This Article Full Text Full Text (PDF) All Versions of this Article: 36/12/2742    most recent 01.STR.0000189748.52500.a7v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ho, P. W. Articles by Donnan, G. A. Search for Related Content PubMed PubMed Citation Articles by Ho, P. W. Articles by Donnan, G. A. Pubmed/NCBI databases Medline Plus Health Information Stroke Related Collections Acute Cerebral Infarction Computerized tomography and Magnetic Resonance Imaging Neuroprotectors

(Stroke. 2005;36:2742.)
© 2005 American Heart Association, Inc.

Research Reports

Is White Matter Involved in Patients Entered into Typical Trials of Neuroprotection?

Prahlad W. Ho, BMedSc; David C. Reutens, MD, FRACP; Thanh G. Phan, MD, FRACP; Peter M. Wright, MD, FRACP; Romesh Markus, MD, FRACP; Indra Indra, BSc; Dennis Young, RN Geoffrey A. Donnan, MD, FRACP

From the National Stroke Research Institute (P.W.H., D.C.R., T.G.P., P.M.W., R.M., I.I., D.Y., G.A.D.) and Department of Medicine (P.W.H., D.C.R., T.G.P., P.M.W., R.M., G.A.D.), University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.

Correspondence to Geoffrey A. Donnan, National Stroke Research Institute, 300 Waterdale Road, Heidelberg Heights, Victoria 3081, Australia. E-mail gdonnan{at}unimelb.edu.au

Background and Purpose— One of the reasons for the failure of trials of neuroprotection in stroke may be the lack of white matter (WM) protection. However, whether patients entered into typical neuroprotection trials have WM involved in the ischemic process is unknown. We studied patients who were enrolled in neuroprotection trials at our center and used a neuroimaging coregistration approach to determine whether final infarcts involved WM and, if so, in what proportion. We also aimed to provide the first in vivo volume distribution of gray matter (GM) and WM in normal stroke-aged brains.

Methods— Patients enrolled in trials of neuroprotection had late computed tomography or magnetic resonance scans coregistered in standard stereotaxic coordinate space after segmentation of symptomatic cerebral infarcts. These were then superimposed on a probabilistic map of GM and WM, which was developed from age-matched normal controls in whom GM and WM volumes were assessed.

Results— Forty-two patients (mean age, 73.7±10.5 years) were studied from 6 trials of neuroprotection. WM formed 41.7% of the brain volume in 37 control subjects (mean age, 73.5±8.4 years). In the segmented infarcts, WM comprised a median of 49% (interquartile range, 36.5 to 77.9) of the infarct volume. Ninety-five percent of infarcts had some involvement of WM tracts.

Conclusions— WM occupies 42% by volume of the normal stroke-aged brain. Patients entered into typical trials of neuroprotection may have significant WM volumes involved in the ischemic process, thus providing a rationale for the development of neuroprotectants for this compartment.

Key Words: imaging • neuroprotective agents • ischemia

This article has been cited by other articles:

				G. A. Donnan The 2007 Feinberg Lecture: A New Road Map for Neuroprotection Stroke, January 1, 2008; 39(1): 242 - 242. [Abstract] [Full Text] [PDF]