The effect of stroke on micturition associated brain activity: A pilot fMRI study

Abstract

Objective: Cerebral stroke is a unique model for studying the role of the brain in lower urinary tract (LUT) control. By its nature, stroke must change the activity of the brain to cause LUT dysfunction. The objective of this study was to describe changes in micturition-related brain activity in patients who develop LUT symptoms (LUTS) after a cerebral stroke. Materials and Methods: Healthy controls (HC, n = 10) and patients who developed storage LUTS after a cerebral stroke (n = 7) were recruited. Functional magnetic resonance imaging was used to assess brain activity in each subject. In the task-based block design, blood-oxygen-level-dependent (BOLD) signal was detected during rest, active bladder filling, and bladder voiding. BOLD signal intensity was compared between HCs and stroke subjects during bladder filling, voiding, and voiding initiation. Results: Stroke subjects exhibited higher activity in the periaqueductal gray and cerebellum during bladder filling and bladder voiding. HCs exhibited more intense activity in higher centers, such as the cingulate cortex, motor cortex, and the dorsolateral prefrontal cortex in each of the phases examined. Conclusions: Subjects with stroke-related LUTS exhibit a specific pattern of brain activity during bladder filling and voiding. There appears to be a greater reliance on primitive centers (cerebellum, midbrain) than in healthy controls during both phases of the micturition cycle. We hypothesize that these findings may reflect loss of connectivity with higher brain centers after a stroke.

How brain diseases affect the lower urinary tract function?

“…The site of lesion responsible for the LUTD seemed to be the pontine tegmentum (adjacent to the PMC), which similar to the experimental observations [109]. A recent fMRI study of seven patients with stroke (mostly lacuna in the basal ganglia) and OAB showed higher activation in the PAG (output area) and cerebellum, whereas activation in the PFC (inhibitory area) was minimum [110].…”

Analysis of the Failure of Removal of the Urinary Catheter for Patients With Intracerebral Hemorrhage Postoperatively

“…5 Another study by Nour et al 21 reported that micturition is associated with increased activity within the pons and several other cortical areas. Kreydin et al's 4 research also indicated that stroke subjects exhibited higher activity in the periaqueductal gray and cerebellum during bladder filling and bladder voiding. Our study also revealed that a group of successful-removal urinary catheter compared to groups of failed-removal urinary catheter were found to be significantly different at sites of intracerebral hematoma (P = 0.004).…”

“…It has been estimated that up to 94% of patients with stroke have at least one lower urinary tract symptom. Kreydin et al 4 demonstrated that stroke patients exhibit a distinct pattern of brain activity during bladder filling and emptying, compared to healthy controls. They hypothesized that if the disparity could be attributed to impaired neural signaling, then it would prevent recruitment of higher cortical centers.…”

“…2,3 Patients often exhibit urinary disturbance following a stroke. 4,5 It has been demonstrated that diabetes mellitus, aphasia, poor functional status, and cognitive impairment may be associated with urinary retention of stroke patients. 6 However, the scientific rationale behind urinary dysfunction of patients following a stroke is not yet well understood.…”

“…Patients often exhibit urinary disturbance following a stroke 4,5. It has been demonstrated that diabetes mellitus, aphasia, poor functional status, and cognitive impairment may be associated with urinary retention of stroke patients 6.…”