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      Integrity of normal-appearing white matter and functional outcomes after acute ischemic stroke

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          Abstract

          Objective:

          To characterize the effect of white matter microstructural integrity on cerebral tissue and long-term functional outcomes after acute ischemic stroke (AIS).

          Methods:

          Consecutive AIS patients with brain MRI acquired within 48 hours of symptom onset and 90-day modified Rankin Scale (mRS) score were included. Acute infarct volume on diffusion-weighted imaging (DWIv) and white matter hyperintensity volume (WMHv) on T2 fluid-attenuated inversion recovery MRI were measured. Median fractional anisotropy (FA), mean diffusivity, radial diffusivity, and axial diffusivity values were calculated within normal-appearing white matter (NAWM) in the hemisphere contralateral to the acute lesion. Regression models were used to assess the association between diffusivity metrics and acute cerebral tissue and long-term functional outcomes in AIS. Level of significance was set at p < 0.05 for all analyses.

          Results:

          Among 305 AIS patients with DWIv and mRS score, mean age was 64.4 ± 15.9 years, and 183 participants (60%) were male. Median NIH Stroke Scale (NIHSS) score was 3 (interquartile range [IQR] 1–8), and median normalized WMHv was 6.19 cm 3 (IQR 3.0–12.6 cm 3). Admission stroke severity (β = 0.16, p < 0.0001) and small vessel stroke subtype (β = −1.53, p < 0.0001), but not diffusivity metrics, were independently associated with DWIv. However, median FA in contralesional NAWM was independently associated with mRS score (β = −9.74, p = 0.02), along with age, female sex, NIHSS score, and DWIv.

          Conclusions:

          FA decrease in NAWM contralateral to the acute infarct is associated with worse mRS category at 90 days after stroke. These data suggest that white matter integrity may contribute to functional recovery after stroke.

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          Author and article information

          Contributors
          Journal
          Neurology
          Neurology
          neurology
          neur
          neurology
          NEUROLOGY
          Neurology
          Lippincott Williams & Wilkins (Hagerstown, MD )
          0028-3878
          1526-632X
          02 May 2017
          02 May 2018
          : 88
          : 18
          : 1701-1708
          Affiliations
          From the J. Philip Kistler Stroke Research Center (M.R.E., O.W., P.C., A.-K.G., L.C., K.M.F., A.S.K., G.B., H.H.K., A.L., N.S.R.), Department of Neurology, and Athinoula A. Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital and Harvard Medical School; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology and Center for Human Genetic Research, Massachusetts General Hospital, Boston; and Department of Neurology (K.L.F.), Rhode Island Hospital, Alpert Medical School of Brown University, Providence.
          Author notes
          Correspondence to Dr. Etherton: metherton@ 123456partners.org

          Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

          Article
          PMC5409847 PMC5409847 5409847 NEUROLOGY2016769539
          10.1212/WNL.0000000000003890
          5409847
          28381507
          c6236490-587b-4cc1-80a7-70758cecc47c
          © 2017 American Academy of Neurology
          History
          : 12 September 2016
          : 06 February 2017
          Funding
          Funded by: NIH–National Institute of Neurological Disorders and Stroke
          Award ID: K23NS064052, R01NS082285 and R01NS086905
          Categories
          13
          120
          130
          153
          Article

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