Department of Neurology (A.-C.S., J.G., O.T., D.M.H.), University Hospital Essen, University of Duisburg-Essen, Germany.
Institute of Diagnostic and Interventional Radiology and Neuroradiology (C.M.), University Hospital Essen, University of Duisburg-Essen, Germany.
Stroke. 2022 Jun;53(6):1904-1914. doi: 10.1161/STROKEAHA.121.037750. Epub 2022 Mar 9.
The thalamus plays an essential role in cognition. Cognitive deficits have to date mostly been studied retrospectively in chronic thalamic stroke in small cohorts. Studies prospectively evaluating the evolution of cognitive deficits and their association with thalamic stroke topography are lacking. This knowledge is relevant for targeted patient diagnostics and rehabilitation.
Thirty-seven patients (57.5±17.5 [mean±SD] years, 57% men) with first-ever acute isolated ischemic stroke covering the anterior (n=5), paramedian (n=12), or inferolateral (n=20) thalamus and 37 in-patient controls without stroke with similar vascular risk factors matched for age and sex were prospectively studied. Cognition was evaluated using predefined tests at 1, 6, 12, and 24 months. Voxel-based lesion-symptom mapping was used to determine associations between neuropsychological deficits and stroke topography.
Patients with anterior thalamic stroke revealed severe deficits in verbal memory (median T score [Q1-Q3]: 39.1 [36.1-44.1]), language (31.8 [31.0-43.8]), and executive functions (43.8 [35.5-48.1]) at 1 month compared with controls (verbal memory: 48.5 [43.6-61.0], language: 55.7 [42.3-61.1], executive functions: 51.3 [50.1-56.8]). Patients with paramedian thalamic stroke showed moderate language (44.7 [42.8-55.9]) and executive (49.5 [44.3-55.1]) deficits and no verbal memory deficits (48.1 [42.5-54.7]) at 1 month compared with controls (59.0 [47.0-64.5]; 59.6 [51.1-61.3]; 52.5 [44.2-55.3]). The language and executive deficits in paramedian thalamic stroke patients almost completely recovered during follow-up. Intriguingly, significant deficits in verbal memory (44.7 [41.5-51.9]), language (47.5 [41.8-54.1]), and executive functions (48.2 [46.2-59.7]) were found in inferolateral thalamic stroke patients at 1 month compared with controls (50.5 [46.7-59.9]; 57.0 [51.2-62.9]; 57.4 [51.2-60.7]). Language, but not executive deficits persisted during follow-up. Voxel-based lesion-symptom mapping revealed an association of verbal memory deficits with anterior thalamus lesions and an association of non-verbal memory, language, and executive deficits with lesions at the anterior/paramedian/inferolateral border.
All 3 stroke topographies exhibited significant deficits in diverse cognitive domains, which recovered to a different degree depending on the stroke localization. Our study emphasizes the need for comprehensive neuropsychological diagnostics to secure adequate patient rehabilitation.
丘脑在认知中起着至关重要的作用。迄今为止，大多数关于慢性丘脑卒中患者认知缺陷的研究都是在小队列中回顾性进行的。缺乏前瞻性评估认知缺陷及其与丘脑卒中部位关系的研究。这些知识对于有针对性的患者诊断和康复至关重要。
37 名首次发生急性孤立性缺血性卒中的患者（57.5±17.5[平均值±标准差]岁，57%为男性），包括前（n=5）、旁正中（n=12）或下外侧（n=20）丘脑，以及 37 名无卒中的住院患者对照，这些对照患者的血管危险因素相似，年龄和性别相匹配。使用预定义的测试在 1、6、12 和 24 个月时评估认知。基于体素的病变-症状映射用于确定神经心理学缺陷与卒中部位之间的关联。
与对照组相比（言语记忆：48.5[43.6-61.0]；语言：55.7[42.3-61.1]；执行功能：51.3[50.1-56.8]），前丘脑卒中患者在 1 个月时表现出严重的言语记忆（中位数 T 评分[Q1-Q3]：39.1[36.1-44.1]）、语言（31.8[31.0-43.8]）和执行功能（43.8[35.5-48.1]）缺陷。旁正中丘脑卒中患者在 1 个月时表现出中度语言（44.7[42.8-55.9]）和执行（49.5[44.3-55.1]）缺陷，以及无言语记忆缺陷（48.1[42.5-54.7]），与对照组相比（59.0[47.0-64.5]；59.6[51.1-61.3]；52.5[44.2-55.3]）。旁正中丘脑卒中患者的语言和执行缺陷在随访期间几乎完全恢复。有趣的是，在下外侧丘脑卒中患者中，在 1 个月时发现言语记忆（44.7[41.5-51.9]）、语言（47.5[41.8-54.1]）和执行功能（48.2[46.2-59.7]）方面存在明显缺陷与对照组（50.5[46.7-59.9]；57.0[51.2-62.9]；57.4[51.2-60.7]）。语言缺陷，而不是执行缺陷，在随访期间持续存在。基于体素的病变-症状映射显示，言语记忆缺陷与前丘脑病变有关，非言语记忆、语言和执行缺陷与前/旁正中/下外侧边界的病变有关。
所有 3 种卒中部位都表现出不同认知领域的明显缺陷，这些缺陷的恢复程度取决于卒中的定位。我们的研究强调了需要进行全面的神经心理学诊断，以确保患者得到充分的康复。
