新生儿卒中后对侧手功能仅取决于病变特征吗？
Does Contralesional Hand Function After Neonatal Stroke Only Depend on Lesion Characteristics?
机构信息
From the Physical and Rehabilitation Medicine Department (M. Dinomais) and Neurosurgery Department (M. Delion), University Hospital Angers, LUNAM-Angers University, Angers, France; UNIACT-Neurospin, CEA-Saclay, InsermU1129 and Paris-Descartes University, Sorbonne Paris-Cité, Paris, France (L.H.-P); Department of Child Neurology, University Hospital Tübingen, Tübingen, Germany (S.G.); Pediatric Radiology Department, University Hospital Bicêtre (B.H.) and Pediatric Neurology Department, University Hospital Necker (M.K.), Assistance-Publique-Hopitaux de Paris, Paris, France; French Centre for Paediatric Stroke, Saint-Étienne and Paris, France (B.H., M.K., C.R., S.C.); Pediatric PRM Department, University Hospital Saint-Étienne, Saint-Étienne, France (S.C.); Inserm CIC1408 and Inserm University Saint-Étienne U1090 Sainbiose: Equipe dysfonction vasculaire et hémostase, Saint-Étienne, France (S.C.); and Pediatric Neurology Department and Environnement Périnatale et Santé, University Hospital Lille, Lille University, Lille, France (S.N.T.T.).
出版信息
Stroke. 2016 Jun;47(6):1647-50. doi: 10.1161/STROKEAHA.116.013545. Epub 2016 May 10.
BACKGROUND AND PURPOSE
In children having suffered from neonatal arterial ischemic stroke, the relationship between contralesional hand performance and structural changes in brain areas remote from the infarct site was examined.
METHODS
Using voxel-based morphometry, we correlated contralesional gross manual dexterity assessed by the box and block test and whole-brain gray and white-matter volume changes on high-resolution magnetic resonance imaging in 37 7-year-old post-neonatal arterial ischemic stroke children. We also compared the volume of the identified structures with magnetic resonance imaging data of 10 typically developing age-matched children.
RESULTS
Areas showing the highest positive correlation with the box and block test scores were ipsilesional mediodorsal thalamus, contralesional cerebellar lobule VIIa Crus I, and ipsilesional corticospinal tract at the level of superior corona radiata, the posterior limb of the internal capsule, and the cerebral peduncle and the ipsilesional body of corpus callosum. When compared with typically developing age-matched children, post-neonatal arterial ischemic stroke children with severe contralesional hand motor deficit exhibited significant volume reductions in these structures (except the cerebellum), whereas no differences were found with those with good manual dexterity. No negative correlation was found between box and block test scores and brain areas.
CONCLUSIONS
Contralesional hand performance after neonatal arterial ischemic stroke is correlated with atrophy in brain areas directly or functionally connected but anatomically remote from the infarct. Our study suggests a role of the cerebellar lobule VIIa Crus I and mediodorsal thalamus in manual dexterity.
CLINICAL TRIAL REGISTRATION
URL: https://clinicaltrials.gov. Unique identifier: NCT02511249.
背景与目的
本研究旨在探讨新生儿期大脑中动脉缺血性卒中后患儿，对侧手运动功能与梗死灶外脑区结构变化的关系。
方法
采用基于体素的形态学测量方法，对 37 例 7 岁的新生儿期大脑中动脉缺血性卒中患儿的磁共振高分辨率成像的全脑灰质和白质体积变化，与箱式和木块测试评估的对侧大体手灵巧性进行相关性分析。我们还将所识别结构的体积与 10 例典型发育年龄匹配的儿童的磁共振成像数据进行了比较。
结果
与箱式和木块测试评分呈最强正相关的区域是同侧丘脑内侧背核、对侧小脑 VIIa 叶 Crus I 以及同侧皮质脊髓束在放射冠上部、内囊后肢和大脑脚水平和同侧胼胝体体部。与典型发育年龄匹配的儿童相比，对侧手运动功能严重障碍的新生儿期大脑中动脉缺血性卒中患儿在这些结构（除了小脑）中表现出明显的体积减少，而手灵巧性良好的患儿则没有差异。箱式和木块测试评分与大脑区域之间没有发现负相关。
结论
新生儿期大脑中动脉缺血性卒中后对侧手运动功能与梗死灶直接或功能上相关但解剖上远离的脑区萎缩有关。我们的研究表明，小脑 VIIa 叶 Crus I 和丘脑内侧背核在手灵巧性中起作用。
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