Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany.
Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Freiburg, Germany; Dept. of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Cortex. 2021 Sep;142:104-121. doi: 10.1016/j.cortex.2021.06.001. Epub 2021 Jun 22.
This study investigates the clinical course of recovery of apraxia after left-hemisphere stroke and the underlying neuroanatomical correlates for persisting or recovering deficits in relation to the major processing streams in the network for motor cognition.
90 patients were examined during the acute (4.74 ± 2.73 days) and chronic (14.3 ± 15.39 months) stage after left-hemisphere stroke for deficits in meaningless imitation, as well as production and conceptual errors in tool use pantomime. Lesion correlates for persisting or recovering deficits were analyzed with an extension of the non-parametric Brunner-Munzel rank-order test for multi-factorial designs (two-way repeated-measures ANOVA) using acute images.
Meaningless imitation and tool use production deficits persisted into the chronic stage. Conceptual errors in tool use pantomime showed an almost complete recovery. Imitation errors persisted after occipitotemporal and superior temporal lesions in the dorso-dorsal stream. Chronic pantomime production errors were related to the supramarginal gyrus, the key structure of the ventro-dorsal stream. More anterior lesions in the ventro-dorsal stream (ventral premotor cortex) were additionally associated with poor recovery of production errors in pantomime. Conceptual errors in pantomime after temporal and supramarginal gyrus lesions persisted into the chronic stage. However, they resolved completely when related to angular gyrus or insular lesions.
The diverging courses of recovery in different apraxia tasks can be related to different mechanisms. Critical lesions to key structures of the network or entrance areas of the processing streams lead to persisting deficits in the corresponding tasks. Contrary, lesions located outside the core network but inducing a temporary network dysfunction allow good recovery e.g., of conceptual errors in pantomime. The identification of lesion correlates for different long-term recovery patterns in apraxia might also allow early clinical prediction of the course of recovery.
本研究调查了左半球卒中后失用症的临床恢复过程，并探讨了与运动认知网络中的主要处理流相关的潜在神经解剖学相关性，以了解持续性或恢复性缺陷。
90 例患者在左半球卒中后的急性期（4.74±2.73 天）和慢性期（14.3±15.39 个月）接受检查，以评估无意义模仿、工具使用手势模仿的生成和概念错误缺陷。使用急性期图像，采用非参数 Brunner-Munzel 秩和检验扩展方法（双向重复测量方差分析）分析持续性或恢复性缺陷的病变相关性。
无意义模仿和工具使用生成缺陷持续存在于慢性期。工具使用手势模仿的概念错误几乎完全恢复。在背侧-背侧流中，枕颞和颞上病变后模仿错误持续存在。慢性模仿生产错误与缘上回有关，这是腹侧-背侧流的关键结构。腹侧-背侧流前部病变（腹侧运动前皮质）与模仿动作生产错误恢复不良相关。颞叶和缘上回病变后的手势模仿概念错误持续存在于慢性期。但是，当与角回或岛叶病变相关时，这些错误完全解决。
不同失用症任务中恢复过程的差异可以与不同的机制相关。关键结构或处理流的入口区域的临界病变导致相应任务中持续性缺陷。相反，位于核心网络之外但导致暂时网络功能障碍的病变允许良好的恢复，例如手势模仿中的概念错误。识别失用症不同长期恢复模式的病变相关性也可能允许早期预测恢复过程。
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