Basal Ganglia Stroke Research Articles

Mineralizing Angiopathy with Basal Ganglia Stroke after Minor Trauma: Case Series Including Two Familial Cases.

Introduction:Basal ganglia stroke following trauma has been known to occur and described in previous case studies. But exact etiology is unknown.Aim:To study the clinical characteristics, imaging features, and neurodevelopmental outcomes of children presented with basal ganglia stroke associated with mineralization in the lenticulostriate arteries in our center from January 2013 to June 2016.Subjects and Methods:Children with subcortical stroke during the study period were identified retrospectively, and those presented with basal ganglia stroke with mineralization of lenticulostriate vessels were analyzed for clinical profile, imaging features, and outcomes. Statistical analysis was carried out using the Statistical Package for the Social Sciences (SPSS) software, version 17 (IBM, New York).Results:Of 38 children with basal ganglia stroke (20 boys, 18 girls, and mean age at presentation 14.026±5.8470 months), 27 had history of trauma preceding the stroke. Thirty-seven children presented with hemiparesis and one presented with hemidystonia. The mean follow-up time was 8 months, three children developed recurrence during that period. Five children with recurrence of stroke, initial episodes were not evaluated as they presented to us for the first time. A total of 17 of 30 infants who did not have stroke recurrence were normal on follow-up, whereas 9 infants showed persistent mild hemiparesis, 2 had motor delay, and 2 others had mild residual distal weakness. No identifiable causes were observed for vascular calcification. Two familial cases were also noted.Conclusion:Most common cause for acute basal ganglia stroke in toddlers was mineralizing angiopathy of lenticulostriate vessels. It was preceded by minor trauma in most cases.

Outcome of epilepsy in patients with mitochondrial disorders: Phenotype genotype and magnetic resonance imaging correlations

ObjectivesStudies exploring the outcome of epilepsy in patients with mitochondrial disorders are limited. This study examined the outcome of epilepsy in patients with mitochondrial disorders and its relation with the clinical phenotype, genotype and magnetic resonance imaging findings. Patients and methodsThe cohort was derived from the database of 67 patients with definite genetic diagnosis of mitochondrial disorders evaluated over a period of 11years (2006–2016). Among this, 27 had epilepsy and were included in final analysis. Data were analyzed with special reference to clinical phenotypes, genotypes, epilepsy characteristics, EEG findings, anti epileptic drugs used, therapeutic response, and magnetic resonance imaging findings. Patients were divided into three groups according to the seizure frequency at the time of last follow up: Group I- Seizure free; Group II- Infrequent seizures; Group III- uncontrolled seizures. For each group the clinical phenotype, genotype, magnetic resonance imaging and duration of epilepsy were compared. ResultsThe phenotypes & genotypes included Mitochondrial Encephalopathy Lactic Acidosis and Stroke like episodes (MELAS) & m.3243A>G mutation (n = 10), Myoclonic Epilepsy Ragged Red Fiber syndrome (MERRF) & m.8344A>G mutation (n = 4), Chronic Progressive External Ophthalmoplegia plus &POLG1 mutation (CPEO, n = 6), episodic neuroregression due to nuclear mutations (n = 6; NDUFV1 (n = 3), NDUFA1, NDUFS2, MPV17-1 one each), and one patient with infantile basal ganglia stroke syndrome, mineralizing angiopathy &MT-ND5 mutations. Seven patients (25.9%) were seizure free; seven had infrequent seizures (25.9%), while thirteen (48.1%) had frequent uncontrolled seizures. Majority of the subjects in seizure free group had episodic neuroregression & leukoencephalopathy due to nuclear mutations (85.7%). Patients in group II with infrequent seizures had CPEO, POLG1 mutation and a normal MRI (71%) while 62% of the subjects in group III had MELAS, m.3243A>G mutation and stroke like lesions on MRI. ConclusionsA fair correlation exists between the outcome of epilepsy, clinical phenotypes, genotypes and magnetic resonance imaging findings in patients with mitochondrial disorders. The recognition of these patterns is important clinically because of the therapeutic and prognostic implications.

