London, United Kingdom 2013 8 Brain imaging Preexisting white matter lesions impair recovery from lacunar thalamic stroke P. Eisele1, M. Griebe2, E. Fischer3, A. Ebert4, C. Roßmanith5, M.G. Hennerici6, K. Szabo7 Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg,, Mann-heim, GERMANY1, Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg,, Mannheim, GERMANY2, Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg,, Mannheim, GERMANY3, Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg,, Mannheim, GERMANY4, Department of Neurology, Uni-versitätsmedizin Mannheim, University of Heidelberg,, Mannheim, GERMANY5, Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg,, Mannheim, GERMANY6, Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg,, Mannheim, GERMANY7 Background: Vascular syndromes of the thalamus have been described according to the vascular supply and the clinical symptoms resulting from ischemia. Due to extensive reciprocal thalamo-cor-tical connections, recovery from thalamic stroke might be impaired by white matter lesions (WML) affecting the integrity of the cerebral network. We analyzed the MRI patterns, clinical features and outcome of acute thalamic stroke. Methods: From our prospectively collected Mannheim stroke database we identified 135 patients with acute lacunar stroke of the thalamus treated between 2004 and 2011. Only patients with an MRI-confirmed isolated lacunar stroke of the thalamus were included; patients with another possible stroke mechanism as defined by the ASCO score were excluded. We analyzed stroke severity (NI-HSS), functional outcome (mRS at 3 months), DWI infarct pattern and WML load (Fazekas score). Effects were calculated using partial rank correlation. Results: Mean age of the collective was 67 years; 64 were female. The lesion pattern distribution ac-cording to the four main arteries was as follows: inferolateral in 72%, paramedian in 15%, posterior choroidal in 8%, and tuberothalamic in 5%. The median premorbid mRS for all pattern groups was 0. WML was graded as follows: 0 in 13%, 1 in 41%, 2 in 27%, and 3 in 20%. The median NIHSS at admission was 2 (range 0-20), and 1 at discharge (range 0-8). The median mRS at 3 months was 1 (range 0-4). While age was also a significant predictor of outcome, the extent of WML predicted mRS at 3 months after correction for age (p<0.022). Conclusions: Chronic WML contribute to a less favorable clinical outcome after focal thalamic stroke. This might be explained by a disturbance of thalamo-cortical interconnections causing aggra-vation E-Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 233 of neurological deficits. 7 Brain imaging Functional anatomy of sensorimotor integration in chronic stroke patients M. Gandolla1, S. Ferrante2, F. Molteni3, E. Guanziroli4, T. Frattini5, A. Martegani6, G. Ferrigno7, A.L.G. Pedrocchi8, N.S. Ward9 Politecnico di Milano, Milano, ITALY1, Politecnico di Milano, Milano, ITALY2, Valduce Hospital, Villa Beretta Rehabilitation Center, Costamasnaga (LC), ITALY3, Valduce Hospital, Villa Beretta Rehabilitation Center, Costamasnaga (LC), ITALY4, Valduce Hospital, Unità Operativa Complessa di Radiologia, Como, ITALY5, Valduce Hospital, Unità Operativa Complessa di Radiologia, Como, ITALY6, Politecnico di Milano, Milano, ITALY7, Politecnico di Milano, Milano, ITALY8, Sobell De-partment of Movement Neuroscience, UCL Institute of Neurology, London, UNITED KINGDOM9 Background Increasing somatosensory input can enhance functionally relevant brain reorganisation after stroke and is a potential mechanism of action of functional electrical stimulation (FES). The site of senso-rimotor integration (SMI) is not yet clear, but may be different in controls and patients because of post-stroke brain reorganisation. Here we used fMRI to investigate SMI in the brain during FES. Methods Subjects were scanned during four conditions in a 2x2 factorial design: (1 & 2) repetitive unilateral active (moved by the subject) ankle dorsiflexion with and without concurrent electrical stimulation, (3 & 4) repetitive passive (moved by the experimenter) ankle dorsiflexion with and without concur-rent electrical stimulation. Movements were performed with the affected ankle. FES was superficial-ly applied to peroneal nerve; current was set subject by subject. Analysis was performed with SPM8. Here, we define SMI as the interaction between volitional movement and augmented proprioception. Results 10 chronic stroke patients and 16 age-matched healthy controls took part (range 28-72 yrs). In con-trols, all conditions elicited activity in S1 and M1. FES led to relative overactivity in SII. FES had an additional effect in M1 and S1 during active compared to passive movement. In patients, all conditions elicited activity in a more widely distributed network that included S1 and M1 (Fig. 1). In particular, FES had a greater effect during active compared to passive movement in ipsilesional postcentral and angular gyrus (Fig. 1). Conclusion In healthy subjects, SMI was seen in primary sensorimotor areas, whereas in patients it was seen in secondary areas (i.e. postcentral gyrus; angular gyrus). Angular gyrus is a recipient of proprioceptive information encoded in the postcentral gyrus. These results suggest that SMI takes place in a more widely distributed network of brain areas after stroke, and that patients may take advantage of sec-ondary areas to support motor learning.
Karger_ESC London_2013
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