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Stroke. 2009 Mar;40(3):780-7. doi: 10.1161/STROKEAHA.108.529958. Epub 2009 Jan 8.

Corticospinal tract pre-wallerian degeneration: a novel outcome predictor for pediatric stroke on acute MRI.

Author information

1
Children's Stroke Program, The Hospital for Sick Children and Institute for Medical Science, University of Toronto, Toronto, ON, Canada.

Abstract

BACKGROUND AND PURPOSE:

In neonatal arterial ischemic stroke, pre-Wallerian degeneration in descending corticospinal tracts (DCST) on diffusion MRI (DWI) predicts poor outcome. This signal has not been studied in older children.

METHODS:

A consecutive arterial ischemic stroke cohort (1 month to 18 years) with acute DWI and >12 months of follow-up were enrolled (SickKids Children's Stroke Program). DCST-DWI variables were quantified with a validated software technique and correlations to the Pediatric Stroke Outcome Measure were sought.

RESULTS:

Abnormal DCST-DWI signal was detected in 20 of 29 children (69%), with 85% having motor deficits on Pediatric Stroke Outcome Measure. DCST variables correlated with hemiparesis included: (1) any abnormal signal within the course of the DCST; (2) midbrain location; (3) percentage of peduncle; (4) vertical length; and (5) relative volume affected (all P<0.003). Unexpectedly, abnormal DWI signal was detected in the contralesional DCST in 7 children, all with severe hemiparesis. DCST signal abnormality increased over time, outlasted infarct DWI changes, and was difficult to appreciate on visual inspection.

CONCLUSIONS:

DCST-DWI signal is an acute predictor of motor outcome in childhood stroke and can help guide management. Previously unrecognized contralesional DCST signal predicts severe hemiparesis.

PMID:
19131656
DOI:
10.1161/STROKEAHA.108.529958
[Indexed for MEDLINE]

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