Prognostic Value of Histopathological Thrombus Age in Large Vessel Occlusion-Related Stroke.

INTRODUCTION: Acute mechanical thrombectomy (MT) is the preferred treatment for large vessel occlusion-related stroke. Histopathological research on the obtained occlusive embolic thrombus may provide information regarding the aetiology and pathology of the lesion to predict prognosis and propose possible future acute ischaemic stroke therapy. METHODS: A total of 75 consecutive patients who presented to the Amphia Hospital with acute large vessel occlusion-related stroke and underwent MT were included in the study. The obtained thrombus materials were subjected to standard histopathological examination. Based on histological criteria, they were considered fresh (<1 day old) or old (>1 day old). Patients were followed for 2 years for documentation of all-cause mortality. RESULTS: Thrombi were classified as fresh in 40 patients (53%) and as older in 35 patients (47%). Univariate Cox regression analysis showed that thrombus age, National Institutes of Health Stroke Scale at hospital admission, and patient age were associated with long-term mortality (p < 0.1). Multivariable Cox hazards and Kaplan-Meier analysis demonstrated that after extensive adjustment for clinical and procedural variables, thrombus age persisted in being independently associated with higher long-term mortality (hazard ratio: 3.34; p = 0.038, log-rank p = 0.013). CONCLUSION: In this study, older thromboemboli are responsible for almost half of acute large ischaemic strokes. Moreover, the presence of an old thrombus is an independent predictor of mortality in acute large vessel occlusion-related stroke. More research is warranted regarding future therapies based on thrombus composition.

No evidence for cerebellar abnormality in adults with developmental dyslexia.

Developmental dyslexia is commonly believed to result from a deficiency in the recognition and processing of speech sounds. According to the cerebellar deficit hypothesis, this phonological deficit is caused by deficient cerebellar function. In the current study, 26 adults with developmental dyslexia and 25 non-dyslexic participants underwent testing of reading-related skills, cerebellar functions, and MRI scanning of the brain. Anatomical assessment of the cerebellum was conducted with voxel-based morphometry. Behavioural evidence, that was indicative of impaired cerebellar function, was found to co-occur with reading impairments in the dyslexic subjects, but a causal relation between the two was not observed. No differences in local grey matter volume, nor in structure-function relationships within the cerebellum were found between the two groups. Possibly, the observed behavioural pattern is due to aberrant white matter connectivity. In conclusion, no support for the cerebellar deficit hypothesis or the presence of anatomical differences of the cerebellum in adults with developmental dyslexia was found.

Etiology of language network changes during recovery of aphasia after stroke.

Knowledge of spatiotemporal patterns of language network changes may help in predicting outcome in aphasic stroke patients. Here we assessed language function and performed functional MRI four times during one year to measure language network activation and cerebrovascular reactivity (with breath-holding) in twelve left-hemispheric stroke patients, of whom two dropped out before the final measurement, and eight age-matched controls. Language outcome was related to increase of activation in left and right posterior inferior temporal gyrus over the first year, while activation increase in right inferior frontal gyrus was inversely correlated to language recovery. Outcome prediction improved by addition of early language-induced activation of the left posterior inferior temporal gyrus to a regression model with baseline language performance as first predictor. Variations in language-induced activation in right inferior frontal gyrus were primarily related to differences in vascular reactivity. Furthermore, several language-activation changes could not be linked to alterations in language proficiency nor vascular reactivity, and were assumed to be caused by unspecified intersession variability. In conclusion, early functional neuroimaging improves outcome prediction of aphasia after stroke. Controlling for cerebrovascular reactivity and unspecified intersession variability may result in more accurate assessment of the relationship between activation pattern shifts and function after stroke.

Increase in sensorimotor cortex response to somatosensory stimulation over subacute poststroke period correlates with motor recovery in hemiparetic patients.

BACKGROUND: . Somatosensory input to the motor cortex may play a critical role in motor relearning after hemiparetic stroke. OBJECTIVE: . The authors tested the hypothesis that motor recovery after hemiparetic stroke relates to changes in responsiveness of the sensorimotor cortex (SMC) to somatosensory input. METHODS: . A total of 10 hemiparetic stroke patients underwent serial functional magnetic resonance imaging (fMRI) during tactile stimulation and testing of sensorimotor function over 1 year-at early subacute, late subacute, and chronic poststroke time points. RESULTS: . Over the subacute poststroke period, increased responsiveness of the ipsilesional SMC to tactile stimulation of a stroke-affected digit correlated strongly with concurrent gains in motor function. Increased responsiveness of the ipsilesional and contralesional SMC over the subacute period also correlated strongly with motor recovery experienced over the first year poststroke. CONCLUSIONS: . These findings suggest that increased responsiveness of the SMC to somatosensory stimulation over the subacute poststroke period may contribute to motor recovery.

Contribution of the left and right inferior frontal gyrus in recovery from aphasia. A functional MRI study in stroke patients with preserved hemodynamic responsiveness.

The relative contribution of dominant and non-dominant language networks to recovery from aphasia is a matter of debate. We assessed with functional magnetic resonance imaging (fMRI) to what extent the left and right hemispheres are associated with recovery from aphasia after stroke. fMRI with three language tasks was performed in 13 aphasic stroke patients and in 13 healthy subjects. Severity of aphasia was examined within 2 months after stroke and after at least 1 year. Recovery of naming ability and scores on the Token Test were correlated with data from fMRI in the chronic phase. A breath-hold paradigm was used to investigate hemodynamic responsiveness. Overall language performance in the chronic phase correlated with higher relative activation of left compared to right perisylvian areas. Recovery of naming ability was positively correlated with activation in the left inferior frontal gyrus (IFG) for semantic decision and verb generation. Recovery on the Token Test was positively correlated with activation in both left and right IFG during semantic decision and verb generation. Hemodynamic response to the breath-hold task was similar in patients and controls. Our study suggests that in the chronic stage after stroke left IFG activity is associated with improvement of picture naming and sentence comprehension, whereas activity in the right IFG may reflect up-regulation of non-linguistic cognitive processing. Altered hemodynamic responsiveness seems an unlikely confounder in the interpretations of fMRI results.