Risk Factors and Imaging Mechanisms of Fatigue After Mild Ischemic Stroke: An Exploratory Study From a Single Chinese Center.

Xiaoxiao Zhang,Ning Zhang,Ding Ma,Chunxue Wang,Yunyun Duan,Zhaozhao Wang,Hongjuan Fang

doi:10.3389/fneur.2021.649021

Abstract

Objective: To explore the biochemical risk factors and imaging mechanisms of post fatigue after mild ischemic stroke among a Chinese population.Methods: Forty consecutive patients with mild ischemic stroke within onset of 14 ± 2 days were enrolled between March and June 2018. The clinical information, scale data, biomarkers in peripheral venous blood, and imaging data during hospitalization and follow-up period were collected.Results: Patient age (range 34–78) was positively correlated with the prevalence of fatigue (p = 0.009). Both blood norepinephrine and serotonin levels during hospitalization were negatively correlated to the prevalence of post-stroke fatigue (model 1 p = 0.009 and model 2 P = 0.043, respectively). Infarct of right cerebral hemisphere is positively correlated with the occurrence of fatigue after mild ischemic stroke (p = 0.020). Compared to non-fatigue patients, amplitude of low-frequency fluctuation (ALFF) was lower in several areas of brain in stroke patients with fatigue, including the right orbital inferior frontal, right inner orbital frontal, right frontal, right triangular frontal inferior, right anterior and lateral cingulate, and right medial frontal gyruses. Analysis of the difference in functional connectivity between the fatigue and non-fatigue groups found no cluster.Conclusions: Frontal lobe-related neural pathways may play an essential role in the regulation of fatigue after mild ischemic stroke. Abnormal neural circuits may reduce the levels of neurotransmitters such as serotonin and norepinephrine and lead to post-stroke fatigue.

Highlights

Stroke is one of the three leading causes of death and the third primary cause of disability worldwide
The pathogenesis of post mild-ischemic-stroke fatigue may be that stroke affects non major hemispheric related neural pathways, especially frontal lobe related neural pathways, resulting in a decrease of neurotransmitters, such as norepinephrine and 5hydroxytryptamine, which leads to post-stroke fatigue
Our study found an incidence of 52.5% (21 out of 40), which is in line with previous studies

Summary

Introduction

Stroke is one of the three leading causes of death and the third primary cause of disability worldwide. Many studies have shown that fatigue significantly lowers the life quality in survivors of mild ischemic stroke and is a predictor of death after stroke [1, 7,8,9], which make such patients an ideal candidate for post-stroke fatigue study. Effective diagnosis and treatment of post-stroke fatigue can improve the quality of life for patients with mild ischemic stroke [10,11,12,13]. In this consideration, it is crucial to understand the pathogenesis of post-stroke fatigue

Methods

Results

Conclusion