Motor plasticity after extra–intracranial bypass surgery in occlusive cerebrovascular disease

Jussen, Daniel; Zdunczyk, Anna; Rösler, Judith; Buchert, Ralph; Julkunen, Petro; Karhu, Jari; Brandt, Stephan A.; Picht, Thomas; Vajkoczy, Peter

doi:10.1212/wnl.0000000000002802

Cited by 24 publications

(25 citation statements)

References 33 publications

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“…Moreover, impaired supratentorial hemodynamic could lead to supratentorial hemispheric atrophy, as already seen in patients with supratentorial disease in whom CCD was suggested by PET [ 25 ]. This would support the “hibernating brain” theory as seen in chronic steno-occlusive patients [ 26 ].…”

Section: Discussionsupporting

confidence: 68%

Crossed Cerebellar Diaschisis in Patients with Diffuse Glioma Is Associated with Impaired Supratentorial Cerebrovascular Reactivity and Worse Clinical Outcome

et al. 2020

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Crossed cerebellar diaschisis (CCD) can be associated with impaired cerebrovascular reactivity (CVR) and poor clinical outcome, but whether this holds true for patients with diffuse glioma is unknown. With blood oxygenation level–dependent (BOLD)-CVR imaging, we determined the presence of CCD in patients with diffuse glioma and investigated its relationship with cerebrovascular reactivity and clinical outcome. For eighteen enrolled subjects (nineteen datasets) with diffuse glioma, CCD was deferred from BOLD-CVR using a predetermined cerebellar asymmetry index (CAI) cutoff value of 6.0%. A FET-PET study was done as a verification of the CCD diagnosis. BOLD-CVR values as well as clinical performance scores (i.e., Karnofsky performance score (KPS), disability rating scale (DRS), and modified Rankin scale (mRS)) by BOLD-CVR scan at 3-month clinical follow-up were assessed and compared for the CCD-positive and CCD-negative group. CCD was present in 26.3% of subjects and strongly associated with impaired BOLD-CVR of the affected (i.e., the hemisphere harboring the glioma) and unaffected supratentorial hemisphere (CCD(+) vs. CCD(−): 0.08 ± 0.11 vs. 0.18 ± 0.04; p = 0.007 and 0.08 ± 0.12 vs. 0.19 ± 0.04; p = 0.007, respectively). This finding was independent of tumor volume (p = 0.48). Furthermore, poorer initial (by scan) clinical performance scores at follow-up were found for the CCD(+) group. The presence of crossed cerebellar diaschisis in patients with diffuse glioma is associated with impaired supratentorial cerebrovascular reactivity and worse clinical outcome.

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Section: Discussionsupporting

confidence: 68%

Crossed Cerebellar Diaschisis in Patients with Diffuse Glioma Is Associated with Impaired Supratentorial Cerebrovascular Reactivity and Worse Clinical Outcome

et al. 2020

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“…This allows BOLD‐CVR to adequately detect CCD through infratentorial CVR impairment 3,13 . The functional metabolic and concomitant vascular changes in the CCD(+) cerebellar hemisphere can be explained by the chronic ischemia concept, where viable neurons enter into a hibernating state due to less blood supply 17 . Together with an impaired BOLD‐CVR, a prolonged MTT and TTP, as well as a reduction in CBF and CBV, should be expected.…”

Section: Discussionmentioning

confidence: 99%

Crossed Cerebellar Diaschisis in Patients With Symptomatic Unilateral Anterior Circulation Stroke Is Associated With Hemodynamic Impairment in the IpsilateralMCATerritory

