Striatal Infarction Elicits Secondary Extrafocal MRI Changes in Ipsilateral Substantia Nigra
Striatal Infarction Elicits Secondary Extrafocal MRI Changes in Ipsilateral Substantia Nigra
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DOI：
10.1371/journal.pone.0136483
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发表时间：
2015-09-01
期刊：
影响因子：
3.7
通讯作者：
Endres, Matthias
中科院分区：
文献类型：
--
作者：
Winter, Benjamin;Brunecker, Peter;Endres, Matthias
局灶性缺血可引起远离原发病灶的脑区域的病理改变。在动物模型中，大脑中动脉（MCA）闭塞后，同侧中脑的病灶外神经元死亡已被描述。采用序列磁共振成像（T2和弥散加权）在3特斯拉，我们研究了急性缺血性脑卒中患者在卒中发作后的第1、2、6、8和10天。16名连续的中风患者被招募到研究中，这些患者涉及尾状核和/或壳核的任何一个半球。另外4例脑中风患者保留尾状核和壳核，但包括至少三分之一的中脑区作为对照。涉及纹状体结构的缺血性病变导致同侧中脑出现高强度病变，这种病变在中风后第6至10天出现，在最初的扫描中没有出现。相比之下，对照组中风患者没有发生继发性中脑病变。皮质脊髓束变性引起的锥体束或脑干的高强度病变可以与继发性中脑灰质病变明显区分，并且在缺血后第2天就可以检测到。高分辨率图像与数字化解剖图谱的共同配准显示继发性病变主要位于黑质致密部。继发性病变的表观扩散系数（ADC）值在第10天呈延迟性急剧下降。在后期测量中观察到ADC值的归一化。综上所述，我们的研究表明纹状体梗死引起同侧黑质致密部的延迟退行性改变。
Focal ischemia may induce pathological alterations in brain areas distant from the primary lesion. In animal models, exofocal neuron death in the ipsilateral midbrain has been described after occlusion of the middle cerebral artery (MCA). Using sequential magnetic resonance imaging (T2- and diffusion-weighted) at 3 Tesla, we investigated acute ischemic stroke patients on days 1, 2, 6, 8, and 10 after stroke onset. Sixteen consecutive patients who had suffered a stroke involving the caudate nucleus and/or putamen of either hemisphere were recruited into the study. Four additional patients with strokes sparing the caudate nucleus and putamen but encompassing at least one-third of the MCA territory served as controls. Ischemic lesions involving striatal structures resulted in hyperintense lesions in ipsilateral midbrain that emerged between days 6 and 10 after stroke and were not present on the initial scans. In contrast, none of the control stroke patients developed secondary midbrain lesions. Hyperintense lesions in the pyramidal tract or the brain stem caused by degeneration of the corticospinal tract could be clearly distinguished from these secondary midbrain gray matter lesions and were detectable from day 2 after ischemia. Co-registration of high-resolution images with a digitized anatomic atlas revealed localization of secondary lesions primarily in the substantia nigra pars compacta. Apparent diffusion coefficient (ADC) values in the secondary lesions showed a delayed sharp decline through day 10. Normalization of ADC values was observed at late measurements. Taken together, our study demonstrates that striatal infarction elicits delayed degenerative changes in ipsilateral substantia nigra pars compacta.