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S058-2

Neuroanatomical Correlates of Neuropsychiatric Disorders in Acute and Chronic
Stroke

Gianfranco Spalletta

IRCCS Santa Lucia Foundation, Italy

Background/Objective: Stroke, defined as a sudden loss of blood supply to the brain leading to
permanent tissue damage caused by thrombotic, embolic, or haemorrhagic events, ranks as the third
leading cause of death (behind only heart disease and cancer) in patients aged 50 years and older.
The psychiatric complications of stroke lesions (e.g. depression, anxiety, pathological affect and
apathy), have received less attention than that has been devoted to poststroke motor deficits,
language problems, or intellectual disturbances (Spalletta et al, 2013). It has been suggested that the
occurrence and severity of post-stroke neuropsychiatric sequelae can be predicted by neuroimaging
parameters (Feng et al, 2014) such as lesion size and site, but strong evidence on the issue is still
lacking.

Method: Here, we investigated the voxel-wise association between lesion location and
neuropsychiatric symptomatology in a high number of stroke patients through Voxel Based Lesion
Symptom Mapping (VLSM, Bates et al, 2003). Briefly, VLSM uses fully continuous information
both at the behavioural (no arbitrary cut-offs are stipulated) and the neuroanatomical level (all
patients are included, independently of lesion location). Statistical analyses on the relationship
between tissue damage and the observed behaviour are carried out on a voxel-by-voxel basis as in
functional imaging, and the results are plotted as colour maps depicting the degree of behavioural
involvement of each voxel. In the present study, we recruited 113 acute and chronic stroke patients
undergoing a complete neuropsychiatric battery and a whole brain high-resolution 3D MRI scan at 3
Tesla. VLSM was used to identify the brain areas involved in the onset and severity of depression,
apathy, anxiety and alexithymia.

Conclusion: Results are discussed in terms of the cerebral mechanisms involved in the genesis of
post-stroke neuropsychiatric phenomenology, with a focus on possible therapeutic approaches.

Reference: Bates E, Wilson SM, Saygin AP, Dick F, Sereno MI, Knight RT, Dronkers NF.
Voxel-based lesion-symptom mapping. Nat Neurosci. 2003 May;6(5):448-50.
Feng C, Fang M, Liu XY. The neurobiological pathogenesis of poststroke depression.
ScientificWorldJournal. 2014 Mar 4;2014:521349.
Spalletta G, Cravello L, Imperiale F, Salani F, Bossù P, Picchetto L, Cao M, Rasura M, Pazzelli F,
Orzi F, Caltagirone C, Robinson RG, Cacciari C. Neuropsychiatric symptoms and interleukin-6
serum levels in acute stroke. J Neuropsychiatry Clin Neurosci. 2