Lesion mapping of stroke-related erectile dysfunction

Abstract

Acute ischaemic stroke in brain areas contributing to male sexual function may impair erectile function depending on the lesion site. This study intended to determine associations between stroke-related erectile dysfunction and cerebral ischaemic lesion sites using voxel-based lesion mapping. In 52 males (mean age 60.5 ± 10.5 years) with first-ever ischaemic strokes, we assessed erectile function after and retrospectively 3 months prior to the stroke using scores of the 5-item International Index of Erectile Function-5 questionnaire. We assessed cardiovascular risk factors and determined clinical stroke severity and infarct volumes as well as total brain volume by neuroimaging. We calculated correlations between patient age, clinical stroke severity, infarct volumes as well as brain volumes and the difference between erectile dysfunction scores before and after stroke. Moreover, we compared patient age, prevalence of cardiovascular risk factors, clinical stroke severity, infarct volumes and brain volumes of patients with unchanged and deteriorated erectile function after stroke. The infarcts were manually outlined and transformed into stereotaxic space. We determined the lesion overlap and performed subtraction analyses of lesions. In a voxel-based lesion analysis, the difference between erectile dysfunction scores before and after stroke was correlated with the lesion site using t-test statistics. Finally, we conducted a region of interest-based multivariate linear regression analysis that was adjusted for potential confounding factors including patient age, clinical stroke severity, imaging modality, lesion size and brain volume. In 32 patients (61.5%) erectile dysfunction scores declined after the stroke and therefore had stroke-related erectile dysfunction. Deterioration of erectile dysfunction scores was not associated with patient age, clinical stroke severity, infarct volume, brain volume, and cardiovascular risk factors. The voxel-wise subtraction analysis showed associations between stroke-related erectile dysfunction and lesion sites in the right occipito-parietal cortex and thalamus, as well as in the left insula and adjacent temporo-parietal areas. Using voxel-wise t-test statistics, we showed associations between deterioration of erectile function and lesion sites in the right occipital and thalamic region, and the left parietal association area. The linear regression analysis showed that stroke-related erectile dysfunction remained associated with lesions of the right occipital and left parietal association areas after adjusting for confounding factors. In conclusion, our voxel-wise analysis indicates that deteriorating erectile function after stroke is associated with lesions in the right occipito-parietal and thalamic areas integrating visual and somatosensory information, as well as lesions in the left insular and adjacent parieto-temporal areas contributing to generating and mapping visceral arousal states.

Cerebral lesion correlates of sympathetic cardiovascular activation in multiple sclerosis

“…While the voxel‐wise analyses showed the above associations between lesion sites and RRI‐LF/HF‐ratios as well as sympathetic BPsys‐LF‐powers, these two autonomic parameters neither correlated with parameters potentially confounding autonomic function, such as patient age, disease duration and severity, nor with the total volume of cerebral MS‐lesions. We therefore conclude that changes in cardiovascular autonomic function depend less on the overall lesion load but more on the site of neuro‐inflammatory lesions and their association with areas or pathways of the central autonomic network (Benarroch, ; Hilz et al, ; Winder et al, ).…”

“…To control for multiple comparisons, we applied a false discovery rate (FDR) correction of q < 0.01. Since increasing total cerebral lesion volume might be associated with an increased risk of afflicting brain areas that are strategically relevant for autonomic function (Karnath, Fruhmann Berger, Küker, & Rorden, ; Winder et al, , ), we calculated the total volume of MS‐lesions throughout the brain using the latest version NPM software implemented in the MRIcron software package (Rorden et al, ). To determine damaged brain regions, affected voxels were overlaid on the automated anatomical labeling (AAL) atlas (Tzourio‐Mazoyer et al, ) or the John Hopkins University (JHU)‐White matter‐labels atlas (1 mm).…”

“…Autonomic cardiovascular modulation depends on the integrity of the central autonomic network which includes the insular and cingulate cortices, the amygdala, the prefrontal or orbitofrontal cortex, the hypothalamus, and brainstem structures (Benarroch, ; Racosta et al, ; Winder et al, ). MS‐associated lesions in the periventricular white matter, juxtacortical U‐fibers, the brainstem, the cerebellum or spinal cord areas (Ge, ; Vigeveno, Wiebenga, Wattjes, Geurts, & Barkhof, ; Winder et al, ) might compromise the centrally mediated sympathetic and parasympathetic cardiovascular modulation (Hilz, ; Racosta et al, ).…”

Distortion of Visuo-Motor Temporal Integration in Apraxia: Evidence From Delayed Visual Feedback Detection Tasks and Voxel-Based Lesion-Symptom Mapping

“…The pathological scan was used to coregister the lesion map to the T2-weighted anatomical scan. Then, a unified-segmentation normalization algorithm was applied to the anatomical scan by assuming a priori maps of gray matter, white matter, and cerebral spinal fluid in the brain (80–82). The modality was FLAIR, the template mask was not set, the bounding box was set to 2 × 3 double, intermediate images were set to define the origin automatically as False, and normalization was conducted.…”

Brain MRI Lesions are Related to Bowel Incontinence in Multiple Sclerosis

“…Due to the study design, we cannot rule out under‐reporting of anorectal incontinence. Moreover, the VLSM technique only supports conclusions regarding associations between bowel incontinence and lesion sites for those brain areas that are compromised in a high enough number of patients, ie, if there is a high enough lesion‐overlap among patients . Thus, associations between bowel incontinence and lesions in areas that are known to usually contribute to autonomic, sensory, and motor processing, such as the prefrontal cortex, somatosensory association cortex, insula, cingulate gyrus, as well as subcortical regions (thalamus, amygdala, and basal ganglia) areas, cannot be adequately determined by the VLSM approach unless the sample size is significantly larger than in our study.…”