Voxel-based lesion-symptom mapping of stroke lesions underlying somatosensory deficits

Abstract

The aim of this study was to investigate the relationship between stroke lesion location and the resulting somatosensory deficit. We studied exteroceptive and proprioceptive somatosensory symptoms and stroke lesions in 38 patients with first-ever acute stroke. The Erasmus modified Nottingham Sensory Assessment was used to clinically evaluate somatosensory functioning in the arm and hand within the first week after stroke onset. Additionally, more objective measures such as the perceptual threshold of touch and somatosensory evoked potentials were recorded. Non-parametric voxel-based lesion-symptom mapping was performed to investigate lesion contribution to different somatosensory deficits in the upper limb. Additionally, structural connectivity of brain areas that demonstrated the strongest association with somatosensory symptoms was determined, using probabilistic fiber tracking based on diffusion tensor imaging data from a healthy age-matched sample. Voxels with a significant association to somatosensory deficits were clustered in two core brain regions: the central parietal white matter, also referred to as the sensory component of the superior thalamic radiation, and the parietal operculum close to the insular cortex, representing the secondary somatosensory cortex. Our objective recordings confirmed findings from clinical assessments. Probabilistic tracking connected the first region to thalamus, internal capsule, brain stem, postcentral gyrus, cerebellum, and frontal pathways, while the second region demonstrated structural connections to thalamus, insular and primary somatosensory cortex. This study reveals that stroke lesions in the sensory fibers of the superior thalamocortical radiation and the parietal operculum are significantly associated with multiple exteroceptive and proprioceptive deficits in the arm and hand.

A Lesion-Proof Brain? Multidimensional Sensorimotor, Cognitive, and Socio-Affective Preservation Despite Extensive Damage in a Stroke Patient

“…In this sense, the patient exhibited various patterns of damage known to systematically disrupt various domains. For example, putative associations have been established between frontostriatal lesions and motor disability (Zgaljardic et al, 2003), insulo-parietal compromise and somatosensory deficiencies (Meyer et al, 2016), bilateral fronto-insular damage and social cognition deficits (Ibáñez et al, 2010, 2016a; Couto et al, 2013; Baez et al, 2014, 2016b; Melloni et al, 2016), bilateral frontal atrophy and executive dysfunctions (Rabinovici et al, 2015), left perisylvian lesions and language impairment (Ullman, 2008), and right-sided frontal disturbances and altered pragmatic skills (Kaplan et al, 1990; Stemmer, 2008). Moreover, the regions affected should typically disrupt multiple functional networks, such as the salience network (Seeley et al, 2007), the social context network (Ibáñez and Manes, 2012; Baez et al, 2016a), and the fronto-parietal attention network (Ptak, 2012).…”

“…These steps are critical and perhaps unavoidable to characterize the organ's functional organization with some degree of external validity. Indeed, thanks to this approach, replicable associations have been established between damage to circumscribed regions and impairments of specific functions, including motor (Zgaljardic et al, 2003), somatosensory (Meyer et al, 2016), socio-cognitive (Gold and Shadlen, 2007; Ibáñez et al, 2010, 2016b; Couto et al, 2013; Baez et al, 2014, 2016b,c; Melloni et al, 2016), interoceptive (Couto et al, 2015; García-Cordero et al, 2016), executive (Rabinovici et al, 2015; Sedeño et al, 2016), linguistic (Ullman, 2008; Cardona et al, 2014; García and Ibáñez, 2014, 2016; Bocanegra et al, 2015; García, 2015; Melloni et al, 2015; García et al, 2016a,b,c; Abrevaya et al, 2017), and pragmatic (Kaplan et al, 1990; Stemmer, 2008) skills.…”

Motor compensation and its effects on neural reorganization after stroke

“…Spasticity due to hyperexcitability of the stretch reflex can develop after stroke 35 , and its severity is correlated with the severity of motor impairments 36 . Motor impairments co-occur to varying degrees with impaired somatosensation 37,38 , which is associated with damage to ascending somatosensory pathways 39 .…”

Neuroanatomical correlates of sensory deficits in children with neonatal arterial ischemic stroke

“…In this manner, we can evaluate the likelihood that damage to any particular brain region will result in a given clinical symptom, with the caveat that regions less susceptible to injury may not be well represented in the resulting heat map. This technique has been used extensively to explore lesion‐deficit associations following stroke in adult populations, including adults with somatosensory deficits . To our knowledge, however, it has not been used in the study of pediatric stroke.…”