Delayed Shrinkage of the Brain After Ischemic Stroke: Preliminary Observations With Voxel‐Guided Morphometry

Background and Purpose. The most important effect of cerebral ischemia is brain infarction. In this magnetic resonance imaging (MRI) study, the authors aimed at assessing postischemic brain atrophy.Methods. Ten patients suffering from their first acute cerebral ischemia in the territory of the middle cerebral artery were studied retrospectively. Three‐dimensional MRI volume scans were recorded in the acute and chronic stage after infarction and analyzed voxel by voxel intraindividually with the newly developed voxel‐guided morphometry.Results. Shrinkage of brain tissue was detected in all patients, not only in the perilesional cortical structures but also in contralateral homolog cortex areas and subcortically in the striatum and thalamus. This secondary shrinkage was not related to the size of the infarcts or to the clinical outcome of patients.Conclusions. Our study suggests that delayed brain atrophy after acute ischemic stroke involved areas anatomically connected with the ischemic brain lesion but nevertheless was accompanied by a simultaneous improvement of the neurological deficit.

[1]  T. Jones,et al.  Motor Skills Training Enhances Lesion-Induced Structural Plasticity in the Motor Cortex of Adult Rats , 1999, The Journal of Neuroscience.

[2]  W. Young,et al.  Neural damage in the rat thalamus after cortical infarcts. , 1990, Stroke.

[3]  K. Chang,et al.  Diffusion-weighted imaging in Wallerian degeneration , 2000, Journal of the Neurological Sciences.

[4]  T Schormann,et al.  Three‐Dimensional linear and nonlinear transformations: An integration of light microscopical and MRI data , 1998, Human brain mapping.

[5]  J. Baron,et al.  Delayed Intrahemispheric Remote Hypometabolism , 2000, Cerebrovascular Diseases.

[6]  Koroshetz Wj,et al.  Tissue plasminogen activator for acute ischemic stroke. , 1996, The New England journal of medicine.

[7]  J. Baron,et al.  Contralateral cerebellar diaschisis 7 hours after MCA-occlusion in primates. , 1995, Neurological research.

[8]  M. Moskowitz,et al.  Pathobiology of ischaemic stroke: an integrated view , 1999, Trends in Neurosciences.

[9]  Thorsten Schormann,et al.  Voxel-guided morphometry ("VGM") and application to stroke , 2003, IEEE Transactions on Medical Imaging.

[10]  H. Feys,et al.  The European Stroke Scale , 1994, Stroke.

[11]  J. Liepert,et al.  Treatment-induced cortical reorganization after stroke in humans. , 2000, Stroke.

[12]  A G Sorensen,et al.  Time course of diffusion imaging abnormalities in human stroke. , 1996, Stroke.

[13]  Karl Zilles,et al.  Statistics of deformations in histology and application to improved alignment with MRI , 1995, IEEE Trans. Medical Imaging.

[14]  H. Freund,et al.  Remote depressions of cerebral metabolism in hemiparetic stroke: Topography and relation to motor and somatosensory functions , 1994 .

[15]  R J Seitz,et al.  Diffusion- and perfusion-weighted MRI. The DWI/PWI mismatch region in acute stroke. , 1999, Stroke.

[16]  G Marchal,et al.  Contralateral cerebellar hypometabolism: a predictor for stroke outcome? , 1994, Journal of neurology, neurosurgery, and psychiatry.

[17]  Theresa A. Jones,et al.  Experience-Dependent Structural Plasticity in Cortex Heterotopic to Focal Sensorimotor Cortical Damage , 2000, Experimental Neurology.

[18]  W. Young,et al.  Corticofugal axonal degeneration in rats after middle cerebral artery occlusion. , 1989, Stroke.

[19]  C. Monakow,et al.  Die Lokalisation im Grosshirn und der Abbau der Funktion durch kortikale Herde , 1914 .

[20]  R. J. Seitz,et al.  Thalamic metabolism and corticospinal tract integrity determine motor recovery in stroke , 1996, Annals of neurology.

[21]  B. Rosen,et al.  A Functional MRI Study of Three Motor Tasks in the Evaluation of Stroke Recovery , 2001, Neurorehabilitation and neural repair.

[22]  T. Hanihara,et al.  Diffusion‐weighted magnetic resonance imaging: Detection of ischemic injury 39 minutes after onset in a stroke patient , 1999, Annals of neurology.

[23]  Joseph P. Broderick,et al.  Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. , 1995 .

[24]  Otto W. Witte,et al.  Delayed differential alterations in human brain volume in affected and remote brain areas after cerebral infarction measured intraindividually in vivo by 3D-MRI volumetry , 2001, NeuroImage.

[25]  J. Korf,et al.  Cobalt-55 Positron Emission Tomography of Ipsilateral Thalamic and Crossed Cerebellar Hypometabolism after Supratentorial Ischaemic Stroke , 1999, Cerebrovascular Diseases.

[26]  Karl Zilles,et al.  Limitations of the principal-axes theory , 1997, IEEE Transactions on Medical Imaging.

[27]  Delayed intrahemispheric remote hypometabolism. Correlations with early recovery after stroke. , 2000, Cerebrovascular diseases.

[28]  V. Hömberg,et al.  Reorganization of motor output in the non-affected hemisphere after stroke. , 1997, Brain : a journal of neurology.

[29]  P. Roland,et al.  Comparison of spatial normalization procedures and their impact on functional maps , 2002, Human brain mapping.

[30]  H. Freund,et al.  Role of the premotor cortex in recovery from middle cerebral artery infarction. , 1998, Archives of neurology.

[31]  B. Rosen,et al.  A functional MRI study of subjects recovered from hemiparetic stroke. , 1997, Stroke.

[32]  O W Witte,et al.  Functional Differentiation of Multiple Perilesional Zones after Focal Cerebral Ischemia , 2000, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[33]  Nick C Fox,et al.  Change in rates of cerebral atrophy over time in early-onset Alzheimer's disease: longitudinal MRI study , 2003, The Lancet.

[34]  Nick C Fox,et al.  A longitudinal study of brain volume changes in normal aging using serial registered magnetic resonance imaging. , 2003, Archives of neurology.

[35]  T. Schormann,et al.  Alignment of 3‐D brain data sets originating from MR and histology , 1993 .

[36]  S. Cramer,et al.  Computerized measurement of motor performance after stroke. , 1997, Stroke.

[37]  David H. Miller,et al.  Diffusion tensor imaging can detect and quantify corticospinal tract degeneration after stroke , 2000, Journal of neurology, neurosurgery, and psychiatry.

[38]  P. Basser,et al.  Water Diffusion Changes in Wallerian Degeneration and Their Dependence on White Matter Architecture , 2000 .