Neurocognitive outcomes in children with unilateral basal ganglia arterial ischemic stroke and secondary hemidystonia

ABSTRACTDystonia is a movement disorder that involves excessive, involuntary muscle contractions resulting in repetitive movements and/or abnormal posturing. One common cause of unilateral dystonia in childhood is ischemic stroke involving the basal ganglia and/or thalamus. Virtually nothing is known about neuropsychological outcomes in children who have dystonia following basal ganglia stroke. The present study explored whether or not children with secondary dystonia experience additional cognitive challenges when compared to children with similar patterns of brain injury, but no dystonia. We examined intellectual function, academics, and several aspects of executive function in children with unilateral basal ganglia stroke during childhood, comparing those with dystonia and those without. Although groups did not differ in terms of lesion size, we found significantly lower performance on measures of verbal and nonverbal reasoning, inhibitory control, and academic ability in children with secondary dystonia compared to those without. In contrast, there were no significant group differences on parent ratings of their child’s executive function in daily life. These findings suggest that maladaptive reorganization following basal ganglia stroke may contribute to the development of secondary dystonia and also to poor intellectual and academic outcomes in this group.

Behavioural inflexibility in a comorbid rat model of striatal ischemic injury and mutant hAPP overexpression

Alzheimer disease (AD) and stroke coexist and interact; yet how they interact is not sufficiently understood. Both AD and basal ganglia stroke can impair behavioural flexibility, which can be reliably modeled in rats using an established operant based set-shifting test. Transgenic Fischer 344-APP21 rats (TgF344) overexpress pathogenic human amyloid precursor protein (hAPP) but do not spontaneously develop overt pathology, hence TgF344 rats can be used to model the effect of vascular injury in the prodromal stages of Alzheimer disease. We demonstrate that the injection of endothelin-1 (ET1) into the dorsal striatum of TgF344 rats (Tg-ET1) produced an exacerbation of behavioural inflexibility with a behavioural phenotype that was distinct from saline-injected wildtype & TgF344 rats as well as ET1-injected wildtype rats (Wt-ET1). In addition to profiling the types of errors made, interpolative modeling using logistic exposure-response regression provided an informative analysis of the timing and efficiency of behavioural flexibility. During set-shifting, Tg-ET1 committed fewer perseverative errors than Wt-ET1. However, Tg-ET1 committed significantly more regressive errors and had a less efficient strategy change than all other groups. Thus, behavioural flexibility was more vulnerable to striatal ischemic injury in TgF344 rats.

Outcome of arterial ischemic stroke in children with heart disease.

Study the outcome of children with heart disease that have suffered AIS and the factors that influence on prognosis. We evaluated all children with heart disease who had suffered AIS between 2000 and 2014 in our hospital. Seventy-four children with heart disease suffered an arterial ischemic stroke. 20% of them died and 10% had new AIS during the study period. Fifty-two patients were evaluated an average of six years after AIS. According to the Paediatric Stroke Outcome Scale (PSOM), most of the patients had some degree of impairment, mainly in sensorimotor and in cognitive-behavioural areas. The modified Rankin scale (mRS) showed an unfavourable outcome in 70% of patients (including patients that have died). Upper limb was more functionally impaired than lower limb. Strokes in neonatal period and early life were associated with poor prognosis. Size of stroke, cortical and subcortical involvement and basal ganglia stroke were associated with an unfavourable outcome. Fever in the acute phase and hemiparesis at presentation were also poor prognostic factors. Epilepsy at time of evaluation was also associated with unfavourable outcome. On the other hand, a normal electroencephalogram was associated with favourable outcome. AIS in children with heart disease had an unfavourable outcome, with impairment in different areas. Epilepsy happened in one third of the patients.

