Unlocking the Mystery of Poststroke Fatigue

Published on June 29, 2022

Imagine you’re exploring a vast labyrinth, searching for the hidden key that holds the secret to poststroke fatigue (PSF). Researchers set out on a mission to uncover the brain’s treasures, investigating which lesions might be linked to this common symptom in stroke survivors. Armed with 3.0 T brain MRI and a keen eye for detail, they mapped the infarct lesions onto a standard template. Using voxel-based lesion-symptom mapping (VLSM), they uncovered a significant association between lesion location and the occurrence and severity of PSF at 6-month follow-up. Interestingly, clusters in the right thalamus were found to increase the risk of fatigue symptoms. But here’s the twist – no significant cluster was found in the acute phase of stroke. These findings suggest that the puzzle of PSF may unravel over time, with the right thalamus playing a crucial role in long-term fatigue after stroke. So dive into the research, explore the intricate maps of the brain, and discover new insights into poststroke fatigue!

Background:Poststroke fatigue (PSF) is a common symptom in stroke survivors, yet its anatomical mechanism is unclear. Our study was aimed to identify which brain lesions are related to the PSF in patients with acute stroke.MethodPatients with first-ever acute ischemic stroke consecutively admitted from the first affiliated hospital of the University of Science and Technology of China (USTC) between January 2017 and June 2020. Fatigue was scored using the Fatigue Severity Scale. All the participants were assessed by 3.0 T brain MRI including diffusion-weighted imaging. The infarct lesions were delineated manually and transformed into a standard template. Voxel-based lesion-symptom mapping (VLSM) was applied to investigate the association between lesion location and the occurrence and severity of fatigue. The same analyses were carried out by flipping the left-sided lesions. Multivariate logistic regressions were applied to verify the associations.ResultsOf the 361 patients with acute stroke, 142 (39.3%) patients were diagnosed with fatigue in the acute phase and 116 (35.8%) at 6 months after the index stroke. VLSM analysis indicated clusters in the right thalamus which was significantly associated with the occurrence and severity of PSF at 6-month follow-up. In contrast, no significant cluster was found in the acute phase of stroke. The flipped analysis did not alter the results. Multivariate logistic regression verified that lesion load in the right thalamus (OR 2.67, 95% CI 1.46–4.88) was an independent predictor of 6-month PSF.ConclusionOur findings indicated that lesions in the right thalamus increased the risk of fatigue symptoms 6 months poststroke.

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