Lesion Distribution Across Different Behavioral Deficit Domains in Acute Ischemic Stroke Patients

The understanding of the underlying neurobiology of behavioral dysfunction provides significant insights in therapeutic intervention planning in stroke. There have been a variety of lesion-behavior mapping studies to relate the location of brain injury to neurological symptoms. However, these studies were mostly focused on exploring the relationship between stroke lesion location with a specific behavioral deficit domain, which were based on a limited sample size. In this study, we investigated the relationship between stroke lesion distribution and behavior deficits based on a large stroke patient cohort ( $\mathrm{N}=632$ ), with neurological symptoms spanning across all the representative domains. We divided the data into five clusters of behavioral deficits, including cognitive, motor, somatosensory, visual deficits and limb ataxia groups, based on the NIHSS sub-scores using the hierarchical agglomerative clustering algorithm. The lesion distribution in major blood supply territories were investigated and the lesion loads in the high injury incidence area were compared across different behavior deficits domains of patients. The middle cerebral artery (MCA) territory contained the most lesions and the cognitive deficit group had the highest lesion rate in MCA. The lesion loads of basal ganglia were higher in patients with dominant visual or cognitive deficits. The lesion load of internal capsule anterior limb was higher in visual and cognitive deficits groups. Our study of lesion characteristics might shed light on the understanding of the lesion-behavior relationship in ischemic stroke patients.