K R Thulborn1, P A Carpenter, M A Just. 1. MR Research Center, University of Pittsburgh Medical Center, PA 15213, USA. keith@mrctr.upmc.edu
Abstract
BACKGROUND AND PURPOSE: This study was undertaken to correlate functional recovery from aphasia after acute stroke with the temporal evolution of the anatomic, physiological, and functional changes as measured by MRI. METHODS: Blood oxygenation level-dependent contrast and echo-planar MRI were used to map language comprehension in 6 normal adults and in 2 adult patients during recovery from acute stroke presenting with aphasia. Perfusion, diffusion, sodium, and conventional anatomic MRI were used to follow physiological and structural changes. RESULTS: The normal activation pattern for language comprehension showed activation predominately in left-sided Wernicke's and Broca's areas, with laterality ratios of 0.8 and 0.3, respectively. Recovery of the patient confirmed as having a completed stroke affecting Broca's area occurred rapidly with a shift of activation to the homologous region in the right hemisphere within 3 days, with continued rightward lateralization over 6 months. In the second patient, in whom mapping was performed fortuitously before stroke, recovery of a Wernicke's aphasia showed a similar increasing rightward shift in activation recruitment over 9 months after the event. CONCLUSIONS: Recovery of aphasia in adults can occur rapidly and is concomitant with an activation pattern that changes from left to a homologous right hemispheric pattern. Such recovery occurs even when the stroke evolves to completion. Such plasticity must be considered when evaluating stroke interventions based on behavioral and neurological measurements.
BACKGROUND AND PURPOSE: This study was undertaken to correlate functional recovery from aphasia after acute stroke with the temporal evolution of the anatomic, physiological, and functional changes as measured by MRI. METHODS: Blood oxygenation level-dependent contrast and echo-planar MRI were used to map language comprehension in 6 normal adults and in 2 adult patients during recovery from acute stroke presenting with aphasia. Perfusion, diffusion, sodium, and conventional anatomic MRI were used to follow physiological and structural changes. RESULTS: The normal activation pattern for language comprehension showed activation predominately in left-sided Wernicke's and Broca's areas, with laterality ratios of 0.8 and 0.3, respectively. Recovery of the patient confirmed as having a completed stroke affecting Broca's area occurred rapidly with a shift of activation to the homologous region in the right hemisphere within 3 days, with continued rightward lateralization over 6 months. In the second patient, in whom mapping was performed fortuitously before stroke, recovery of a Wernicke's aphasia showed a similar increasing rightward shift in activation recruitment over 9 months after the event. CONCLUSIONS: Recovery of aphasia in adults can occur rapidly and is concomitant with an activation pattern that changes from left to a homologous right hemispheric pattern. Such recovery occurs even when the stroke evolves to completion. Such plasticity must be considered when evaluating stroke interventions based on behavioral and neurological measurements.
Authors: Margaret A Naeser; Paula I Martin; Ethan Treglia; Michael Ho; Elina Kaplan; Shahid Bashir; Roy Hamilton; H Branch Coslett; Alvaro Pascual-Leone Journal: Restor Neurol Neurosci Date: 2010 Impact factor: 2.406
Authors: Jacquie Kurland; Carlos R Cortes; Marko Wilke; Anne J Sperling; Susan N Lott; Malle A Tagamets; John Vanmeter; Rhonda B Friedman Journal: Brain Imaging Behav Date: 2008-09 Impact factor: 3.978
Authors: J P Szaflarski; J B Allendorfer; A W Byars; J Vannest; A Dietz; K A Hernando; S K Holland Journal: Restor Neurol Neurosci Date: 2014 Impact factor: 2.406
Authors: Jean-Claude Baron; Leonardo G Cohen; Steven C Cramer; Bruce H Dobkin; Heidi Johansen-Berg; Isabelle Loubinoux; Randolph S Marshall; N S Ward Journal: Cerebrovasc Dis Date: 2004 Impact factor: 2.762
Authors: Anne Gallagher; Naoaki Tanaka; Nao Suzuki; Hesheng Liu; Elizabeth A Thiele; Steven M Stufflebeam Journal: Epilepsy Res Date: 2012-10-23 Impact factor: 3.045