Monai Elena, Silvestri Erica, Bisio Marta, Cagnin Annachiara, Aiello Marco, Cecchin Diego, Bertoldo Alessandra, Corbetta Maurizio
Clinica Neurologica, University Hospital of Padova, Padua, Italy.
Department of Neuroscience, University of Padova, Padua, Italy.
Front Neurol. 2023 Mar 17;14:1142734. doi: 10.3389/fneur.2023.1142734. eCollection 2023.
There is overwhelming evidence that focal lesions cause structural, metabolic, functional, and electrical disconnection of regions directly and indirectly connected with the site of injury. Unfortunately, methods to study disconnection (positron emission tomography, structural and functional magnetic resonance imaging, electroencephalography) have been applied primarily in isolation without capturing their interaction. Moreover, multi-modal imaging studies applied to focal lesions are rare.
We analyzed with a multi-modal approach the case of a patient presenting with borderline cognitive deficits across multiple domains and recurrent delirium. A post-surgical focal frontal lesion was evident based on the brain anatomical MRI. However, we were able to acquire also simultaneous MRI (structural and functional) and [18F]FDG using a hybrid PET/MRI scan along with EEG recordings. Despite the focality of the primary anatomical lesion, structural disconnection in the white matter bundles extended far beyond the lesion and showed a topographical match with the cortical glucose hypometabolism seen both locally and remotely, in posterior cortices. Similarly, a right frontal delta activity near/at the region of structural damage was associated with alterations of distant occipital alpha power. Moreover, functional MRI revealed even more widespread local and distant synchronization, involving also regions not affected by the structural/metabolic/electrical impairment.
Overall, this exemplary multi-modal case study illustrates how a focal brain lesion causes a multiplicity of disconnection and functional impairments that extend beyond the borders of the anatomical irrecoverable damage. These effects were relevant to explain patient's behavior and may be potential targets of neuro-modulation strategies.
有大量证据表明，局灶性病变会导致与损伤部位直接和间接相连的区域出现结构、代谢、功能和电连接中断。不幸的是，研究连接中断的方法（正电子发射断层扫描、结构和功能磁共振成像、脑电图）主要是单独应用，未捕捉到它们之间的相互作用。此外，应用于局灶性病变的多模态成像研究很少。
我们采用多模态方法分析了一名在多个领域存在边缘性认知缺陷并反复出现谵妄的患者的病例。基于脑部解剖MRI，术后可见局灶性额叶病变。然而，我们还能够使用PET/MRI混合扫描同时获取MRI（结构和功能）以及[18F]FDG，并进行脑电图记录。尽管原发性解剖病变具有局灶性，但白质束中的结构连接中断远远超出了病变范围，并且在局部和远处（后皮质）与所见的皮质葡萄糖代谢减低呈现出地形学上的匹配。同样，结构损伤区域附近/处的右侧额叶δ活动与远处枕叶α波功率的改变有关。此外，功能MRI显示出更广泛的局部和远处同步，还涉及未受结构/代谢/电损伤影响的区域。
总体而言，这个典型的多模态病例研究说明了局灶性脑损伤如何导致多种连接中断和功能障碍，这些障碍超出了解剖学上不可恢复损伤的边界。这些影响与解释患者的行为相关，并且可能是神经调节策略的潜在靶点。
