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Introduction/Background Lesion characteristics exert a dominant effect on the severity of motor impairment following stroke and on the likelihood of obtaining natural and treatment-induced recovery. Here we aimed to assess the relationship between location of brain damage and residual motor function using voxel-based lesion-symptom mapping (VLSM). Material and method Residual motor function of the hemiparetic upper limb (HUL) was examined in 3 groups of patients — Subacute (n = 72), Chronic (n = 31), and Delta (n = 20; patients examined both in the subacute and chronic stages) — using the proximal and distal sub-divisions of the Upper Extremity module of the Fugl-Meyer test and the Box and Blocks test. Normalized lesion data were used for VLSM analyses of lesion impact on motor function, separately for left and right hemisphere damage (LHD, RHD). Results HUL function following LHD was affected in the subacute phase mainly by damage to the sensory-motor and premotor cortices, with an additional impact of damage to white matter tracts. In the chronic phase, the impact of damage to cortical structures was restricted to a smaller part of the sensory-motor cortex, whereas damage to white matter tracts maintained a dominant impact on HUL function. The RHD group revealed a less salient effect of assessment time and in both phases the major impact on HUL function was attributed to damage to the insular cortex, the basal ganglia and the adjacent white matter tracts. Proximal and distal HUL functions were affected mainly by lesions to dorsal and ventral cortical regions, respectively. Conclusion The functional neuroanatomy underlying motor recovery is different in LHD and RHD patients. Proximal and distal HUL motor control is affected by different lesion patterns. Time after stroke onset (subacute, chronic) affects significantly the results of VLSM analyses. |
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