Institut Clínic de Malalties Mèdiques i Quirúrgiques, Hospital Clínic, Barcelona, Spain.
Magnetic Resonance Imaging Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
J Stroke Cerebrovasc Dis. 2024 Jun;33(6):107708. doi: 10.1016/j.jstrokecerebrovasdis.2024.107708. Epub 2024 Apr 4.
Post-stroke fatigue (PSF) has been described as early exhaustion with tiredness that develops during physical or mental activity and generally does not improve with rest. There are inconsistent findings on the relationship between the characteristics of the ischemic brain lesion and PSF. However, some studies suggest that specific neuroanatomical and neuroplastic changes could explain post-stroke fatigue. The aim was to evaluate the severity of PSF in relation to the location and the size of the ischemic lesion in acute stroke patients to establish possible predictors of PSF.
We performed a prospective observational study to establish potential early predictors of long-term PSF, which was assessed using the Fatigue Assessment Scale six months after ischemic stroke. After segmenting brain infarcts on Diffusion-Weighted Imaging (DWI) images, we studied the association with PSF using Voxel-Based Lesion-Symptom Mapping (VLSM).
Out of 104 patients, 61 (59 %) reported PSF. Female sex and history of diabetes mellitus were associated with a greater risk of developing PSF. The association of PSF with female sex was confirmed in a replication cohort of 50 patients. The ischemic lesion volume was not associated with PSF, and VBLSM analysis did not identify any specific brain area significantly associated with PSF.
PSF is frequent in stroke patients, especially women, even after six months. The absence of neuroanatomical correlates of PSF suggests that it is a multifactorial process with biological, psychological, and social risk factors that require further study.
卒中后疲劳（PSF）被描述为在体力或脑力活动过程中出现的早期疲劳，通常不会通过休息得到改善。目前，缺血性脑损伤的特征与 PSF 之间的关系存在不一致的发现。然而，一些研究表明，特定的神经解剖和神经可塑性变化可以解释卒中后疲劳。本研究旨在评估 PSF 的严重程度与急性卒中患者缺血性病灶的位置和大小之间的关系，以确定 PSF 的可能预测因素。
我们进行了一项前瞻性观察性研究，以确定长期 PSF 的潜在早期预测因素，PSF 使用缺血性卒中后 6 个月的疲劳评估量表进行评估。在弥散加权成像（DWI）图像上对脑梗死进行分割后，我们使用基于体素的病灶-症状映射（VLSM）研究其与 PSF 的关联。
在 104 例患者中，61 例（59%）报告存在 PSF。女性性别和糖尿病史与发生 PSF 的风险增加相关。在 50 例患者的复制队列中，PSF 与女性性别之间的关联得到了证实。缺血性病灶体积与 PSF 无关，VLSM 分析也未发现任何与 PSF 显著相关的特定脑区。
PSF 在卒中患者中很常见，尤其是女性，即使在 6 个月后也是如此。PSF 没有神经解剖学相关性表明它是一个多因素过程，具有生物学、心理和社会风险因素，需要进一步研究。
