Common behavioral clusters and subcortical anatomy in stroke.
A long-held view is that stroke causes many distinct neurological syndromes due to damage of specialized cortical and subcortical centers. However, it is unknown if a syndrome-based description is helpful in characterizing behavioral deficits across a large number of patients. We studied a large prospective sample of first-time stroke patients with heterogeneous lesions at 1-2 weeks post-stroke. We measured behavior over multiple domains and lesion anatomy with structural MRI and a probabilistic atlas of white matter pathways. Multivariate methods estimated the percentage of behavioral variance explained by structural damage. A few clusters of behavioral deficits spanning multiple functions explained neurological impairment. Stroke topography was predominantly subcortical, and disconnection of white matter tracts critically contributed to behavioral deficits and their correlation. The locus of damage explained more variance for motor and language than memory or attention deficits. Our findings highlight the need for better models of white matter damage on cognition.
Department of Neurology, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA; Radiology, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA; Department of Anatomy and Neurobiology, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA; Department of Bioengineering, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA. Electronic address: mau@npg.wustl.edu.
Maurizio
M
Corbetta
Department of Neurology, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA; Division of Biomedical Sciences, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA.
Lenny
L
Ramsey
Department of Neurology, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA.
Alicia
A
Callejas
Department of Neurology, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA.
Antonello
A
Baldassarre
Department of Bioengineering, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA.
Carl D
CD
Hacker
Division of Biomedical Sciences, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA.
Joshua S
JS
Siegel
Department of Neurology, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA.
Serguei V
SV
Astafiev
Department of Neurology, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA.
Jennifer
J
Rengachary
Department of Neurology, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA.
Kristina
K
Zinn
Department of Neurology, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA; Department of Physical Therapy, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA; Department of Occupational Therapy, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA.
Catherine E
CE
Lang
Department of Neurology, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA; Radiology, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA; Department of Occupational Therapy, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA.
Lisa Tabor
LT
Connor
Department of Neurology, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA.
Robert
R
Fucetola
Department of Psychology, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA.
Michael
M
Strube
Department of Neurology, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA.
Alex R
AR
Carter
Department of Neurology, Washington University School of Medicine, Box 8111, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA.
Gordon L
GL
Shulman
D001931:Brain Mapping / Q000379:methods*; D016208:Databases, Factual / Q000639:trends; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000378:metabolism / Q000523:psychology; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000378:metabolism / Q000473:pathology*; D010468:Perceptual Disorders / Q000175:diagnosis* / Q000378:metabolism / Q000523:psychology*; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000378:metabolism / Q000523:psychology*