Early Progressive Changes in White Matter Integrity Are Associated with Stroke Recovery
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ORIGINAL ARTICLE
Early Progressive Changes in White Matter Integrity Are Associated with Stroke Recovery Daniela Pinter 1,2 & Thomas Gattringer 2,3 & Simon Fandler-Höfler 2 & Markus Kneihsl 2 & Sebastian Eppinger 2 & Hannes Deutschmann 3 & Alexander Pichler 2 & Birgit Poltrum 2 & Gernot Reishofer 3 & Stefan Ropele 2 & Reinhold Schmidt 2 & Christian Enzinger 1,2,3 Received: 11 December 2019 / Revised: 12 February 2020 / Accepted: 24 February 2020 # The Author(s) 2020
Abstract Information on microstructural white matter integrity has been shown to explain post-stroke recovery beyond clinical measures and focal brain damage. Especially, knowledge about early white matter changes might improve prediction of outcome. We investigated 42 acute reperfused ischemic stroke patients (mean age 66.5 years, 40% female, median admission NIHSS 9.5) with a symptomatic MRI-confirmed unilateral middle cerebral artery territory infarction 24–72 h post-stroke and after 3 months. All patients underwent neurological examination and brain MRI. Fifteen older healthy controls (mean age 57.3 years) were also scanned twice. We assessed fractional anisotropy (FA), mean diffusivity (MD), axial (AD), and radial diffusivity (RD). Patients showed significantly decreased white matter integrity in the hemisphere affected by the acute infarction 24–72 h post-stroke, which further decreased over 3 months compared with controls. Less decrease in FA of remote white matter tracts was associated with better stroke recovery even after correcting for infarct location and extent. A regression model including baseline information showed that the modified Rankin Scale and mean FA of the genu of the corpus callosum explained 53.5% of the variance of stroke recovery, without contribution of infarct volume. Furthermore, early dynamic FA changes of the corpus callosum within the first 3 months post-stroke independently predicted stroke recovery. Information from advanced MRI measures on white matter integrity at the acute stage, as well as early dynamic white matter degeneration beyond infarct location and extent, improve our understanding of post-stroke reorganization in the affected hemisphere and contribute to an improved prediction of recovery. Keywords Stroke . DTI . Corpus callosum . Prediction . Recovery . Longitudinal
Introduction Stroke represents a leading cause of a long-term disability in adults [1]. A better understanding of cerebral mechanisms associated with recovery holds promise to improve Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12975-020-00797-x) contains supplementary material, which is available to authorized users. * Daniela Pinter [email protected] 1
Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria
2
Department of Neurology, Medical University of Graz, Graz, Austria
3
Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria
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