Evidence of motor injury due to damaged corticospinal tract following acute hemorrhage in the basal ganglia region

Li, Jing; Wei, Xue Hu; Liu, Yong Kang; Chen, Lingshan; Zhu, Zheng; Hou, Si Yuan; Fang, Xiao Kun; Wang, Zhong Qiu

doi:10.1038/s41598-020-73305-8

Cited by 6 publications

(4 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Motor impairment is the most common domain of functional deficits after stroke, 1 which is attributed to a high prevalence of subcortical motor pathway damage (typically caused by basal ganglia stroke). 2 The extent of lesions, the integrity of descending motor pathways (e.g., corticospinal tracts [CSTs]), 3,4 and the secondary degeneration remote from lesions (e.g., corpus callosum [CC]) 5,6 have the potential to predict motor function after stroke. Moreover, these focal lesions can lead to a wide range of functional reorganization, such as overactivation of the contralesional areas during motor execution, 5,7 and the alterations of resting-state functional connectivity (FC) pattern [8][9][10] or network topology, 11 some of which also showed association with the degree of motor dysfunction.…”

mentioning

confidence: 99%

Pathway-Specific Mediation Effect Between Structure, Function, and Motor Impairment After Subcortical Stroke

Yin

Kaiser

et al. 2023

Neurology

View full text Add to dashboard Cite

Objective:To investigate the pathway-specific correspondence between structural and functional changes resulting from focal subcortical stroke as well as their causal influence on clinical symptom.Methods:In this retrospective, cross-sectional study, we mainly focused on unilateral subcortical chronic stroke patients with moderate-severe motor impairment assessed by Fugl-Meyer Assessment (upper extremity), as well as healthy controls. All participants underwent both resting-state functional magnetic resonance imaging and diffusion tensor imaging. To parse the pathway-specific structure-function covariation, we performed association analyses between the fine-grained corticospinal tracts (CSTs) originating from 6 subareas of the sensorimotor cortex (SMC) and functional connectivity (FC) of the corresponding subarea, along with the refined corpus callosum (CC) sections and interhemispheric FC. A mediation analysis with FC as the mediator was used to further assess pathway-specific effects of structural damage on motor impairment.Results:Thirty-five patients (mean age 52.7 ± 10.2 years, 27 men) and forty-three healthy controls (mean age 56.2 ± 9.3 years, 21 men) were enrolled. Among the six CST tracts, we identified nine structurally and functionally covaried pathways, originating from the ipsilesional primary motor area (M1), dorsal premotor area (PMd), and primary somatosensory cortex (p < 0.05, corrected). Functional connectivity for the bilateral M1, PMd and ventral premotor cortex covaried with secondary degeneration of the corresponding CC sections (p < 0.05, corrected). Moreover, these covarying structures and functions were significantly correlated with the Fugl-Meyer assessment (upper extremity) scores (p < 0.05, uncorrected). In particular, FC between the ipsilesional PMd and contralesional cerebellum (β = −0.141, p < 0.05, CI = [-0.319, -0.015]) and interhemispheric FC of PMd (β = 0.169, p < 0.05, CI = [0.015, 0.391]) showed significant mediation effects in the prediction of motor impairment with structural damage of the CST and CC.Conclusions:This study reveals causal influence of structural and functional pathways on motor impairment after subcortical stroke and provides a promising way to investigate pathway-specific structure-function coupling. Clinically, our findings may offer a circuit-based evidence for PMd as a critical neuromodulation target in more impaired stroke patients and also suggest cerebellum as a potential target.

show abstract

mentioning

confidence: 99%

Pathway-Specific Mediation Effect Between Structure, Function, and Motor Impairment After Subcortical Stroke

Yin

Kaiser

et al. 2023

Neurology

View full text Add to dashboard Cite

show abstract

“…The influence of deep HE on the clinical severity is dependent on the functional integrity of impaired fiber bundles and the specific anatomic regions of lesions. Damage to pyramidal tracts caused by HE of the internal capsule not only triggers physical disability but also gives rise to subjective discomfort and distress ( 20 , 21 ). Once thalamic ICH occurs, there is a higher probability that blood will leak into the ventricles and that massive bleeding will add pressure to the brainstem, resulting in acute obstructive hydrocephalus and even rapid death ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

