Deans' stroke musings: Predicting Future Atrophy from White Matter Connectivity Disruption in Ischemic Stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, February 20, 2014

Predicting Future Atrophy from White Matter Connectivity Disruption in Ischemic Stroke

Finally someone thinking about objectively measuring white matter damage. What does your doctor think of that?
http://stroke.ahajournals.org/content/45/Suppl_1/AWP41.short

+ Author Affiliations

¹Radiology, Weill Cornell Med College, New York, NY
²Neurology, Weill Cornell Med College, New York, NY

Abstract

Background: The Network Modification (NeMo) Tool uses a library of brain connectivity maps from normal subjects to quantify the amount of structural connectivity loss caused by focal brain lesions. We hypothesized that the NeMo Tool could predict remote brain tissue loss caused by Wallerian degeneration after stroke.

Methods: Baseline and follow-up MRIs from 27 patients with acute ischemic stroke were collected (74±14 years, initial NIHSS 2±3, 5.7±2.8 months b/w scans). Diffusion-weighted image derived lesion masks were superimposed on the NeMo Tool’s connectivity maps in order to predict changes to the structural connectivity network and to investigate correlations with future atrophy. Regional connectivity losses were estimated via the Change in Connectivity (ChaCo) score, i.e. the percent of “injured” tracks going through lesions that connect to a given region. ChaCo scores and longitudinal tissue changes were calculated using a standard 116 region atlas.

Results: Lesion location and size varied greatly, but they occurred more frequently in the left hemisphere. The ChaCo scores, which were generally higher in regions near stroke lesions, reflected this heterogeneity. In general, ChaCo was higher in the left hemisphere than the right and was high in the postcentral and precentral gyri, insula, middle cingulate, thalami, putamen, caudate nuclei, and pallidum. Moderate correlations were found between ChaCo scores at baseline and measures of subsequent tissue loss (change in volume and average mean diffusivity [MD] from baseline to follow-up, see Figure 1).

Conclusions: ChaCo scores varied greatly, but the most affected regions included those with sensorimotor, perception, learning and memory functions. Moderate correlations were found between ChaCo scores at baseline and subsequent tissue loss. These results suggest that the NeMo Tool could enable more accurate prognosis, as it may identify regions most susceptible to degeneration from remote infarcts.