Disruptions in Structural and Functional Connectivity Relate to Poststroke Fatigue.
Disruptions in Structural and Functional Connectivity Relate to Poststroke Fatigue.
复制标题
结构和功能连接的破坏与中风后疲劳有关。
DOI：
10.1089/brain.2022.0021
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发表时间：
2023
影响因子：
3.4
通讯作者：
Loggia,MarcoL
中科院分区：
文献类型：
--
作者：
Schaechter,JudithD;Kim,Minhae;Hightower,BaileighG;Ragas,Trevor;Loggia,MarcoL
前言：卒中后疲劳是一种病因不明的致残性疾病。脑部病变被认为是PSF的一个重要原因，尽管局灶性病变的特征，如大小和位置，尚未被证明是可预测的。鉴于卒中损伤不仅导致局灶性组织死亡，而且导致结构和功能上与受损组织相连的脑网络的广泛变化，我们假设PSF与结构和功能连接的破坏有关。材料和方法：12名患者在1-3年前在大脑中动脉(MCA)区域发生缺血性中风，目前正在经历一系列的疲劳严重程度。患者接受结构和静息状态的功能磁共振成像(MRI)。结构MRI数据用于测量病变至白质通路引起的灰质结构性脱节。结果：患者在不同的皮质和皮质下区均表现为结构性连接中断。疲劳的严重程度与大脑半球和对侧大脑半球几个额叶皮质区域的结构断开显著相关。与疲劳相关的结构断裂在IL吻侧中额叶皮质最为严重。与疲劳相关的额叶皮质区域的子集，包括IL吻侧的额叶中叶皮质，结构上的更大程度的断开倾向于与更大的功能连接丧失显著相关。在已识别的疲劳相关额叶皮质区域中，只有白质头端额中叶皮质的功能连通性丧失与疲劳程度显著相关。结论：我们的结果提供了证据，双侧大脑半球额叶皮质结构和功能连通性的丧失在MCA卒中后的PSF中起作用，其中白介素头中额叶皮质的连通性障碍具有中枢作用。我们假设PSF与继发于局灶性病变的结构和功能连接的中断有关。在慢性大脑中动脉(MCA)卒中患者中，利用结构和静息状态的功能连接磁共振成像(MRI)，我们发现大脑中动脉(MCA)慢性卒中患者大脑半球和对侧大脑半球的额叶皮质区域存在较大的结构分离，与较大的疲劳感相关。在这些与疲劳相关的皮质中，IL吻侧中额叶皮质表现出与疲劳相关的功能连接缺失。这些发现表明，结构和功能连接的中断在MCA卒中后的PSF中发挥了作用。
Introduction:Poststroke fatigue (PSF) is a disabling condition with unclear etiology. The brain lesion is thought to be an important causal factor in PSF, although focal lesion characteristics such as size and location have not proven to be predictive. Given that the stroke lesion results not only in focal tissue death but also in widespread changes in brain networks that are structurally and functionally connected to damaged tissue, we hypothesized that PSF relates to disruptions in structural and functional connectivity.Materials and Methods:Twelve patients who incurred an ischemic stroke in the middle cerebral artery (MCA) territory 1–3 years prior, and currently experiencing a range of fatigue severity, were enrolled. The patients underwent structural and resting-state functional magnetic resonance imaging (MRI). The structural MRI data were used to measure structural disconnection of gray matter resulting from lesion to white matter pathways. The functional MRI data were used to measure network functional connectivity.Results:The patients showed structural disconnection in varying cortical and subcortical regions. Fatigue severity correlated significantly with structural disconnection of several frontal cortex regions in the ipsilesional (IL) and contralesional hemispheres. Fatigue-related structural disconnection was most severe in the IL rostral middle frontal cortex. Greater structural disconnection of a subset of fatigue-related frontal cortex regions, including the IL rostral middle frontal cortex, trended toward correlating significantly with greater loss in functional connectivity. Among identified fatigue-related frontal cortex regions, only the IL rostral middle frontal cortex showed loss in functional connectivity correlating significantly with fatigue severity.Conclusion:Our results provide evidence that loss in structural and functional connectivity of bihemispheric frontal cortex regions plays a role in PSF after MCA stroke, with connectivity disruptions of the IL rostral middle frontal cortex having a central role.Impact statementPoststroke fatigue (PSF) is a common disabling condition with unclear etiology. We hypothesized that PSF relates to disruptions in structural and functional connectivity secondary to the focal lesion. Using structural and resting-state functional connectivity magnetic resonance imaging (MRI) in patients with chronic middle cerebral artery (MCA) stroke, we found frontal cortex regions in the ipsilesional (IL) and contralesional hemispheres with greater structural disconnection correlating with greater fatigue. Among these fatigue-related cortices, the IL rostral middle frontal cortex showed loss in functional connectivity correlating with fatigue. These findings suggest that disruptions in structural and functional connectivity play a role in PSF after MCA stroke.