Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Taegu, 705-717, Republic of Korea.
Department of Medical Statistics, College of Medicine, Catholic University of Daegu, Daegu, Republic of Korea.
Acta Neurol Belg. 2021 Aug;121(4):921-926. doi: 10.1007/s13760-020-01309-2. Epub 2020 Feb 27.
We assessed the state of the thalamocortical connection between the mediodorsal nucleus (MD) and the dorsolateral prefrontal cortex (DLPFC) in patients with corona radiata infarct using diffusion tensor tractography (DTT). Altogether, 110 patients with corona radiata infarct were recruited, all of whom underwent DTT at an early stage following infarct onset. Based on the integrity of CST (CST+: CST was preserved around the infarct, CST-: CST was interrupted by the infarct) and the integrity of thalamocortical connection between the MD of thalamus and the DLPFC (DLPFC+: the connection was preserved, DLPFC-: the connection was interrupted), patients were divided into 4 groups: CST+/DLPFC+ (37 patients), CST+/DLPFC- (21 patients), CST-/DLPFC+ (25 patients), and CST-/DLPFC- (27 patients) groups. Motor function was evaluated using the upper Motricity Index (MI), lower MI, modified Brunnstrom classification, and the functional ambulation category at baseline and at 6 months post-onset. In patients with preserved CST integrity, the status of the thalamocortical connection had no impact on the assessed motor outcomes at 6 months post-stroke. However, in patients with disrupted CST integrity, those with preserved thalamocortical connection integrity had significantly higher motor function scores in all assessed outcomes 6 months post-stroke than those with disrupted thalamocortical connection integrity. The preservation or disruption of the thalamocortical connection between the MD of the thalamus and the DLPFC is an important factor for motor function recovery when CST integrity is also disrupted.
我们使用弥散张量纤维束成像（DTT）评估了 110 例皮质下梗死患者中 MED 核与背外侧前额叶皮质（DLPFC）之间的丘脑皮质连接状态。所有患者均在梗死发生后早期进行 DTT。根据 CST（CST+：CST 在梗死周围保留，CST-：CST 被梗死中断）和丘脑 MED 与 DLPFC 之间的丘脑皮质连接完整性（DLPFC+：连接保留，DLPFC-：连接中断），将患者分为 4 组：CST+/DLPFC+（37 例）、CST+/DLPFC-（21 例）、CST-/DLPFC+（25 例）和 CST-/DLPFC-（27 例）。在基线和发病后 6 个月，使用上肢运动指数（MI）、下肢 MI、改良 Brunstrom 分级和功能性步行类别评估运动功能。在 CST 完整性保留的患者中，丘脑皮质连接状态对发病后 6 个月的运动结局没有影响。然而，在 CST 完整性中断的患者中，丘脑皮质连接完整性保留的患者在所有评估结局中的运动功能评分均显著高于丘脑皮质连接完整性中断的患者。当 CST 完整性也中断时，丘脑 MED 与 DLPFC 之间的丘脑皮质连接的保留或中断是运动功能恢复的重要因素。
