Ipsilesional volume loss of basal ganglia and thalamus is associated with poor hand function after ischemic perinatal stroke

Abstract

Background Perinatal stroke (PS) is the leading cause of hemiparetic cerebral palsy (CP). Involvement of the corticospinal tract on neonatal magnetic resonance imaging (MRI) is predictive of motor outcome in patients with hemiparetic CP. However, early MRI is not available in patients with delayed presentation of PS and prediction of hemiparesis severity remains a challenge. Aims To evaluate the volumes of the basal ganglia, amygdala, thalamus, and hippocampus following perinatal ischemic stroke in relation to hand motor function in children with a history of PS and to compare the volumes of subcortical structures in children with PS and in healthy controls. Methods Term born PS children with arterial ischemic stroke (AIS) (n = 16) and with periventricular venous infarction (PVI) (n = 18) were recruited from the Estonian Pediatric Stroke Database. MRI was accuired during childhood (4-18 years) and the volumes of the basal ganglia, thalamus, amygdala and hippocampus were calculated. The results of stroke patients were compared to the results of 42 age- and sex-matched healthy controls. Affected hand function was evaluated by Assisting Hand Assessment (AHA) and classified by the Manual Ability Classification System (MACS). Results Compared to the control group, children with AIS had smaller volumes of the ipsi- and contralesional thalami, ipsilesional globus pallidus, nucleus accumbens and hippocampus (p < 0.005). Affected hand function in children with AIS was correlated with smaller ipsilesional thalamus, putamen, globus pallidus, hippocampus, amygdala and contralesional amygdala (r > 0.5; p < 0.05) and larger volume of the contralesional putamen and hippocampus (r < − 0.5; p < 0.05). In children with PVI, size of the ipsilesional caudate nucleus, globus pallidus, thalamus (p ≤ 0.001) and hippocampus (p < 0.03) was smaller compared to controls. Smaller volume of the ipsi- and contralesional thalami and ipsilesional caudate nucleus was correlated with affected hand function (r > 0.55; p < 0.05) in children with PVI. Conclusions Smaller volume of ipsilesional thalamus was associated with poor affected hand function regardless of the perinatal stroke subtype. The pattern of correlation between hand function and volume differences in the other subcortical structures varied between children with PVI and AIS. Evaluation of subcortical structures is important in predicting motor outcome following perinatal stroke.

Bihemispheric developmental alterations in basal ganglia volumes following unilateral perinatal stroke

“…In contrast, the diagnostic criteria for PVI ( Kirton et al, 2008 ) deliberately include sparing of the caudal basal ganglia (specifically the putamen) which is not typically drained by the medullary venous system ( Raets et al, 2015 ). Likewise, a recent study has shown that ipsilesional volume loss in the basal ganglia due to perinatal stroke was associated with poor hand function, however this relationship was highly dependent on the type of stroke ( Ilves et al, 2022 ). Given the extensive functions of the basal ganglia, damage to these structures may result in complex disabilities following perinatal stroke but their role remains poorly defined.…”

Subcortical brain volumes in neonatal hypoxic-ischemic encephalopathy

“…(30) Previous studies have consistently reported that neonates with reduced basal ganglia volumes experience more developmental delays and deficits than their healthy counterparts. (31)(32)(33)(34)(35) Smaller subcortical structures are associated with poor motor and higher-order executive functions, as found in the 7-year follow-up of neonates born with HIE. (36) We also found that HIE severity was associated with subcortical volumes, particularly impacting the basal ganglia, adjusting for clinical and demographic factors, including TH.…”

Neurocognitive Dysfunction With Neuronal Injury in People With HIV on Long-Duration Antiretroviral Therapy

“…Thus, even a small reduction in the volume of these regions may result in functional changes. 26 On cognitive testing, PWH were slower to complete a motor task measuring manual dexterity with their dominant hand. It is possible that this impairment may be related to reductions in basal ganglia volume, a region important in motor pathways.…”