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Stroke. 2007;38:974-980
Published online before print February 1, 2007, doi: 10.1161/01.STR.0000258101.67119.72
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(Stroke. 2007;38:974.)
© 2007 American Heart Association, Inc.

Original Contributions

Quantified Corticospinal Tract Diffusion Restriction Predicts Neonatal Stroke Outcome

Adam Kirton, MD, MSc, FRCPC; Manohar Shroff, MD; Tharshini Visvanathan, BSc Gabrielle deVeber, MD, MHSc, FRCPC

From Children’s Stroke Program (A.K., T.V., G.d.V.), Division of Neurology and Department of Radiology (M.S.), The Hospital for Sick Children, Toronto, ON, Canada.

Correspondence to Dr Adam Kirton, Children’s Stroke Program, Division of Neurology, Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8. E-mail adam.kirton{at}sickkids.ca

Background and Purpose— Neonatal arterial ischemic stroke occurs in ≥1:4000 births. Many children experience motor deficits but acute predictors of outcome are lacking. Diffusion-weighted MRI changes in descending corticospinal tracts remote from arterial ischemic stroke may represent pre-Wallerian degeneration. We verify and quantify this signal and correlate it with motor outcome.

Methods— Fourteen neonates with acute arterial ischemic stroke and ≥12 months follow-up with the Pediatric Stroke Outcome Measure were included. Quantitative measurements of descending corticospinal tracts diffusion-weighted MRI signal were developed using Image J software.

Results— Ipsilesional descending corticospinal tract diffusion-weighted MRI signal was abnormal in 10 neonates with decreased apparent diffusion coefficients (P<0.001). Poor outcome correlated with: (1) percentage of peduncle (P=0.002); (2) length of descending corticospinal tracts P<0.001); and (3) volume of descending corticospinal tracts (P=0.002). None of: (1) any peduncle; (2) any posterior limb of the internal capsule; or (3) infarct volume correlated with outcome. All children without descending corticospinal tracts signal had normal outcome. Chronic Wallerian degeneration was seen in all children with hemiparesis. Software-assisted analysis was superior to visual inspection with excellent reliability (intra-class correlation coefficient ≥0.9).

Conclusion— Descending corticospinal tracts diffusion-weighted MRI signal is predictive of motor outcome from neonatal arterial ischemic stroke. This accurate, reliable, and simple tool will impact decision making in acute neonatal stroke.


Key Words: cerebral palsy • diffusion-weighted imaging • neonate • stroke




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