Abstract
BackgroundThe cerebellum receives afferent signals from spinocerebellar pathways regulating lower limb movements. However, the longitudinal changes in the spinocerebellar pathway in the early stage of unilateral supratentorial stroke and their potential clinical significance have received little attention.MethodsDiffusion tensor imaging and Fugl-Meyer assessment of lower limb were performed 1, 4, and 12 weeks after onset in 33 patients with acute subcortical infarction involving the supratentorial areas, and in 33 healthy subjects. We evaluated group differences in diffusion metrics in the bilateral inferior cerebellar peduncle (ICP) and analyzed the correlation between ICP diffusion metrics and changes to the Fugl-Meyer scores of the affected lower limb within 12 weeks after stroke.ResultsSignificantly decreased fractional anisotropy and increased mean diffusivity were found in the contralesional ICP at week 12 after stroke compared to controls (all P < 0.01) and those at week 1 (all P < 0.05). There were significant fractional anisotropy decreases in the ipsilesional ICP at week 4 (P = 0.008) and week 12 (P = 0.004) compared to controls. Both fractional anisotropy (rs = 0.416, P = 0.025) and mean diffusivity (rs = -0.507, P = 0.005) changes in the contralesional ICP correlated with changes in Fugl-Meyer scores of the affected lower limb in all patients.ConclusionsBilateral ICP degeneration occurs in the early phase of supratentorial stroke, and diffusion metric values of the contralesional ICP are useful indicators of affected lower limb function after supratentorial stroke.
Highlights
The cerebellum receives afferent signals from spinocerebellar pathways regulating lower limb movements
Kim et al [6] found a secondary degeneration characterized by reduced fractional anisotropy (FA) and elevated mean diffusivity (MD) in the contralesional inferior cerebellar peduncle (ICP) in 23 patients with subacute middle cerebral artery (MCA) stroke, a change associated with patients’ ambulatory and lower limb (LL) function
They believed that insufficient peripheral proprioceptive stimulation to the cerebellum due to LL weakness might result in secondary changes in the spinocerebellar pathway, but they could not fully determine whether FA reduction in the contralesional ICP was affected by hemiplegic muscles, a hypofunctional cerebellum, or both, due to the retrospective and cross-sectional design of their study
Summary
The cerebellum receives afferent signals from spinocerebellar pathways regulating lower limb movements. Kim et al [6] found a secondary degeneration characterized by reduced fractional anisotropy (FA) and elevated mean diffusivity (MD) in the contralesional ICP in 23 patients with subacute middle cerebral artery (MCA) stroke, a change associated with patients’ ambulatory and lower limb (LL) function. They believed that insufficient peripheral proprioceptive stimulation to the cerebellum due to LL weakness might result in secondary changes in the spinocerebellar pathway, but they could not fully determine whether FA reduction in the contralesional ICP was affected by hemiplegic muscles, a hypofunctional cerebellum, or both, due to the retrospective and cross-sectional design of their study. Whether supratentorial stroke lesions can cause secondary damage in the ipsilesional ICP due to a connectivity disruption between the ICP and sensory-motor cortices remains unclear
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