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(Stroke. 2004;35:92.)
© 2004 American Heart Association, Inc.

Original Contributions

Editorial Comment— Finding Landmarks for Understanding White Matter Stroke

Paul M. Matthews, MD, DPhil, FRCP, Guest Editor

Centre for Functional Magnetic Resonance Imaging of the Brain, University of Oxford, Oxford, United Kingdom

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Stroke care has entered a new era of treatment rather than simply supportive care. However, the benefits of treatment also bring new risks. Considerable attention has been given to the problem of identifying features that may minimize risks of intracerebral hemorrhage with tissue plasminogen activator in consequence. It also is important to maximize benefit. One approach to this is establishing the prognosis for an untreated stroke at the earliest possible time after onset.

For 150 years, clinical-pathological correlations have been based on cortical localization; outcomes have been anticipated based on the location and extent of lesion involvement of the cortex. However, this powerful strategy has not addressed the problems posed by patients with predominantly white matter lesions. Unlike cortical anatomy, which can be defined from gyral surface structure, the anatomy of white matter has not been able to be defined clearly in individual brains. Because white matter has well-defined tracts leading between major cortical and subcortical regions and these show regular patterns of organization (eg, a region of somatotopically organized fiber bundles in the posterior limb of the internal capsule), important clinicopathological information would come from relating white matter organization to stroke localization directly.

There have been previous attempts to use a general template of white matter anatomy for understanding the relationship between stroke lesion distributions and outcomes. For example, Pineiro et al estimated the path of the corticospinal tract based on the major anatomic landmarks of the precentral gyrus and basal ganglia.¹ Using a population-based, probabilistic description of the . . . [Full Text of this Article]