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Visual recovery after perinatal stroke evidenced by functional and diffusion MRI: case report
Mohamed L Seghier1, François Lazeyras, Slava Zimine
1Department of Radiology, Geneva University Hospitals, Micheli-du-Crest 24, 1211 Geneva, Switzerland. Mohamed.Seghier@medecine.unige.ch
Insights
New non-invasive neuroimaging techniques like diffusion tensor imaging (DTI) and event-related functional MRI (ER-fMRI) show visual cortex recovery after perinatal stroke in infants. These methods reveal structural and functional brain plasticity, aiding diagnosis and rehabilitation strategies.
Area of Science:
- Pediatric neurology
- Neuroimaging techniques
- Brain plasticity research
Background:
- Evaluating functional deficits and brain plasticity after perinatal brain injury in infants is clinically challenging.
- There is a need for non-invasive methods for early functional diagnosis in infants with perinatal brain injury.
Observation:
- A case study combined diffusion tensor imaging (DTI) and event-related functional MRI (ER-fMRI) to assess visual system recovery in an infant with perinatal stroke.
- ER-fMRI at 20 months revealed significant negative activation in the injured left visual cortex, not present earlier.
- DTI maps indicated recovery and increased prominence of the optic radiation near the lesion site at 20 months compared to 12 months.
Findings:
- Functional cortical recovery in the visual system is associated with structural changes in major visual pathways.
- Neuroimaging demonstrated recovery of the optic radiation following perinatal stroke.
- Combined DTI and ER-fMRI can detect functional and structural recovery in infant brains.
Implications:
- These neuroimaging findings support the concept of brain plasticity in infants post-stroke.
- The study highlights the potential of advanced neuroimaging for early diagnosis and tailored rehabilitation strategies.
- This approach may improve clinical evaluation of brain injury recovery in young children.
Background:
After perinatal brain injury, clinico-anatomic correlations of functional deficits and brain plasticity remain difficult to evaluate clinically in the young infant. Thus, new non-invasive methods capable of early functional diagnosis are needed in young infants.
Case Presentation:
The visual system recovery in an infant with perinatal stroke is assessed by combining diffusion tensor imaging (DTI) and event-related functional MRI (ER-fMRI). All experiments were done at 1.5T. A first DTI experiment was performed at 12 months of age. At 20 months of age, a second DTI experiment was performed and combined with an ER-fMRI experiment with visual stimuli (2 Hz visual flash). At 20 months of age, ER-fMRI showed significant negative activation in the visual cortex of the injured left hemisphere that was not previously observed in the same infant. DTI maps suggest recovery of the optic radiation in the vicinity of the lesion. Optic radiations in the injured hemisphere are more prominent in DTI at 20 months of age than in DTI at 12 months of age.
Conclusion:
Our data indicate that functional cortical recovery is supported by structural modifications that concern major pathways of the visual system. These neuroimaging findings might contribute to elaborate a pertinent strategy in terms of diagnosis and rehabilitation.
