
 A recent clinical trial on efficacy of citalopram to prevent stroke recurrence: unresolved controversies


Cerebral small vessel disease (CSVD) impairs visuospatial function, and this is one of the most obvious areas of cognitive impairment in CSVD. So, recognizing, monitoring, and treating visuospatial dysfunction are all important to the prognosis of CSVD. This review discussed the anatomical and pathological mechanisms, clinical recognition (scales, imaging, and biomarkers), and treatment of cognitive impairment especially visuospatial dysfunction in CSVD. 

A Review: Visuospatial Dysfunction in Patients with the Cerebral Small Vessel Disease

Background Acupuncture, as an alternative and complementary therapy recommended by the World Health Organization for stroke treatment, holds potential in ameliorating neurofunctional deficits induced by ischemic stroke (IS). Understanding the immediate and long-term effects of acupuncture and their interrelation would contribute to a better comprehension of the mechanisms underlying acupuncture efficacy. Methods Activation likelihood estimation (ALE) meta-analysis was used to analyze the brain activation patterns reported in 21 relevant functional neuroimaging studies. Among these studies, 12 focused on the immediate brain activation and 9 on the long-term activation. Single dataset analysis were employed to identify both immediate and long-term brain activation of acupuncture treatment in IS patients, while contrast and conjunction analysis were utilized to explore distinctions and connections between the two. Results According to the ALE analysis, immediately after acupuncture treatment, IS patients exhibited an enhanced cluster centered around the right precuneus (PCUN) and a reduced cluster centered on the left middle frontal gyrus (MFG). After long-term acupuncture treatment, IS patients showed an enhanced cluster in the left PCUN, along with two reduced clusters in the right insula (INS) and hippocampus (HIP), respectively. Additionally, in comparison to long-term acupuncture treatment, the right angular gyrus (ANG) demonstrated higher ALE scores immediately after acupuncture, whereas long-term acupuncture resulted in higher scores in the left superior parietal gyrus (SPG). The intersecting cluster activated by both of them was located in the left cuneus (CUN). Conclusion The findings provide initial insights into both the immediate and long-term brain activation patterns of acupuncture treatment for IS, as well as the intricate interplay between them. Both immediate and long-term acupuncture treatments showed distinct patterns of brain activation, with the left CUN emerging as a crucial regulatory region in their association. Systematic Review Registration https://www.crd.york.ac.uk/prospero/ , CRD42023480834. 

Immediate and long-term brain activation of acupuncture on ischemic stroke patients: an ALE meta-analysis of fMRI studies

Background. Stroke is one of the leading causes of disability, resulting in both limb disability and also cognitive impairment. Cognitive impairment can occur post-stroke due to lesions in specific cortex areas. Visuospatial function, a domain of cognitive function related to visual imaging, is commonly affected by parietal lobe lesions. However, visuospatial processing also requires sustained attention, planning, and error correction, functions of the frontal lobe. There is a paucity of studies evaluating the relationship between isolated frontal lobe stroke and patients’ visuospatial function. Objective. To analyze the relationship between subacute-chronic frontal lobe ischemic stroke and visuospatial function in post-ischemic stroke patients using the MoCA-Ina. Material and methods. Patients from Siloam Karawaci General Hospital’s neurology outpatient department with ages under 65 years, Glasgow Coma Scale of 15, diagnosis of first-time stroke based on CT scan result, and ischemic lesion confined to one brain lobe were recruited using non-probability consecutive sampling for this cross-sectional study. Patients were divided into frontal lobe and non-frontal lobe stroke subgroups. Visuospatial function was assessed using MoCA-Ina and analyzed using Mann Whitney U test. Outcomes. Fifty patients were included; 25 had frontal lobe stroke, and 25 had non-frontal lobe stroke. The median visuospatial score was lower in the frontal lobe group (2, min/max = 0/4) compared to the non-frontal lobe group (3, min/ max = 0/5), with a p-value of 0.044. There was no significant difference in visuospatial scores between different frontal hemisphere locations. Conclusion. Subacute-chronic frontal lobe ischemic stroke affects visuospatial function in post-ischemic stroke patients. 

Visuospatial function impairment in patients with subacute-chronic isolated frontal lobe ischemic stroke: A cross-sectional study using MoCA-Ina in a private hospital

HSCFA: Hierarchical sparse and collaborative fusion attention with large foundation models for diagnosing Alzheimer’s disease

Effıcacy of cıtalopram on stroke recurrence: A randomızed clınıcal trıal

OBJECTIVE
The authors investigated for presence of cognitive impairment after occurrence of bilateral lesions of the genu of the internal capsule (GIC). Clinical and neuropsychological features of unilateral GIC lesions have previously been studied, but the cognitive profile of bilateral lesions of the GIC has not been fully explored.


METHODS
An investigation was conducted of neurocognitive deficits and computerized tomography MRI findings among 4,200 stroke patients with bilateral GIC involvement who were admitted to the hospital between January 2010 and October 2018.


RESULTS
Eight patients with bilateral lesions of the capsular genu were identified and their data analyzed. Overall, behavioral and cognitive dysfunction were characterized by impairment of frontal, memory, and executive functions. Attention and abstraction were present among all eight patients (100%); apathy, abulia, and executive dysfunctions, among seven (87.5%); global mental dysfunction and planning deficits, among six (75.0%); short-term verbal memory deficits and language dysfunctions, among five (62.5%); long-term verbal memory deficits, among four (50.0%); and spatial memory deficits, reading, writing, counting dysfunctions, and anarthria, among two (25.0%). Four of the patients (50.0%) without a history of cognitive disorder showed severe mental deterioration compatible with the clinical picture of dementia. A clinical picture of dementia was still present in these patients 6 months after stroke.


CONCLUSIONS
Bilateral lesions of the capsular genu appearing either simultaneously or at different times were significantly associated with executive dysfunctions.

Exploring Cognitive Impairment in Patients With Bilateral Capsular Genu Lesions.

Depression is an independent risk factor for stroke reccurence and cognitive impairment in stroke patients

Autoscopic phenomena or an “invisible doppelgänger” refer to the illusory reduplication of one's own body. Body image disorder involves distorted perception or decreased body awareness. In the literature, feeling of presence (FOP) is rarely presented with a circumscribed cerebral pathology due to acute vascular lesions, and concomitant FOP and disorders of the body image or the body schema (BIBS) have rarely been reported. We present three cases of both FOP and BIBS disorders. All patients reported the two types of symptoms almost simultaneously: The first patient had the symptom of somatoparaphrenia characterized by deny ownership of the hand and feeling that it does not belong to her, the second patient had the sign of fading limb presented with misuse of his left hand when it was not under visual control and could not mentally represent and locate this part of the body in space, and the third patient had autotopagnosia; he was unable to localize any touched area below the elbow and knee. All patients had right parietal ischemic lesions involving the superior parietal lobule, and two patients had an adjacent additional precuneal involvement. Based on the cases presented here, it is plausible that BIBS may develop in addition to FOP, especially in lesions involving the superior parietal lobule and precuneus. 

Invisible doppelgänger and body image disorders in right superior parietal lobule stroke, a case series

Association between recurrence of stroke and peripheral artery disease after first-ever stroke.

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