Acute basal ganglia infarcts in poststroke fatigue: an MRI study

Abstract

Lesions located in the basal ganglia (BG) are thought to be involved in the fatigue observed in neurological disorders. However, the significance of the location of infarcts in poststroke fatigue (PSF) is unknown. This study examined the association between BG infarcts and PSF. A total of 334 Chinese patients with acute ischemic stroke consecutively admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong participated in the study. At admission, a host of demographic and clinical characteristics was collected and the number and location of acute infarcts were evaluated with MRI. All participants were assessed for PSF with the fatigue severity scale (FSS) 3 months after their index stroke. PSF was defined as a mean FSS score of 4.0 or more. Depressive symptoms were measured by the geriatric depression scale (GDS). Seventy-eight (23.4%) patients had PSF. In the univariate analysis, the PSF group included more females, had higher GDS scores, and a higher number of acute infarcts, and the PSF patients were more likely to have acute infarcts at the BG. Acute BG infarct remained an independent predictor of PSF in the multivariate analysis. In conclusion, these results suggest that BG infarcts may play a role in the development of PSF.

Examining the relationship between fatigue and cognition after stroke: A systematic review

“…Four studies (Kutlubaev et al, 2013;Naess et al, 2005;Naess & Nyland, 2013;Tang et al, 2010) did not provide information on lateralisation and one study reported missing data for 852 participants (57%). Two participants had suffered a subarachnoid haemorrhage (SAH) (0.1%).…”

“…Overall, the studies provided data on 1597 participants post-stroke 982 men (62%) and 615 women (38%). Generally, the studies had a small sample and only two (Tang et al, 2010;van Eijsden et al, 2012) had more than 200 participants. Of the total 809 (51%) participants had ischemic stroke, 197 (12%) haemorrhagic stroke and 591 (40%) were unspecified; 206 (13%) participants had a recurrent stroke whereas the rest had a first stroke.…”

Poststroke Fatigue: Emerging Evidence and Approaches to Management: A Scientific Statement for Healthcare Professionals From the American Heart Association

“…Although patients with PSF are often depressed, 4,14,18,31,62,74 the relationship between PSF and depression is difficult to evaluate because many of the tools for assessing depression contain items about fatigue. Fatigue is one of the somatic symptoms that have high discriminative power for predicting poststroke depression.…”

“…77,86 Some studies suggest an association between PSF and subcortical infarcts 26,74,87,88 and infratentorial infarcts. 30,77 Physiologically, PSF appears be related to low excitability of corticospinal output and facilitatory synaptic inputs from cortical and subcortical sites.…”

Cognitive and Graded Activity Training Can Alleviate Persistent Fatigue After Stroke

“…On the one hand, direct relationships have been described between the type and extent of the brain lesion, with infratentorial lesions, infarction of the basal ganglia, and recurrent stroke yielding a greater risk of fatigue. 1,4,8,9 On the other hand, depression, anxiety, reduced functional health status, sleep disturbances, pain, and poor physical fitness have all been associated with PSF. 1 Overall, the exact mechanisms of origin and persistence of PSF are still elusive, 1 and no effective pharmacological or nonpharmacological treatment for PSF is yet available.…”