These authors contributed equally.
Proximity of brain infarcts to regions of endogenous neurogenesis and involvement of striatum in ischaemic stroke
Article first published online: 11 OCT 2012
© 2012 The Author(s) European Journal of Neurology © 2012 EFNS
European Journal of Neurology
Volume 20, Issue 3, pages 473–479, March 2013
How to Cite
Delavaran, H., Sjunnesson, H., Arvidsson, A., Lindvall, O., Norrving, B., van Westen, D., Kokaia, Z. and Lindgren, A. (2013), Proximity of brain infarcts to regions of endogenous neurogenesis and involvement of striatum in ischaemic stroke. European Journal of Neurology, 20: 473–479. doi: 10.1111/j.1468-1331.2012.03877.x
- Issue published online: 14 FEB 2013
- Article first published online: 11 OCT 2012
- Manuscript Accepted: 21 AUG 2012
- Manuscript Received: 30 MAY 2012
- Swedish Research Council
- Rut and Erik Hardebo's Donation Fund
- Elsa Schmitz' Foundation
- Swedish Brain Foundation
- Promobilia Foundation
- King Gustaf V's
- Queen Victoria's Foundation
- Swedish Stroke Association
- Swedish Government Initiative for Strategic Research Areas (StemTherapy)
- Southern Swedish Healthcare Region
- Foundation of Medical Imaging in the Memory of Erik Lysholm
- cerebral infarct;
- stem cell therapy;
- subventricular zone
Background and purpose
Clinical stroke trials with stem cell-based approaches aiming for trophic actions, modulation of inflammation and neuroprotection are ongoing. However, experimental studies also suggest that neuronal replacement by grafted neural stem cells (NSCs) and possibly by endogenous NSCs from the subventricular zone (SVZ) may restore function in the stroke-damaged striatum. To evaluate the potential clinical impact of these findings, we analyzed the spatial relationship of infarcts to the SVZ and the proportion of individuals with striatal lesions in a consecutive series of ischaemic stroke patients.
Patients aged 20–75 years with first-ever ischaemic stroke underwent DW-MRI of the brain within 4 days after stroke onset. We analyzed location, size, number of acute focal ischaemic abnormalities and their spatial relationship to the SVZ. Stroke severity was assessed using NIH Stroke Scale (NIHSS).
Of 108 included patients, the distance from the nearest margin of the infarct(s) to the SVZ was ≤2 mm in 51/102 patients with visible ischaemic lesions on DW-MRI. Twenty-four patients had involvement of striatum. Eight of these had predominantly striatal lesions, that is >50% of the total ischaemic lesion volume was located in caudate nucleus and/or putamen. These 8 patients had a median NIHSS of 3.
Many stroke patients have infarcts located close to the SVZ, providing some supportive evidence that optimized endogenous neurogenesis may have therapeutic potential. However, predominantly striatal infarcts are rare and tend to give mild neurological deficits, indicating that striatum should not be the primary target for neuronal replacement efforts in humans.