Basal ganglia stroke in pediatric population: Single center experience

Basal ganglia stroke in pediatric population: Single center experience

Quantitative EEG abnormalities in major depressive disorder with basal ganglia stroke with lesions in different hemispheres

BackgroundThis study aimed to examine the aberrant EEG oscillation in major depressive subjects with basal ganglia stroke with lesions in different hemispheres. MethodsResting EEG of 16 electrodes in 58 stroke subjects, 26 of whom had poststroke depression (13 with left-hemisphere lesion and 13 with right) and 32 of whom did not (18 with left lesion and 14 with right), was recorded to obtain spectral power analysis for several frequency bands. Multiple analysis of variance and receiver operating characteristic (ROC) curves were used to identify differences between poststroke depression (PSD) and poststroke non-depression (PSND), treating the different lesion hemispheres separately. Moreover, Pearson linear correlation analysis was conducted to test the severity of depressive symptoms and EEG indices. ResultsPSD with left-hemisphere lesion showed increased beta2 power in frontal and central areas, but PSD with right-hemisphere lesion showed increased theta and alpha power mainly in occipital and temporal regions. Additionally, for left-hemisphere lesions, beta2 power in central and right parietal regions provided high discrimination between PSD and PSND, and for right-hemisphere lesions, theta power was similarly discriminative in most regions, especially temporal regions. We also explored the association between symptoms of depression and the power of abnormal bands, but we found no such relationship. LimitationsThe sample size was relatively small and included subjects with different lesions of the basal ganglia. ConclusionsThe aberrant EEG oscillation in subjects with PSD differs between subjects with lesions of the left and right hemispheres, suggesting a complex association between depression and lesion location in stroke patients.

Neural Correlates of Motor Recovery Measured by SPECT at Six Months After Basal Ganglia Stroke.

ObjectiveTo investigate neural correlates associated with recovery of motor function over 6 months in patients with basal ganglia (BG) stroke using acetazolamide (ACZ) stress brain-perfusion single-photon emission computed tomography (SPECT).MethodsMedical records of 22 patients presenting first-ever BG stroke were retrospectively reviewed. Regional cerebral blood flow (CBF) and cerebrovascular reserve (CVR) were measured for 9 regions in each cerebral hemisphere (primary motor cortex, supplementary motor area, premotor cortex, prefrontal cortex, temporal lobe, parietal lobe, occipital lobe, BG, and thalamus). The Fugl-Meyer Assessment (FMA) motor score was used to assess motor function.ResultsAfter ACZ injection, CBF of all regions of interest (ROIs) increased compared with baseline. Baseline CBF of all ROIs was not significantly correlated with changes in FMA upper or lower motor score. However, multivariate analysis revealed CVR was significantly associated with change in FMA upper score in the ipsilateral primary motor cortex (R2=0.216, p=0.017), the ipsilateral parietal lobe (R2=0.135, p=0.029), and the contralateral primary motor cortex (R2=0.210, p=0.041).ConclusionCVR in the bilateral primary motor cortex and ipsilateral parietal lobe was associated with restoration of upper motor function 6 months after BG stroke. SPECT is a readily available imaging modality useful in studying brain residual function in patients with BG stroke.

Changes in the Gait Pattern of Hemiparetic Patients with Subacute Basal Ganglia Stroke: a Retrospective Study