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Piccirelli

et al. 2020

Magnetic Resonance Imaging

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Background In patients with steno‐occlusive disease, recent findings suggest that hemodynamic alterations may also be associated with crossed cerebellar diaschisis (CCD) rather than a functional disruption alone. Purpose To use a quantitative multiparametric hemodynamic MRI to gain a better understanding of hemodynamic changes related to CCD in patients with unilateral anterior circulation stroke. Study Type Prospective cohort study. Population Twenty‐four patients (25 datasets) with symptomatic unilateral anterior circulation stroke. Field Strength/Sequence 3T/two sequences: single‐shot (echo‐planar imaging) EPI sequence and T2* gradient echo perfusion‐weighted imaging study. Assessment The presence of CCD was inferred from the cerebellar asymmetry index (CAI) of the blood oxygenation‐level dependent cerebrovascular reactivity (BOLD‐CVR) exam, which was calculated from the mean BOLD‐CVR and standard deviation of the CAI of the healthy control group. For all perfusion‐weighted (PW)‐MRI parameters, the cerebellar and middle cerebral artery (MCA) territory asymmetry indices were calculated. Statistical Tests Independent Student's t‐test to compare the variables from the CCD positive(+) and CCD negative(–) groups and analysis of covariance (ANCOVA) to statistically control the effect of covariates (infarct volume and time since ischemia onset). Results CCD was present in 33% of patients. In the MCA territory of the affected hemisphere, BOLD‐CVR was significantly more impaired in the CCD(+) group as compared to the CCD(–) group (mean BOLD‐CVR ± SD [%BOLD signal/ΔmmHgCO2]: –0.03 ± 0.12 vs. 0.11 ± 0.13, P < 0.05). Moreover, the mean transit time (MTT) (asymmetry index (%) CCD(+) vs. CCD(–): 28 ± 23 vs. 4 ± 11, P < 0.05) and time to peak (TTP) (10 ± 10 vs. 2 ± 5, P < 0.05) in the MCA territory of the affected hemisphere were significantly prolonged, while cerebral blood volume was, on average, increased in the CCD(+) group (25 ± 15 vs. 4 ± 19, P < 0.05). Data Conclusion Our findings show that, in patients with symptomatic unilateral anterior circulation stroke, CCD is associated with hemodynamic impairment in the ipsilateral MCA territory, which further supports the concept of a vascular component of CCD. Level of Evidence 3 Technical Efficacy Stage 3

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“…Of note, after revascularization, these participants showed an increase in cortical excitability and a decrease in motor resting threshold with alleviation of misery perfusion. 40 This would explain why recovery of CCD is seen in participants with small infarcts after reperfusion with thrombolysis 2 and CCD is even found in stenoocclusive disease participants with misery perfusion but without radiologically defined stroke lesions. 41 From our point of view, we believe a pathophysiologic distinction needs to be made between lesion-induced and hemodynamic-induced CCD, especially as the current definition of CCD still requires the presence of a supratentorial lesion.…”

Section: Significance Of Ccd Detectionmentioning

confidence: 99%

“…Since not only larger infarctions, but on average overall larger supratentorial hemodynamic impairment is seen in participants with CCD, 2,29 we postulate that CCD not only occurs in case of direct damage to the corticopontine cerebellar fiber tracts, but that severe acute or chronic supratentorial hemodynamic impairment may also induce CCD. It is known that hemodynamic impairment, in absence of acute stroke, can alter brain structure and function 39,40 -for instance, the theory of a "hibernating brain concept" in patients with chronic stroke. 40 This concept postulates the decrease of cortical excitability and increase in resting motor threshold, in case of a misery cerebral perfusion (impaired or negative CVR).…”

Section: Significance Of Ccd Detectionmentioning

confidence: 99%

“…It is known that hemodynamic impairment, in absence of acute stroke, can alter brain structure and function 39,40 -for instance, the theory of a "hibernating brain concept" in patients with chronic stroke. 40 This concept postulates the decrease of cortical excitability and increase in resting motor threshold, in case of a misery cerebral perfusion (impaired or negative CVR). Of note, after revascularization, these participants showed an increase in cortical excitability and a decrease in motor resting threshold with alleviation of misery perfusion.…”

Section: Significance Of Ccd Detectionmentioning

confidence: 99%

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BOLD cerebrovascular reactivity as a novel marker for crossed cerebellar diaschisis

et al. 2018

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Motor plasticity after extra–intracranial bypass surgery in occlusive cerebrovascular disease

Cited by 24 publications

References 33 publications

Crossed Cerebellar Diaschisis in Patients with Diffuse Glioma Is Associated with Impaired Supratentorial Cerebrovascular Reactivity and Worse Clinical Outcome

Crossed Cerebellar Diaschisis in Patients with Diffuse Glioma Is Associated with Impaired Supratentorial Cerebrovascular Reactivity and Worse Clinical Outcome

Crossed Cerebellar Diaschisis in Patients With Symptomatic Unilateral Anterior Circulation Stroke Is Associated With Hemodynamic Impairment in the IpsilateralMCATerritory

BOLD cerebrovascular reactivity as a novel marker for crossed cerebellar diaschisis

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