Imaging Study Of Post-stroke Fatigue

Objective: Post-stroke fatigue(PSF)is one of the common symptoms of patients with cerebral infarction,which can reduce the functional prognosis of patients significantly,reduce the chance of patients returning to work,and improve the mortality of stroke survivors.At present,the pathogenesis of PSF is still unclear.To provide the basis for further exploring the occurrence and development of PSF,we used resting state functional magnetic resonance imaging(rs-f MRI)to determine the activity of its related brain regions.Methods: Eighty-four patients with first episode cerebral infarction were recruited in this study.PSF was evaluated at the early stage(when the condition was stable within 7 days)and 3 months after the onset.According to the fatigue severity scale(FSS),the patients were divided into fatigue(F)group and no fatigue(NF)group.The regional homogeneity(ReHo)maps were performed using rs-f MRI based on Matlab R2014 a platform.Two sample t test was used to compare the maps differences and SPSS 21.0software was used to analyze the gender,age,years of education and NIHSS score between the two groups.Results:1.The incidence rate of PSF was 57% in the early stage of cerebral infarction,and 62% in PSF 3 months after onset.2.There were no significant difference in gender,age,education level and NIHSS score between group F and group NF at the early stage and 3months after the onset of cerebral infarction(P>0.05).3.In the early stage of cerebral infarction,compared with NF group,ReHo values of left anterior central gyrus,left inferior temporal gyrus,right fusiform gyrus,bilateral cingulate gyrus,left inferior parietal lobule,right suboccipital gyrus,right lenticular nucleus,right thalamus,right anterior cerebellar lobe and bilateral posterior cerebellar lobe were increased in group F.However,the ReHo values of bilateral superior frontal gyrus,bilateral middle frontal gyrus,right middle temporal gyrus,right superior parietal lobule,left anterior cingulate gyrus,left precuneus,right anterior cerebellar lobe,left posterior cerebellar lobe,bilateral brainstem and midbrain were decreased in group F(P<0.05).4.At 3 months after cerebral infarction,compared with NF group,ReHo values of left anterior central gyrus,bilateral posterior central gyrus,bilateral superior frontal gyrus,bilateral middle frontal gyrus,right superior temporal gyrus,right middle temporal gyrus,right inferior parietal lobule,right cingulate gyrus,right occipital wedge,left insular lobe and right fusiform gyrus were increased in group F.However,the ReHo values of bilateral posterior central gyrus,right middle frontal gyrus,right middle temporal gyrus,right precuneus lobe,left cuneiform lobe,right superior occipital gyrus,right middle occipital gyrus,left anterior cerebellar lobe and thalamus,bilateral posterior cerebellar lobe were decreased in group F(P<0.05).Conclusions:1.The changes of ReHo in brain functional of PSF patients indicated the changes of compensatory function and default mode network(DMN).2.In the early stage of cerebral infarction,the fatigue of PSF patients may come from psychological and cognitive aspects.3.There may be additional brain regions for PSF to compensate for the extra “effort” to cope with fatigue continuously and may be some compensatory mechanism or some cross recombination pattern in the brain of PSF.4.There may be different activation patterns of PSF in the early stage and 3 months of cerebral infarction.5.rs-f MRI has potential application value in exploring the pathogenesis of PSF patients.