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DTI-MR tractography of white matter damage in stroke patients with neglect

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Abstract

Left visual neglect is a dramatic neurological condition that impairs awareness of left-sided events. Neglect has been classically reported after strokes in the territory of the right middle cerebral artery. However, the precise lesional correlates of neglect within this territory remain discussed. Recent evidence strongly suggests an implication of dysfunction of large-scale perisylvian networks in chronic neglect, but the quantitative relationships between neglect signs and damage to white matter (WM) tracts have never been explored. In this prospective study, we used diffusion tensor imaging (DTI) tractography in twelve patients with a vascular stroke in the right hemisphere. Six of these patients showed signs of neglect. Nonparametric voxel-based comparisons between neglect and controls on fractional anisotropy maps revealed clusters in the perisylvian WM and in the external capsule. Individual DTI tractography identified specific disconnections of the fronto-parietal and fronto-occipital pathways in the neglect group. Voxel-based correlation statistics highlighted correlations between patients’ performance on two visual search tasks and damage to WM clusters. These clusters were located in the anterior limb of the internal capsule and in the WM underlying the inferior frontal gyrus, along the trajectory of the anterior segment of the arcuate fasciculus (asAF). These results indicate that chronic visual neglect can result from, and correlate with, damage to fronto-parietal connections in the right hemisphere, within large-scale cortical networks important for orienting of spatial attention, arousal and spatial working memory.

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Notes

  1. These correlations should be interpreted with caution because they are calculated across groups with non-overlapping performance (with and without neglect) that may drive an artefactual correlation. However, visual inspection of the graphs in Fig. 5 shows that patients with more severe micro-structural damage tend to show more severe neglect on cancellation tests.

  2. In order to avoid acute ischemic MRI artefacts such as cell swelling or cytotoxic oedema (see Sotak 2002), we established a minimum necessary time interval of 3 weeks between stroke and DT-MR acquisition; as a consequence, many patients tested behaviourally could not be included because they had left the hospital before any DTI sequence could be acquired. Time interval between stroke onset and MRI was chosen on the basis of several studies indicating an initial increase of FA at the acute stage due to cell swelling. At the sub-acute and chronic stages, there is a decreasing of FA in the lesion, due to wallerian degeneration (Thomalla et al. 2005). This decrease could remain significant (compared to the FA in the homologous controlateral lesion) even 6 months after the stroke (Sotak 2002). The second raison was the probability of frequent consecutive oedema at the acute stage, which could have disturbed the sensitivity of the DTI sequence to the lesion.

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Acknowledgments

Supported by grants from the AP-HP (interface programme) and the Université Pierre et Marie Curie, Paris 6 (Bonus Qualité Recherche) to PB.

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Authors and Affiliations

  1. INSERM-UPMC UMR S 975, G.H. Pitié-Salpêtrière, 47 boulevard de l’Hôpital, 75013, Paris, France

    M. Urbanski, B. Dubois & P. Bartolomeo

  2. Natbrainlab, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King’s College London, London, UK

    M. Thiebaut de Schotten

  3. Department of Neuroradiology, Hôpital Sainte-Anne, Université Paris Descartes, Paris, France

    S. Rodrigo, C. Oppenheim & J.-F. Méder

  4. Department of Neurology, Hôpital Sainte-Anne, Université Paris Descartes, Paris, France

    E. Touzé

  5. Department of Functional Rehabilitation, Hôpital National de Saint-Maurice, Saint-Maurice, France

    M. Urbanski, K. Moreau & C. Loeper-Jeny

  6. Department of Neurology, AP-HP, IFR 70, Hôpital de la Salpêtrière, Paris, France

    B. Dubois & P. Bartolomeo

  7. Department of Psychology, Catholic University, Milan, Italy

    P. Bartolomeo

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  1. M. Urbanski
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Urbanski, M., Thiebaut de Schotten, M., Rodrigo, S. et al. DTI-MR tractography of white matter damage in stroke patients with neglect. Exp Brain Res 208, 491–505 (2011). https://doi.org/10.1007/s00221-010-2496-8

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