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November 13, 2012; 79 (20) Article

Incident subcortical infarcts induce focal thinning in connected cortical regions

Marco Duering, Ruthger Righart, Endy Csanadi, Eric Jouvent, Dominique Hervé, Hugues Chabriat, Martin Dichgans
First published October 10, 2012, DOI: https://doi.org/10.1212/WNL.0b013e3182749f39
Marco Duering
From the Institute for Stroke and Dementia Research (M. Duering, R.R., E.C., M. Dichgans) and Department of Neurology (E.C.), Ludwig-Maximilians-University, Munich; German Center for Neurodegenerative Diseases (DZNE, Munich) (R.R., M. Dichgans), Munich; Munich Cluster for Systems Neurology (SyNergy) (M. Duering), Munich, Germany; and Department of Neurology (E.J., D.H., H.C.), CHU Lariboisière, Assistance Publique des Hôpitaux de Paris, Paris, France.
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Ruthger Righart
From the Institute for Stroke and Dementia Research (M. Duering, R.R., E.C., M. Dichgans) and Department of Neurology (E.C.), Ludwig-Maximilians-University, Munich; German Center for Neurodegenerative Diseases (DZNE, Munich) (R.R., M. Dichgans), Munich; Munich Cluster for Systems Neurology (SyNergy) (M. Duering), Munich, Germany; and Department of Neurology (E.J., D.H., H.C.), CHU Lariboisière, Assistance Publique des Hôpitaux de Paris, Paris, France.
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Endy Csanadi
From the Institute for Stroke and Dementia Research (M. Duering, R.R., E.C., M. Dichgans) and Department of Neurology (E.C.), Ludwig-Maximilians-University, Munich; German Center for Neurodegenerative Diseases (DZNE, Munich) (R.R., M. Dichgans), Munich; Munich Cluster for Systems Neurology (SyNergy) (M. Duering), Munich, Germany; and Department of Neurology (E.J., D.H., H.C.), CHU Lariboisière, Assistance Publique des Hôpitaux de Paris, Paris, France.
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Eric Jouvent
From the Institute for Stroke and Dementia Research (M. Duering, R.R., E.C., M. Dichgans) and Department of Neurology (E.C.), Ludwig-Maximilians-University, Munich; German Center for Neurodegenerative Diseases (DZNE, Munich) (R.R., M. Dichgans), Munich; Munich Cluster for Systems Neurology (SyNergy) (M. Duering), Munich, Germany; and Department of Neurology (E.J., D.H., H.C.), CHU Lariboisière, Assistance Publique des Hôpitaux de Paris, Paris, France.
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Dominique Hervé
From the Institute for Stroke and Dementia Research (M. Duering, R.R., E.C., M. Dichgans) and Department of Neurology (E.C.), Ludwig-Maximilians-University, Munich; German Center for Neurodegenerative Diseases (DZNE, Munich) (R.R., M. Dichgans), Munich; Munich Cluster for Systems Neurology (SyNergy) (M. Duering), Munich, Germany; and Department of Neurology (E.J., D.H., H.C.), CHU Lariboisière, Assistance Publique des Hôpitaux de Paris, Paris, France.
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Hugues Chabriat
From the Institute for Stroke and Dementia Research (M. Duering, R.R., E.C., M. Dichgans) and Department of Neurology (E.C.), Ludwig-Maximilians-University, Munich; German Center for Neurodegenerative Diseases (DZNE, Munich) (R.R., M. Dichgans), Munich; Munich Cluster for Systems Neurology (SyNergy) (M. Duering), Munich, Germany; and Department of Neurology (E.J., D.H., H.C.), CHU Lariboisière, Assistance Publique des Hôpitaux de Paris, Paris, France.
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Martin Dichgans
From the Institute for Stroke and Dementia Research (M. Duering, R.R., E.C., M. Dichgans) and Department of Neurology (E.C.), Ludwig-Maximilians-University, Munich; German Center for Neurodegenerative Diseases (DZNE, Munich) (R.R., M. Dichgans), Munich; Munich Cluster for Systems Neurology (SyNergy) (M. Duering), Munich, Germany; and Department of Neurology (E.J., D.H., H.C.), CHU Lariboisière, Assistance Publique des Hôpitaux de Paris, Paris, France.
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Citation
Incident subcortical infarcts induce focal thinning in connected cortical regions
Marco Duering, Ruthger Righart, Endy Csanadi, Eric Jouvent, Dominique Hervé, Hugues Chabriat, Martin Dichgans
Neurology Nov 2012, 79 (20) 2025-2028; DOI: 10.1212/WNL.0b013e3182749f39

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ABSTRACT

Objective: Brain atrophy is common in subcortical ischemic vascular disease, but the underlying mechanisms are poorly understood. We set out to examine the effects of incident subcortical infarcts on cortical morphology.

Methods: A total of 276 subjects with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, an inherited small vessel disease, were enrolled in a prospective study. Incident subcortical infarcts were identified on follow-up magnetic resonance scans after 18, 36, and 54 months using difference images. Probabilistic fiber tracking and cortical thickness measurements were applied to study the longitudinal relationship between incident infarcts and connected cortical areas. Cortical thickness was assessed before and after infarction using FreeSurfer software. Focal cortical thinning was defined as change of cortical thickness in the connected region of interest exceeding the global change of cortical thickness.

Results: Nine subjects had a single incident infarct during the follow-up and were suitable for analysis. There was a strong correlation between the probability of connectivity and mean focal cortical thinning (p = 0.0039). In all subjects, there was focal cortical thinning in cortical regions with high probability of connectivity with the incident infarct. This pattern was not observed when using control tractography seeds.

Conclusions: Our findings provide in vivo evidence for secondary cortical neurodegeneration after subcortical ischemia as a mechanism for brain atrophy in cerebrovascular disease.

Glossary

CADASIL=
cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy;
ROI=
region of interest

Footnotes

  • ↵* These authors contributed equally to this work.

  • Study funding: Supported by the German Center for Neurodegenerative Diseases (DZNE), the Vascular Dementia Research Foundation, PHRC grant AOR 02-001 (DRC/APHP), and Association de Recherché en Neurologie Vasculaire (ARNEVA), Hôpital Lariboisiere, Paris, France.

  • Go to Neurology.org for full disclosures. Disclosures deemed relevant by the authors, if any, are provided at the end of this article.

  • Editorial, page 2016

  • Supplemental data at www.neurology.org

  • Received March 14, 2012.
  • Accepted July 16, 2012.
  • © 2012 American Academy of Neurology
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