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Brain Advance Access originally published online on September 8, 2005
Brain 2005 128(10):2462-2469; doi:10.1093/brain/awh629
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© The Author (2005). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Normalized perfusion MRI to identify common areas of dysfunction: patients with basal ganglia neglect

Hans-Otto Karnath1, Regine Zopf1, Leif Johannsen1, Monika Fruhmann Berger1, Thomas Nägele2 and Uwe Klose3

1 Section Neuropsychology, Department of Cognitive Neurology, Hertie-Institute for Clinical Brain Research, 2 Department of Neuroradiology and 3 Section Experimental MR of the CNS, Department of Neuroradiology, University of Tübingen, Tübingen, Germany

Correspondence to: Prof. Hans-Otto Karnath, MD, PhD, Center of Neurology, University of Tübingen, Hoppe-Seyler-Strasse 3, D-72076 Tübingen, Germany E-mail: Karnath{at}uni-tuebingen.de

Perfusion-weighted imaging (PWI) is used to identify brain regions that are receiving enough blood supply to remain structurally intact, but not enough to function normally. Previous observations suggest that spatial neglect due to subcortical stroke can be explained by dysfunction of cortical areas rather than through the neuronal loss in the subcortical structures itself. The present study aimed to identify the dysfunctional cortical regions induced by basal ganglia stroke in patients with spatial neglect. In a patient group with stroke lesions centring on the basal ganglia, we examined the common area(s) of structurally intact but dysfunctional cortical tissue by using spatial normalization of PWI maps as well as symmetric voxel-wise inter-hemispheric comparisons. These new techniques allow comparison of the structurally intact but abnormally perfused areas of different individuals in the same stereotaxic space, and at the same time avoid problems due to regional perfusion differences and to possible observer-dependent biases. We found that strokes centring on the right basal ganglia which provoke spatial neglect induce abnormal perfusion in a circumscribed area of intact cortex that typically involves those three regions that have previously been described to provoke spatial neglect when damaged directly by cortical infarction: the superior temporal gyrus, the inferior parietal lobule and the inferior frontal gyrus. The data suggest that spatial neglect following a right basal ganglia lesion typically is caused by the dysfunction of (part of) these specific cortical areas.

Key Words: spatial neglect; basal ganglia; attention; visual search; exploration; perfusion-weighted imaging; human

Abbreviations: PWI = perfusion-weighted imaging; DWI = diffusion-weighted imaging; FLAIR = fluid-attenuated inversion-recovery

Received April 2, 2005. Revised July 12, 2005. Accepted August 8, 2005.


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