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Prog Neurobiol. 2016 Jun;141:45-60. doi: 10.1016/j.pneurobio.2016.04.005. Epub 2016 Apr 14.

White matter injury in ischemic stroke.

Author information

1
Department of Neurology, Xuanwu Hospital, Capital University of Medicine, Beijing 100053, China.
2
Department of Bioengineering, University of Pittsburgh School of Engineering, United States.
3
Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, United States.
4
Department of Neurosurgery, Xuanwu Hospital, Capital University of Medicine, Beijing 100053, China. Electronic address: robertjixm@hotmail.com.
5
Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, United States; Geriatric Research Education and Clinical Centers, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, United States. Electronic address: caog@upmc.edu.

Abstract

Stroke is one of the major causes of disability and mortality worldwide. It is well known that ischemic stroke can cause gray matter injury. However, stroke also elicits profound white matter injury, a risk factor for higher stroke incidence and poor neurological outcomes. The majority of damage caused by stroke is located in subcortical regions and, remarkably, white matter occupies nearly half of the average infarct volume. Indeed, white matter is exquisitely vulnerable to ischemia and is often injured more severely than gray matter. Clinical symptoms related to white matter injury include cognitive dysfunction, emotional disorders, sensorimotor impairments, as well as urinary incontinence and pain, all of which are closely associated with destruction and remodeling of white matter connectivity. White matter injury can be noninvasively detected by MRI, which provides a three-dimensional assessment of its morphology, metabolism, and function. There is an urgent need for novel white matter therapies, as currently available strategies are limited to preclinical animal studies. Optimal protection against ischemic stroke will need to encompass the fortification of both gray and white matter. In this review, we discuss white matter injury after ischemic stroke, focusing on clinical features and tools, such as imaging, manifestation, and potential treatments. We also briefly discuss the pathophysiology of WMI and future research directions.

KEYWORDS:

Axonal damage; Demyelination; Ischemic stroke; MRI; Oligodendrogenesis; Therapy; White matter injury

PMID:
27090751
PMCID:
PMC5677601
DOI:
10.1016/j.pneurobio.2016.04.005
[Indexed for MEDLINE]
Free PMC Article

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