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(Stroke. 2009;40:780.)
© 2009 American Heart Association, Inc.

Original Contributions

Corticospinal Tract Pre-Wallerian Degeneration

A Novel Outcome Predictor for Pediatric Stroke on Acute MRI

Trish Domi, MA; Gabrielle deVeber, MD; Manohar Shroff, MD; Elizabeth Kouzmitcheva, BSc; Daune L. MacGregor, MD Adam Kirton, MD

From the Children’s Stroke Program (T.D., G.d.V., E.K., D.L.M., A.K.), Division of Neurology and Department of Radiology (M.S.), The Hospital for Sick Children and Institute for Medical Science, University of Toronto, Toronto, ON, Canada.

Correspondence to Dr Gabrielle deVeber, Children’s Stroke Program, Division of Neurology, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8. E-mail deveber{at}sickkids.ca

Background and Purpose— In neonatal arterial ischemic stroke, pre-Wallerian degeneration in descending corticospinal tracts (DCST) on diffusion MRI (DWI) predicts poor outcome. This signal has not been studied in older children.

Methods— A consecutive arterial ischemic stroke cohort (1 month to 18 years) with acute DWI and >12 months of follow-up were enrolled (SickKids Children’s Stroke Program). DCST-DWI variables were quantified with a validated software technique and correlations to the Pediatric Stroke Outcome Measure were sought.

Results— Abnormal DCST-DWI signal was detected in 20 of 29 children (69%), with 85% having motor deficits on Pediatric Stroke Outcome Measure. DCST variables correlated with hemiparesis included: (1) any abnormal signal within the course of the DCST; (2) midbrain location; (3) percentage of peduncle; (4) vertical length; and (5) relative volume affected (all P<0.003). Unexpectedly, abnormal DWI signal was detected in the contralesional DCST in 7 children, all with severe hemiparesis. DCST signal abnormality increased over time, outlasted infarct DWI changes, and was difficult to appreciate on visual inspection.

Conclusions— DCST-DWI signal is an acute predictor of motor outcome in childhood stroke and can help guide management. Previously unrecognized contralesional DCST signal predicts severe hemiparesis.

Key Words: childhood • diffusion weighted imaging • outcome • stroke