiple thalamic infarcts) showed infarction outside the classical territories, allowing us to delineate three variant distributions; (i) unilateral multiple variant infarcts [seven patients (9%) in the anteromedian, central, and posterolateral territories] presented with predominantly decreased vigilance (66% with right lesions, 75% with left lesions), cognitive impairment including amnesia (71%), aphasia (57%) in left-sided or bilateral lesions, and executive dysfunction (43%). The most frequent stroke mechanism was cardioembolism (43%). (ii) Bilateral multiple variant infarcts [five patients (6%)], with lesions on the variant territories of the thalamus, resulting in a variety of neurological and neuropsychological signs, consciousness disturbances (80%), sensory-motor deficits (80%). Cardioembolism (60%) was the most frequent etiology. (iii) Combined multiple variant and classical infarcts [nine patients (11%)], characterized by hemihypesthesia (89%) as the most frequent manifestation, followed by hemiataxia (78%), and cognitive deficits. Cardioembolism (56%) and large-artery disease of the vertebrobasilar system (33%) were the main stroke mechanisms. CONCLUSIONS We described multiple variant topographic patterns of thalamic infarction with distinct manifestations and etiologies. We thought that multiple variant infarcts are the result of variation in thalamic arterial supply or reflect a source of embolism.
Collapse
Affiliation(s)
- E. Kumral
- Stroke Unit; Neurology Department; School of Medicine; Ege University; İzmir Turkey
| | - E. E. Deveci
- Stroke Unit; Neurology Department; School of Medicine; Ege University; İzmir Turkey
| | - A. Y. Çolak
- Stroke Unit; Neurology Department; School of Medicine; Ege University; İzmir Turkey
| | - A. D. Çağında
- Stroke Unit; Neurology Department; School of Medicine; Ege University; İzmir Turkey
| | - C. Erdoğan
- Stroke Unit; Neurology Department; School of Medicine; Ege University; İzmir Turkey
| |
Collapse
|
6
|
Cognitive, affective and behavioural disturbances following vascular thalamic lesions: a review. Cortex 2010; 47:273-319. [PMID: 21111408 DOI: 10.1016/j.cortex.2010.09.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 06/21/2010] [Accepted: 09/15/2010] [Indexed: 11/23/2022]
Abstract
During the last decades, many studies have shown that the thalamus is crucially involved in language and cognition. We critically reviewed a study corpus of 465 patients with vascular thalamic lesions published in the literature since 1980. 42 out of 465 (9%) cases with isolated thalamic lesions allowed further neurocognitive analysis. On the neurolinguistic level, fluent output (=31/33; 93.9%), normal to mild impairment of repetition (=33/35; 94.3%), mild dysarthria (=8/9; 88.9%) and normal to mild impairment of auditory comprehension (=27/34; 79.4%) were most commonly found in the group of patients with left and bilateral thalamic lesions. The taxonomic label of thalamic aphasia applied to the majority of the patients with left thalamic damage (=7/11; 63.6%) and to one patient with bithalamic lesions (=1/1). On the neuropsychological level, almost 90% of the left thalamic and bithalamic patient group presented with amnestic problems, executive dysfunctions and behaviour and/or mood alterations. In addition, two thirds (2/3) of the patients with bilateral thalamic damage presented with a typical cluster of neurocognitive disturbances consisting of constructional apraxia, anosognosia, desorientation, global intellectual dysfunctioning, amnesia, and executive dysfunctions associated with behaviour and/or mood alterations. Our study supports the long-standing view of a 'lateralised linguistic thalamus' but restates the issue of a 'lateralised cognitive thalamus'. In addition, critical analysis of the available literature supports the view that aphasia following left or bithalamic damage constitutes a prototypical linguistic syndrome.
