Thalamic metabolism and corticospinal tract integrity determine motor recovery in stroke

Abstract

We studied the role of remote metabolic depressions and pyramidal tract involvement regarding motor recovery following a first hemiparetic ischemic stroke. In 23 patients the regional cerebral glucose metabolism (rCMRGlu) was measured with positron emission tomography and the location and spatial extent of the stroke lesions were assessed by magnetic resonance imaging. Motor impairment during the acute and chronic stages (4 weeks after stroke) was determined by a motor score and recordings of magnetic evoked motor potentials. Twelve patients recovered significantly, whereas 11 patients retained a disabling hemiparesis. In contrast to patients with good motor recovery, rCMRGlu was severely depressed in the thalamus on the lesion side in patients with poor motor recovery. This patient group also showed more severe damage to the pyramidal tract on magnetic resonance images and a more pronounced reduction of the magnetic evoked motor potential amplitude. Neither the size of the stroke lesions nor the spatial extent of the lesional and remote rCMRGlu depressions outside the thalamus correlated with the thalamic hypometabolism and the improvement of the motor score. We conclude that preservation both of parts of the pyramidal tract and of the thalamic circuitry is a major determinant for the quality of hand motor recovery following acute brain ischemia in the adult.

Plasticity of the human motor cortex and recovery from stroke

“…In a number of Most TMS studies have shown that presence of contralaclinical trials, there have been behavioral improvement teral MEPs early after the stroke is a marker for good even in patients with chronic and apparently stable stroke. recovery [2,8,9,20,31,46,53,55,62]. Preservation of corLiepert and co-workers [38,39] have shown that TMS ticospinal tract with MRI imaging was also found to maps increase in size in this circumstance showing that the correlate with good recovery confirming the TMS studies expected cortical changes appear to be occurring.…”

“…Preservation of corLiepert and co-workers [38,39] have shown that TMS ticospinal tract with MRI imaging was also found to maps increase in size in this circumstance showing that the correlate with good recovery confirming the TMS studies expected cortical changes appear to be occurring. [2]. Clearly, contralateral control, even if reorganized, Another method for improving rehabilitation is the seems superior to ipsilateral control in recovery.…”

Stimulation of autophagy by rapamycin protects neurons from remote degeneration after acute focal brain damage

“…23 There is a consensus that mechanisms of remote degeneration are critical for the overall clinical profile in many acute CNS pathologies. 24 In this study, we examined the function of autophagy and its kinetics during apoptosis in an in vivo model of acute focal CNS lesion, focusing on remote changes that are induced by hemicerebellectomy (HCb). 22 HCb is a unique experimental paradigm in which axonal damage-induced neuronal death mechanisms can be studied.…”

Chronic Hyperperfusion and Angiogenesis Follow Subacute Hypoperfusion in the Thalamus of Rats with Focal Cerebral Ischemia

“…Also, remote metabolic depression could be responsible for hypoperfusion and this has been shown within 1 week after focal ischemia (Watanabe et al, 1998;Barbelivien et al, 2002). In stroke patients, thalamic hypometabolism is thought to result from depressed synaptic activity (diaschisis) due to acute structural damage in the infarcted cortex (Binkofski et al, 1996).…”