Striatal Infarction Elicits Secondary Extrafocal MRI Changes in Ipsilateral Substantia Nigra.
Focal ischemia may induce pathological alterations in brain areas distant from the primary lesion. In animal models, exofocal neuron death in the ipsilateral midbrain has been described after occlusion of the middle cerebral artery (MCA). Using sequential magnetic resonance imaging (T2- and diffusion-weighted) at 3 Tesla, we investigated acute ischemic stroke patients on days 1, 2, 6, 8, and 10 after stroke onset. Sixteen consecutive patients who had suffered a stroke involving the caudate nucleus and/or putamen of either hemisphere were recruited into the study. Four additional patients with strokes sparing the caudate nucleus and putamen but encompassing at least one-third of the MCA territory served as controls. Ischemic lesions involving striatal structures resulted in hyperintense lesions in ipsilateral midbrain that emerged between days 6 and 10 after stroke and were not present on the initial scans. In contrast, none of the control stroke patients developed secondary midbrain lesions. Hyperintense lesions in the pyramidal tract or the brain stem caused by degeneration of the corticospinal tract could be clearly distinguished from these secondary midbrain gray matter lesions and were detectable from day 2 after ischemia. Co-registration of high-resolution images with a digitized anatomic atlas revealed localization of secondary lesions primarily in the substantia nigra pars compacta. Apparent diffusion coefficient (ADC) values in the secondary lesions showed a delayed sharp decline through day 10. Normalization of ADC values was observed at late measurements. Taken together, our study demonstrates that striatal infarction elicits delayed degenerative changes in ipsilateral substantia nigra pars compacta.
Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Charitéplatz 1,10117, Berlin, Germany; Department of Neurology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Benjamin
B
Winter
Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Charitéplatz 1,10117, Berlin, Germany.
Peter
P
Brunecker
Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Charitéplatz 1,10117, Berlin, Germany.
Jochen B
JB
Fiebach
Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Charitéplatz 1,10117, Berlin, Germany; Department of Neurology, Jüdisches Krankenhaus Berlin, Heinz-Galinski-Strasse 1, 13347, Berlin, Germany.
Gerhard Jan
GJ
Jungehulsing
Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Charitéplatz 1,10117, Berlin, Germany; Department of Neurology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany; Department of Psychiatry, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany; Max-Delbrück Center and Charité Medical Faculty, Experimental and Clinical Research Center, Lindenbergerweg 80, 13125, Berlin, Germany.
Golo
G
Kronenberg
Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Charitéplatz 1,10117, Berlin, Germany; Department of Neurology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany; Excellence Cluster Neurocure, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany; German Center for Neurodegenerative Diseases (DZNE), Ludwig-Erhard-Allee, 53175, Bonn, Germany; German Centre for Cardiovascular Research (DZHK), Oudenarder Straße 16, 13347, Berlin, Germany.
Matthias
M
Endres
D000368:Aged; D020520:Brain Infarction / Q000150:complications*; D002544:Cerebral Infarction / Q000150:complications* / Q000473:pathology; D003342:Corpus Striatum / Q000098:blood supply* / Q000473:pathology; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D020521:Stroke / Q000150:complications* / Q000473:pathology; D013378:Substantia Nigra / Q000473:pathology*