Open AccessNatural History and Prognostic Value of Corticospinal Tract Wallerian Degeneration in Intracerebral Hemorrhage
Author(s) -
Venkatasubramanian Chitra,
Kleinman Jonathan T.,
Fischbein Nancy J.,
Olivot JeanMarc,
Gean Alisa D.,
Eyngorn Irina,
Snider Ryan W.,
Mlynash Michael,
Wijman Christine A. C.
Publication year - 2013
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.113.000090
Subject(s) - medicine , interquartile range , intracerebral hemorrhage , corticospinal tract , modified rankin scale , wallerian degeneration , magnetic resonance imaging , hematoma , stroke (engine) , radiology , prospective cohort study , diffusion mri , surgery , pathology , glasgow coma scale , ischemic stroke , ischemia , mechanical engineering , engineering
Background The purpose of this study was to define the incidence, imaging characteristics, natural history, and prognostic implication of corticospinal tract Wallerian degeneration ( CST ‐ WD ) in spontaneous intracerebral hemorrhage ( ICH ) using serial MR imaging. Methods and Results Consecutive ICH patients with supratentorial ICH prospectively underwent serial MRI s at 2, 7, 14, and 21 days. MRI s were analyzed by independent raters for the presence and topographical distribution of CST ‐ WD on diffusion‐weighted imaging ( DWI ). Baseline demographics, hematoma characteristics, ICH score, and admission National Institute of Health Stroke Score ( NIHSS ) were systematically recorded. Functional outcome at 3 months was assessed by the modified Rankin Scale ( mRS ) and the motor‐ NIHSS . Twenty‐seven patients underwent 93 MRI s; 88 of these were serially obtained in the first month. In 13 patients (48%), all with deep ICH , CST ‐ WD changes were observed after a median of 7 days (interquartile range, 7 to 8) as reduced diffusion on DWI and progressed rostrocaudally along the CST . CST ‐ WD changes evolved into T 2 ‐hyperintense areas after a median of 11 days (interquartile range, 6 to 14) and became atrophic on MRI s obtained after 3 months. In univariate analyses, the presence of CST ‐ WD was associated with poor functional outcome (ie, mRS 4 to 6; P =0.046) and worse motor‐ NIHSS (5 versus 1, P =0.001) at 3 months. Conclusions Wallerian degeneration along the CST is common in spontaneous supratentorial ICH , particularly in deep ICH . It can be detected 1 week after ICH on DWI and progresses rostrocaudally along the CST over time. The presence of CST ‐ WD is associated with poor motor and functional recovery after ICH .