Objectives This study observed changes in gait pattern according to the motor grade of the paretic lower limb in patients with basal ganglia stroke who are in the subacute phase. Methods We used the Manual Muscle Test (MMT) to evaluate the motor grade of the paretic lower limb of 21 patients with subacute basal ganglia stroke and then divided them into two groups based on the MMT results. Stroke patients with a motor grade above Gr. III were put in group I (15 people) and those with a grade less than Gr. III in group II (6 people). We also estimated spatiotemporal factors using treadmill gait analysis equipment. The values were gait velocity, step length, step time, double support phase, and cadence. The first measure was conducted during the early period of admission and the second was between four and five weeks after admission. Results In Group I, the gait velocity and step length of both legs significantly increased. In Group II, the step length and step time of the paretic side and the gait velocity tended to decrease, but not significantly. The step length of the paretic side in Group II was significantly longer than that in Group I at the first measure. The step time of the paretic side in Group I was significantly shorter than that in Group II and gait velocity and cadence in Group I were significantly higher than in Group II at the second measure. Conclusions The gait parameters of all stroke patients improved in terms of time. In addition, the changes in gait pattern were different depending on the motor grade of the paretic lower limb. Keywords: stoke, basal ganglia, subacute, velocity, step length, step time, double support phase, cadence

Poster 212 Functional Improvement through Inpatient Rehabilitation in a Patient with Hyperkinetic Movement Disorder Secondary to Thalamic and Basal Ganglia Stroke: A Case Report.

Poster 212 Functional Improvement through Inpatient Rehabilitation in a Patient with Hyperkinetic Movement Disorder Secondary to Thalamic and Basal Ganglia Stroke: A Case Report.

Vascular Risk Factors and Diseases Modulate Deficits of Reward-Based Reversal Learning in Acute Basal Ganglia Stroke.

BackgroundBesides motor function, the basal ganglia have been implicated in feedback learning. In patients with chronic basal ganglia infarcts, deficits in reward-based reversal learning have previously been described.MethodsWe re-examined the acquisition and reversal of stimulus-stimulus-reward associations and acquired equivalence in eleven patients with acute basal ganglia stroke (8 men, 3 women; 57.8±13.3 years), whose performance was compared eleven healthy subjects of comparable age, sex distribution and education, who were recruited outside the hospital. Eleven hospitalized patients with a similar vascular risk profile as the stroke patients but without stroke history served as clinical control group.ResultsIn a neuropsychological assessment 7±3 days post-stroke, verbal and spatial short-term and working memory and inhibition control did not differ between groups. Compared with healthy subjects, control patients with vascular risk factors exhibited significantly reduced performance in the reversal phase (F[2,30] = 3.47; p = 0.044; post-hoc comparison between risk factor controls and healthy controls: p = 0.030), but not the acquisition phase (F[2,30] = 1.01; p = 0.376) and the acquired equivalence (F[2,30] = 1.04; p = 0.367) tasks. In all tasks, the performance of vascular risk factor patients closely resembled that of basal ganglia stroke patients. Correlation studies revealed a significant association of the number of vascular risk factors with reversal learning (r = -0.33, p = 0.012), but not acquisition learning (r = -0.20, p = 0.121) or acquired equivalence (r = -0.22, p = 0.096).ConclusionsThe previously reported impairment of reward-based learning may be attributed to vascular risk factors and associated diseases, which are enriched in stroke patients. This study emphasizes the necessity of appropriate control subjects in cognition studies.

Procedural learning as a measure of functional impairment in a mouse model of ischemic stroke

Basal ganglia stroke is often associated with functional deficits in patients, including difficulties to learn and execute new motor skills (procedural learning). To measure procedural learning in a murine model of stroke (30min right MCAO), we submitted C57Bl/6J mice to various sensorimotor tests, then to an operant procedure (Serial Order Learning) specifically assessing the ability to learn a simple motor sequence. Results showed that MCAO affected the performance in some of the sensorimotor tests (accelerated rotating rod and amphetamine rotation test) and the way animals learned a motor sequence. The later finding seems to be caused by difficulties regarding the chunking of operant actions into a coherent motor sequence; the appeal for food rewards and ability to press levers appeared unaffected by MCAO. We conclude that assessment of motor learning in rodent models of stroke might improve the translational value of such models.

