Evolution of Neuropsychological Deficits in First-Ever Isolated Ischemic Thalamic Stroke and Their Association With Stroke Topography: A Case-Control Study

Abstract

Background: The thalamus plays an essential role in cognition. Cognitive deficits have to date mostly been studied retrospectively in chronic thalamic stroke in small cohorts. Studies prospectively evaluating the evolution of cognitive deficits and their association with thalamic stroke topography are lacking. This knowledge is relevant for targeted patient diagnostics and rehabilitation. Methods: Thirty-seven patients (57.5±17.5 [mean±SD] years, 57% men) with first-ever acute isolated ischemic stroke covering the anterior (n=5), paramedian (n=12), or inferolateral (n=20) thalamus and 37 in-patient controls without stroke with similar vascular risk factors matched for age and sex were prospectively studied. Cognition was evaluated using predefined tests at 1, 6, 12, and 24 months. Voxel-based lesion-symptom mapping was used to determine associations between neuropsychological deficits and stroke topography. Results: Patients with anterior thalamic stroke revealed severe deficits in verbal memory (median T score [Q1–Q3]: 39.1 [36.1–44.1]), language (31.8 [31.0–43.8]), and executive functions (43.8 [35.5–48.1]) at 1 month compared with controls (verbal memory: 48.5 [43.6–61.0], language: 55.7 [42.3–61.1], executive functions: 51.3 [50.1–56.8]). Patients with paramedian thalamic stroke showed moderate language (44.7 [42.8–55.9]) and executive (49.5 [44.3–55.1]) deficits and no verbal memory deficits (48.1 [42.5–54.7]) at 1 month compared with controls (59.0 [47.0–64.5]; 59.6 [51.1–61.3]; 52.5 [44.2–55.3]). The language and executive deficits in paramedian thalamic stroke patients almost completely recovered during follow-up. Intriguingly, significant deficits in verbal memory (44.7 [41.5–51.9]), language (47.5 [41.8–54.1]), and executive functions (48.2 [46.2–59.7]) were found in inferolateral thalamic stroke patients at 1 month compared with controls (50.5 [46.7–59.9]; 57.0 [51.2–62.9]; 57.4 [51.2–60.7]). Language, but not executive deficits persisted during follow-up. Voxel-based lesion-symptom mapping revealed an association of verbal memory deficits with anterior thalamus lesions and an association of non-verbal memory, language, and executive deficits with lesions at the anterior/paramedian/inferolateral border. Conclusions: All 3 stroke topographies exhibited significant deficits in diverse cognitive domains, which recovered to a different degree depending on the stroke localization. Our study emphasizes the need for comprehensive neuropsychological diagnostics to secure adequate patient rehabilitation.

Association of regional white matter hyperintensities with hypertension and cognition in the population‐based 1000BRAINS study

“…As one possible reason for these discrepancies, it was suggested that besides the severity, the location of WMH might be an important determinant of cognitive impairment [6,7]. For example, small lesions in the thalamus can strongly affect cognition [8], while widely distributed deep WMH can remain clinically silent [9]. In addition to being followed by different cognitive consequences, different locations of WMH might be influenced by different pathomechanisms.…”

Role of neurorehabilitation in the recovery of bilateral thalamic stroke related to the artery of Percheron anatomical variant

“…After any stroke, rehabilitation is fundamental and can critically impact the patient’s recovery 21–23. Targeted neurorehabilitation programmes are particularly effective, as demonstrated in our case 23 24. To date, solid scientific evidence emphasises how intensive rehabilitation programmes should be started as soon as possible, although 24 hours after the stroke.…”

“…Besides rehabilitation, other factors that shape the prognosis of thalamic strokes are (1) the extent of the damaged thalamic territory, which affects the amount of altered connections24; (2) the location of the stroke, which affects the quality of the damaged connections24 and (3) secondary prevention strategies 29 30. Although the first two factors are relevant to classify the clinical features and implementing a tailored neurorehabilitation programme, ‘classical’ risk factors should not be overlooked.…”

Neuroimaging biomarkers of cognitive recovery after ischemic stroke

“…In their fully adjusted models, infarct in the thalamus more than quadrupled the risk of cognitive decline among these patients. A recent study further characterized cognitive recovery among patients with ischemic thalamic stroke: in this case control study with a 2-year follow-up period, patients with anterior and inferolateral thalamic strokes were found to have poorer recovery of language, memory, and executive function than those with paramedian strokes ( 42 ).…”