Collapse
|
8
|
Carrera E, Michel P, Bogousslavsky J. Anteromedian, central, and posterolateral infarcts of the thalamus: three variant types. Stroke 2004; 35:2826-31. [PMID: 15514194 DOI: 10.1161/01.str.0000147039.49252.2f] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Thalamic infarcts have traditionally been classified into 4 territories: anterior, paramedian, inferolateral, and posterior. The purpose of this study was to review this classical versus variant distribution in patients with thalamic stroke. METHODS We reviewed all patients with a first clinical stroke included in the Lausanne Stroke Registry between 1990 and 2002. Among 71 patients with an acute stroke isolated to the thalamus confirmed by MRI, we selected all patients with lesions outside the classical territories and studied their clinical, etiological, and radiological features. RESULTS A total of 21 patients (30% of all thalamic stroke patients) showed infarction outside the classical territories, allowing us to delineate 3 variant distributions: (1) Anteromedian territory (9 patients [13%]) involving anterior and paramedian territories, with predominantly cognitive impairment, including executive dysfunction, anterograde amnesia, and aphasia in left-sided or bilateral lesions. The most frequent stroke mechanism was cardiac embolism. (2) Central territory (4 patients [6%]), with lesions on the central part of the thalamus, resulting in a variety of neurological and neuropsychological signs, reflecting the involvement of several adjacent structures. Microangiopathy was the most frequent etiology. (3) Posterolateral territory (8 patients [11%]), involving inferolateral and posterior territories, with hemihypesthesia as the most frequent manifestation, followed by hemiataxia, executive dysfunction, and aphasia in left-sided lesions. Artery-to-artery embolism and microangiopathy were the main stroke mechanisms. CONCLUSIONS We describe 3 variant topographic patterns of thalamic infarction with distinct manifestations and etiologies. We postulate that these infarcts are the result of a variation in thalamic arterial supply or reflect borderzone ischemia.
Collapse
Affiliation(s)
- Emmanuel Carrera
- Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | | |
Collapse
|
11
|
Ghika-Schmid F, Ghika J, Regli F, Bogousslavsky J. Hyperkinetic movement disorders during and after acute stroke: the Lausanne Stroke Registry. J Neurol Sci 1997; 146:109-16. [PMID: 9077506 DOI: 10.1016/s0022-510x(96)00290-0] [Citation(s) in RCA: 158] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE To study consecutive patients with acute or delayed hyperkinetic movement disorders in the Lausanne Stroke Registry. METHODS We have identified 29 patients with acute or delayed movement disorders among 2500 patients who had their first-ever acute stroke in the Lausanne Stroke Registry. SETTING Department of Neurology, Lausanne University Hospital. RESULTS Our patients presented with hemichorea-hemiballism (11 patients), hemidystonia (5 patients), stereotypias (2 patients), jerky dystonic unsteady hand (3 patients), asterixis (2 patients), initial limb-shaking (2 patients), bilateral tremor (1 patients), bilateral jaw myoclonus (1 patient), hemiakathisia (1 patient) and dysarthria-dyskinetic hand (1 patient). On neuroimaging a lesion was found in 25 of the 29 cases in the territory of the middle cerebral artery (7 deep, 2 superficial and 2 complete), the posterior cerebral artery (11 patients), both middle and posterior cerebral arteries (2 patients) or the anterior cerebral artery (1 patient). The jerky dystonic unsteady hand syndrome was associated with a specific lesion, an infarct in the territory of the posterior choroidal artery. Presumed small-vessel disease was the commonest cause of stroke (15 patients). Only 3 patients had persistent movements (> 6 months). CONCLUSION Hyperkinetic movement disorders are uncommon in acute stroke (1%), the commonest types being hemichorea-hemiballism and hemidystonia. These movement disorders are associated with stroke involving the basal ganglia and adjacent white matter in the territory of the middle or the posterior cerebral artery. The jerky dystonic unsteady hand syndrome is specifically associated with a small infarct in the territory of the posterior choroidal artery. The abnormal movements usually regress spontaneously.
Collapse
Affiliation(s)
- F Ghika-Schmid
- Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | | | | |
Collapse
|