Functional lateralization in cingulate cortex predicts motor recovery after basal ganglia stroke

The basal ganglia (BG) is involved in higher order motor control such as movement planning and execution of complex motor synergies. Neuroimaging study on stroke patients specifically with BG lesions would help to clarify the consequence of BG damage on motor control. In this paper, we performed a longitudinal study in the stroke patients with lesions in BG regions across three motor recovery stages, i.e., less than 2week (Session 1), 1–3m (Session 2) and more than 3m (Session 3). The patients showed an activation shift from bilateral hemispheres during early sessions (<3m) to the ipsilesional cortex in late session (>3m), suggesting a compensation effect from the contralesional hemisphere during motor recovery. We found that the lateralization of cerebellum(CB) for affected hand task correlated with patients' concurrent Fugl-Meyer index (FMI) in Session 2. Moreover, the cingulate cortex lateralization index in Session 2 was shown to significantly correlate with subsequent FMI change between Session 3 and Session 2, which serves as a prognostic marker for motor recovery. Our findings consolidated the close interactions between BG and CB during the motor recovery after stroke. The dominance of activation in contralateral cingulate cortex was associated with a better motor recovery, suggesting the important role of ipsilesional attention modulation in the early stage after BG stroke.

Childhood Basal Ganglia Stroke and its Association with Trivial Head Trauma.

This study explored the clinical profile, risk factors, neuroimaging and outcome of childhood basal ganglia stroke. Children (6 months-12 years) with basal ganglia stroke registered between 2007-2011 were retrospectively enrolled, while newly diagnosed cases over the 2-year study period were enrolled prospectively. Children with recent trivial head trauma were compared with those without it. Of the 35 children enrolled, trivial head trauma was seen in 74%. The non-trivial head trauma group (n = 9) comprised unidentified etiology (4), Moyamoya syndrome (2), varicella infection (1), homocysteinemia (1), and probable mitochondrial cytopathy (1). Median duration to complete recovery was significantly less in the trivial head trauma group (median = 12, range = 1-72 weeks vs median = 38, range = 20-48 weeks,P= .001). Moreover, these children had increased chances of complete recovery (85% [22/26] vs 44.5% [4/9],P= .029). Basal ganglia stroke can follow trivial head trauma and may have a more favorable outcome.

Mineralizing angiopathy with basal ganglia stroke in an infant.

Basal ganglia stroke is known following trivial head trauma. Recently a distinct clinic-radiological entity termed ‘mineralizing angiopathy’ was described. We report an infant who developed basal ganglia stroke following trivial fall. His clinic-radiological features are described.

DTI Findings Correlated with Neurocognitive Impairments in Basal Ganglia Stroke: A Preliminary Study

Objective: Subcortical lesion involving basal ganglia can cause a wide range of behavioral and cognitive alterations largely attributed to disconnection of subcortical fibers; however, the underlying neural correlates of cognitive dysfunction based on the integrity of the white matter fiber has not yet been explored in stroke patients. Methods: The correlations among cognitive function and diffusion metrics of each subcortical fiber were investigated in nine basal ganglia stroke patients by diffusion tensor imaging (DTI) in our study. Results: Patient’s general cognitive and verbal working memory function correlated well with the integrity of the left superior longitudinal fasciculus (SLF), nonverbal attention with the right inferior longitudinal fasciculus (ILF), SLF, and frontostriatal (FS) fibers. On the other hand, nonverbal long-term memory correlated well with the integrity of the right ILF and FS fibers. Conclusions: Neurocognitive characteristics of patients with basal ganglia stroke seem to reflect the integrity of subcortical fiber connectivity.