Association Between Anatomical Location and Hematoma Expansion in Deep Intracerebral Hemorrhage

et al. 2022

View full text Add to dashboard Cite

ObjectiveTo establish the relationship between hematoma sites of involvement and hematoma expansion (HE) in patients with deep intracerebral hemorrhage (ICH).MethodsEligible patients with deep ICH admitted to hospital within 6 hours of onset between 2018 and 2020 were included in this retrospective multi-center study. Individuals with secondary ICH were excluded. The volume of HE was evaluated based on admission and follow-up computed tomography scans. Associations between deep ICH sites of involvement and HE were examined using multivariable logistic regression analysis while adjusting for confounding covariates of HE.ResultsWe enrolled 583 individuals from three stroke centers. Data from a final total of 460 patients were used in the analysis; of these patients, 159 (34.6%) had HE. In the crude model without adjustment, external capsule, anterior limb of the internal capsule, and posterior limb of the internal capsule (PLIC) involvement were correlated with HE. After fully adjusted models for sex, age, intraventricular hemorrhage, Glasgow Coma Scale admission score, baseline ICH volume, and time from onset to initial computed tomography, multivariable logistic regression revealed that the PLIC is a robust predictor of HE in patients with deep ICH (adjusted odds ratio = 2.73; 95% confidence interval = 1.75–4.26; p < 0.001).ConclusionInvolvement of the posterior limb of the internal capsule in deep hemorrhage could be a promising predictor of HE.

show abstract

“…In view of the BG’s deep location and highly metabolic nature, BBGHs may arise from coup-contrecoup contusions after closed-head injury, hypertensive crises, cerebral venous thrombosis, viral infections, or chemical poisoning [ 5 – 9 ]. Clinical presentation is severe and prognosis dismal, characterized by early neurological deterioration from hematoma expansion and corticospinal tract compression, secondary injury from perihematomal brain swelling with intracranial hypertension, and late hemotoxicity from blood degradation products [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Bilateral basal ganglia hemorrhage: a systematic review of etiologies, management strategies, and clinical outcomes

et al. 2023

View full text Add to dashboard Cite

Bilateral basal ganglia hemorrhages (BBGHs) represent rare accidents, with no clear standard of care currently defined. We reviewed the literature on BBGHs and analyzed the available conservative and surgical strategies. PubMed, Scopus, Web of Science, and Cochrane were searched following the PRISMA guidelines to include studies reporting patients with BBGHs. Clinical characteristics, management, and outcomes were analyzed. We included 64 studies comprising 75 patients, 25 (33%) traumatic and 50 (67%) non-traumatic. Traumatic cases affected younger patients (mean age 35 vs. 46 years, p =0.014) and males (84% vs. 71%, p =0.27) and were characterized by higher proportion of normal blood pressures at admission (66% vs. 13%, p =0.0016) compared to non-traumatic cases. Most patients were comatose at admission (56%), with a mean Glasgow Coma Scale (GCS) score of 7 and a higher proportion of comatose patients in the traumatic than in the non-traumatic group (64% vs. 52%, p =0.28). Among the traumatic group, motor vehicle accidents and falls accounted for 79% of cases. In the non-traumatic group, hemorrhage was most associated with hypertensive or ischemic (54%) and chemical (28%) etiologies. Management was predominantly conservative (83%). Outcomes were poor in 56% of patients with mean follow-up of 8 months. Good recovery was significantly higher in the traumatic than in the non-traumatic group (48% vs. 17%, p =0.019). BBGHs are rare occurrences with dismal prognoses. Standard management follows that of current intracerebral hemorrhage guidelines with supportive care and early blood pressure management. Minimally invasive surgery is promising, though substantial evidence is required to outweigh the potentially increased risks of bilateral hematoma evacuation. Supplementary Information The online version contains supplementary material available at 10.1007/s10143-023-02044-x.

show abstract

Evidence of motor injury due to damaged corticospinal tract following acute hemorrhage in the basal ganglia region

Cited by 6 publications

References 33 publications

Pathway-Specific Mediation Effect Between Structure, Function, and Motor Impairment After Subcortical Stroke

Pathway-Specific Mediation Effect Between Structure, Function, and Motor Impairment After Subcortical Stroke

Association Between Anatomical Location and Hematoma Expansion in Deep Intracerebral Hemorrhage

Bilateral basal ganglia hemorrhage: a systematic review of etiologies, management strategies, and clinical outcomes

Contact Info

Product

Resources

About