Association between Severe Upper Limb Spasticity and Brain Lesion Location in Stroke Patients

Abstract

Association between the site of brain injury and poststroke spasticity is poorly understood. The present study investigated whether lesion analysis could document brain regions associated with the development of severe upper limb poststroke spasticity. A retrospective analysis was conducted on 39 chronic stroke patients. Spasticity was assessed at the affected upper limb with the modified Ashworth scale (shoulder, elbow, wrist, and fingers). Brain lesions were traced from magnetic resonance imaging performed within the first 7 days after stroke and region of interest images were generated. The association between severe upper limb spasticity (modified Ashworth scale ≥2) and lesion location was determined with the voxel-based lesion-symptom mapping method implemented in MRIcro software. Colored maps representing the z statistics were generated and overlaid onto the automated anatomical labeling and the Johns Hopkins University white matter templates provided with MRIcron. Thalamic nuclei were identified with the Talairach Daemon software. Injuries to the insula, the thalamus, the basal ganglia, and white matter tracts (internal capsule, corona radiata, external capsule, and superior longitudinal fasciculus) were significantly associated with severe upper limb poststroke spasticity. Further advances in our understanding of the neural correlates of spasticity may lead to early targeted rehabilitation when key regions are damaged.

Brain lesions affecting gait recovery in stroke patients

“…Caudate nucleus injury was related to motor recovery in the lower limbs (Lee et al., ). Neuronal injury in the corona radiata, caudate nucleus, and putamen of patients with chronic stroke changed their walking speed (Jones et al., ; Picelli et al., ). Our results showed that involvement of the globus pallidus and putamen was related to poor recovery in stroke patients at 3 months after onset.…”

Management of spasticity with onabotulinumtoxinA: practical guidance based on the italian real-life post-stroke spasticity survey

“…Other factors found to be related to the development of post-stroke spasticity are left-sided weakness, a history of smoking, low quality of life, manual activities before stroke, a previous history of stroke, and extensive lesions (Leathley et al, 2004;de Cássia do Reis Moura et al, 2009;Urban et al, 2010). Lastly, lesion mapping-based analysis of the association of post-stroke spasticity with stroke lesions showed involvement of the insula, thalamus, basal ganglia and white matter tracts (internal capsule, corona radiata, external capsule, superior longitudinal fasciculus) (Picelli et al, 2014d).…”

Complex Rehabilitation Patients With Post-Stroke Spasticity of the Lower Limb: The Efficacy of Botulinum Toxin (Onabotulinumtoxin A)

“…после инсульта [4]. ПС имеет тенденцию к нарастанию в течение первых месяцев после инсульта, что ведет к формированию контрактур, затрудняет самообслуживание, делает уход за пациентом обременительным и оказывает отрицательное влияние на качество жизни больных и их семей [5][6][7][8]. Наличие спастичности требует проведения дополнительных реабилитационных мероприятий, что приводит к увеличению прямых затрат, связанных с ОНМК.…”