Language recovery and evidence of residual deficits after nonthalamic subcortical stroke: A 1 year follow-up study

A variety of language disturbances including aphasia have been described after subcortical stroke but less is known about the factors that influence the long-term recovery of stroke-induced language dysfunction. We prospectively examined the role of the affected hemisphere and the lesion site in the occurrence and recovery of language deficits in nonthalamic subcortical stroke. Forty patients with unilateral basal ganglia stroke underwent language assessment within 1 week, 3 months and 1 year after stroke. Disturbances in at least one language domain were observed in 35 patients during the first week post stroke including aphasia diagnosed in 11 patients. Importantly, the appearance of deficits after stroke onset and the improvement of language function were not determined by the site of subcortical lesion, but instead were critically influenced by the affected hemisphere. In fact, the language impairments following left and right basal ganglia stroke mirrored the language dysfunction observed after cortical lesions

Modulatory effect of acupuncture at Waiguan (TE5) on the functional connectivity of the central nervous system of patients with ischemic stroke in the left basal ganglia.

ObjectiveTo study the influence of acupuncture at Waiguan (TE5) on the functional connectivity of the central nervous system of patients with ischemic stroke.MethodsTwenty-four patients with ischemic stroke in the left basal ganglia were randomized based on gender to receive TE5 acupuncture (n = 12) or nonacupoint acupuncture (n = 12). Each group underwent sham acupuncture and then verum acupuncture while being scanned with functional magnetic resonance imaging. Six regions of interest (ROI) were defined, including bilateral motor, somatosensory, and bilateral basal ganglia areas. The functional connectivity between these ROIs and all voxels of the brain was analyzed in Analysis of Functional NeuroImages(AFNI) to explore the differences between verum acupuncture and sham acupuncture at TE5 and between TE5 acupuncture and nonacupoint acupuncture. The participants were blinded to the allocation.ResultThe effect of acupuncture on six seed-associated networks was explored. The result demonstrated that acupuncture at Waiguan (TE5) can regulate the sensorimotor network of the ipsilesional hemisphere, stimulate the contralesional sensorimotor network, increase cooperation of bilateral sensorimotor networks, and change the synchronization between the cerebellum and cerebrum. Furthermore, a lot of differences of effect existed between verum acupuncture and sham acupuncture at TE5, but there was little difference between TE5 acupuncture and nonacupoint acupuncture.ConclusionThe modulation of synchronizations between different regions within different brain networks might be the mechanism of acupuncture at Waiguan (TE5). Stimulation of the contralesional sensorimotor network and increase of cooperation of bilateral hemispheres imply a compensatory effect of the intact hemisphere, whereas changes in synchronization might influence the sensorimotor function of the affected side of the body.Trial RegistrationChinese Clinical Trial Registry ChiCTR-ONRC-08000255

Acute-Onset Choreiform Movements in a Previously Healthy 4-Year-Old Patient

We report the case of 4-year-old male with sinus venous thrombosis leading to bilateral thalamic and basal ganglia strokes presenting as generalized choreiform movements. Acute-onset chorea in the pediatric population is most commonly associated with Sydenham chorea, which is a manifestation of acute rheumatic fever. Chorea is a much less commonly noted sign of stroke, and when it occurs, it typically presents as hemichorea. Given the unlikely presentation, rapid and appropriate imaging was the key to diagnosis.

The effects of cognitive function training on motor and executive functions after basal ganglia stroke

Objective To observe the effect of cognition training on the motor and executive functioning of patients after a basal ganglia stroke.Methods Thirty patients with basal ganglia stroke were randomly divided into a treatment group and a control group.The control group received standard stroke rehabilitation training,while the treatment group received in addition 2 months of cognitive function training.The executive and motor functions of all of the subjects and their facility in the activities of daily living (ADL) were tested using the Tower of Hanoi,the Wisconsin card sorting test,a Stroop-3 test and the Fugl-Meyer assessment,the Berg balance scale and the modified Barthel index before and at the end of treatment.Results After two months of training,both within-group and between group comparisons showed that the treatment group had improved significantly more in executive function,cognition and motor function.Conclusion Cognition training can improve executive function,motor function and ADL performance after a basal ganglia stroke. Key words: Cognition training; Executive function; Motor function; Stroke