In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

  • Interhemispheric Connectivity in ICH

    Final Number:

    Charles B. Mikell MD; Michael Maurice McDowell BS; Marc Louis Otten MD; Andrew Kai-Hong Chan BS; Blake Eaton Samuel Taylor BS; Rachel Bruce; Eric S Sussman; Samuel S. Bruce BA; Guy M. McKhann MD; E. Sander Connolly MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Intracerebral hemorrhage (ICH) has the highest mortality of all stroke subtypes. Motor deficits are a major cause of ongoing disability after ICH. However, the underlying pathophysiology of motor deficits after ICH is not clear. We hypothesized that deficits in both intrahemispheric and interhemispheric connectivity within motor networks correlate immediate hemiplegia after intracerebral hemorrhage.

    Methods: We enrolled six left-sided ICH patients with hemorrhages within the basal ganglia and/or thalamus, and we performed both structural and resting-state functional MRI. Patients were divided into a hemiplegic group and a non-hemiplegic group. Seed-based were performed to evaluate motor networks. Graphs were constructed between key nodes in the motor network. Mean edge weights, as well as directional connectivity using Granger causality were derived.

    Results: The motor network was significantly less connected in patients who were hemiplegic. Group analysis revealed that contralateral connectivity was preserved in non-hemiplegic patients when the map was derived from a right PMC seed, as well as in hemiplegic patients when the network was derived from a left PMC seed. Granger causality revealed that the mean flow of information was from left to right in non-hemiplegic subjects, whereas hemiplegic subjects experienced an information flow from right to left.

    Conclusions: Resting fMRI differentiates hemiplegic and non-hemiplegic patients after subcortical stroke. These data, while preliminary, support a role for interhemispheric connectivity in recovery from stroke. Specifically, information flow from left to right is associated with maintenance of strength after hemorrhage and flow right to left is associated with potentially an inhibitory influence.

    Patient Care: This provides the groundwork for an improved ability to prognosticate and advances our understanding of the factors which contribute to neurological deficits and recovery.

    Learning Objectives: 1)Understand the relationship between motor deficits and connectivity 2)Elucidate the role of the contralesional hemisphere in the mediation of motor deficits and recovery

    References: 1. Adeoye O, Hornung R, Khatri P, Ringer A, Kleindorfer D. The rate of hemicraniectomy for acute ischemic stroke is increasing in the United States. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2011 May-Jun;20(3):251-4. 2. Kellner CP, Connolly ES, Jr. Neuroprotective strategies for intracerebral hemorrhage: trials and translation. Stroke; a journal of cerebral circulation. 2010 Oct;41(10 Suppl):S99-102. 3. Mendelow AD, Gregson BA, Fernandes HM, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet. 2005 Jan 29-Feb 4;365(9457):387-97. 4. Brott T, Broderick J, Kothari R, et al. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke. 1997 Jan;28(1):1-5. 5. Katrak PH, Black D, Peeva V. Do stroke patients with intracerebral hemorrhage have a better functional outcome than patients with cerebral infarction? PM R. 2009 May;1(5):427-33. 6. Otten ML, Mikell CB, Youngerman BE, et al. Motor deficits correlate with resting state motor network connectivity in patients with brain tumours. Brain : a journal of neurology. 2012 Apr;135(Pt 4):1017-26. 7. Bullmore E, Sporns O. Complex brain networks: graph theoretical analysis of structural and functional systems. Nature Reviews Neuroscience. 2009 Mar;10(3):186-98. 8. Jang SH, Kwon YH, Lee MY, Lee DY, Hong JH. Difference of neural connectivity for motor function in chronic hemiparetic stroke patients with intracerebral hemorrhage. Neuroscience letters. 2012 Nov 2. 9. Loubinoux I, Carel C, Pariente J, et al. Correlation between cerebral reorganization and motor recovery after subcortical infarcts. NeuroImage. 2003 Dec;20(4):2166-80. 10. Calautti C, Leroy F, Guincestre JY, Baron JC. Dynamics of motor network overactivation after striatocapsular stroke: a longitudinal PET study using a fixed-performance paradigm. Stroke; a journal of cerebral circulation. 2001 Nov;32(11):2534-42.

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy