Site of the ischemic penumbra as a predictor of potential for recovery of functions

Hillis, Argye E.; Gold, Larry B.; Kannan, Vijay C.; Cloutman, Lauren; Kleinman, Jonathan T.; Newhart, Melissa; Heidler‐Gary, Jennifer; Davis, Cameron; Aldrich, Eric M.; Llinás, Rafael H.; Gottesman, Rebecca F.

doi:10.1212/01.wnl.0000317091.17339.98

Cited by 38 publications

(27 citation statements)

References 28 publications

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“…38,39 These trials used the mismatch hypothesis with either MRI (perfusion/diffusion mismatch) or CT (perfusion/cerebral blood volume mismatch) as a signature of the putative penumbra. 19,20,22,24,25,40 -43 Apart from the recent DIAS II trial, 18 these trials had supported the physiologic basis of the mismatch concept.…”

Section: Discussionmentioning

confidence: 99%

Mismatch-Based Delayed Thrombolysis

Mishra

Albers

Davis

et al. 2010

Stroke

151

111

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Background and Purpose-Clinical benefit from thrombolysis is reduced as stroke onset to treatment time increases. The use of "mismatch" imaging to identify patients for delayed treatment has face validity and has been used in case series and clinical trials. We undertook a meta-analysis of relevant trials to examine whether present evidence supports delayed thrombolysis among patients selected according to mismatch criteria. Methods-We collated outcome data for patients who were enrolled after 3 hours of stroke onset in thrombolysis trials and had mismatch on pretreatment imaging. We selected the trials on the basis of a systematic search of the Web of Knowledge. We compared favorable outcome, reperfusion and/or recanalization, mortality, and symptomatic intracerebral hemorrhage between the thrombolyzed and nonthrombolyzed groups of patients and the probability of a favorable outcome among patients with successful reperfusion and clinical findings for 3 to 6 versus 6 to 9 hours from poststroke onset. Results are expressed as adjusted odds ratios (a-ORs) with 95% CIs. Heterogeneity was explored by test statistics for clinical heterogeneity, I 2 (inconsistency), and L'Abbé plot. Results-We identified articles describing the DIAS, DIAS II, DEDAS, DEFUSE, and EPITHET trials, giving a total of 502 mismatch patients thrombolyzed beyond 3 hours. The combined a-ORs for favorable outcomes were greater for patients who had successful reperfusion (a-ORϭ5.2; 95% CI, 3 to 9; I 2 ϭ0%). Favorable clinical outcome was not significantly improved by thrombolysis (a-ORϭ1.3; 95% CI, 0.8 to 2.0; I 2 ϭ20.9%). Odds for reperfusion/recanalization were increased among patients who received thrombolytic therapy (a-ORϭ3.0; 95% CI, 1.6 to 5.8; I

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Section: Discussionmentioning

confidence: 99%

Mismatch-Based Delayed Thrombolysis

Mishra

Albers

Davis

et al. 2010

Stroke

151

111

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“…Overall, these findings suggest that post-stroke cortical language plasticity may be related in part to several and potentially age-dependent mechanisms [6]. In contrast to the recovery after perinatal and early postnatal LMCA stroke and unmasking of the pre-existing pathways in the non-dominant homologues [11,12], improvements in adult-acquired aphasia may be dependent on the preservation or recovery of the left cortical language-producing regions [17–20,68,69] although, as we have illustrated in this study, the left hemisphere brain regions actually engaged to achieve better task performance in stroke patients are different from those utilized in HC.…”

Section: Discussionmentioning

confidence: 99%

Different patterns of language activation in post-stroke aphasia are detected by overt and covert versions of the verb generation fMRI task

et al. 2012

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Summary Background Post-stroke language functions depend on the relative contributions of the dominant and non-dominant hemispheres. Thus, we aimed to identify the neural correlates of overt and covert verb generation in adult post-stroke aphasia. Material/Methods Sixteen aphasic LMCA stroke patients (SPs) and 32 healthy controls (HCs) underwent language testing followed by fMRI while performing an overt event-related verb generation task (ER-VGT) isolating activations related to noun-verb semantic processing or to articulation and auditory processing, and a covert block design verb generation task (BD-VGT). Results BD-VGT activation patterns were consistent with previous studies, while ER-VGT showed different patterns in SPs relative to HCs including less left-hemispheric involvement during semantic processing and predominantly right-sided activation related to articulation and auditory processing. ER-VGT intra-scanner performance was positively associated with activation during semantic associations in the left middle temporal gyrus for HCs (p=0.031) and left middle frontal gyrus for SPs (p=0.042). Increased activation in superior frontal/cingulate gyri was associated with better intra-scanner performance (p=0.020). Lesion size negatively impacted verbal fluency tested with Controlled Oral Word Association Test (p=0.0092) and the Semantic Fluency Test (p=0.033) and trended towards a negative association with verb generation performance on the event-related verb generation task (p=0.081). Conclusions Greater retention of pre-stroke language skills is associated with greater involvement of the left hemisphere with different cortical recruitment patterns observed in SPs versus HCs. Post-stroke verbal fluency may depend more upon the structural and functional integrity of the dominant left hemisphere language network rather than the shift to contralateral homologues.

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“…The ischemic penumbra allows a fair prediction of functional improvement, which will take place during the acute stage. 26 The recovery during the following months cannot, however, be predicted reliably on the basis of lesion size, language performance in the acute stage, age, or education. 9 Current research in predictive models of recovery aims at large scale databases, comparing anatomic and functional data.…”

Section: From the Wernicke-lichtheim-geschwind Model To Current Concementioning

confidence: 99%

“…Ишемическая пенумбра позволяет сделать справедливый прогноз относительно функционального улучшения во время острого периода [26]. Однако на основании размера зоны поражения, степени нарушения функции речи в остром периоде, возраста или уровня образования невозможно точно прогнозировать темп восстановле-ния в течение последующих месяцев [9].…”

Section: Strokeunclassified