Article

The development of effective neurobiological adjuvants to rehabilitation of
paresis caused by stroke will depend on understanding mechanisms of paresis.
Our objective was to determine the extent to which upper-limb (UL) paresis after
nonlacunar ischemic middle cerebral artery (MCA) distribution stroke is caused by
infarction of posterior periventricular white matter (PVWM), where corticospinal
fibers serving movement descend, and caused by infarction of the arm-hand region
of precentral gyrus (ahPCG). We conducted a blinded, retrospective analysis of
computed tomography and magnetic resonance imaging from a convenience sample of
64 prospectively evaluated subjects with UL paresis resulting from MCA
distribution stroke. Of the subjects, 96.5% had PVWM involvement while 53% had
minimal or no ahPCG involvement. Even in subjects with no UL function, 56% had
very minimal infarction (<25%) of the ahPCG. Degree of paresis was statistically
associated with presence or absence of detectable posterior PVWM damage but not
with extent of ahPCG involvement. These preliminary findings suggest that
posterior PVWM involvement may be a major, if not the principal, determinant of
paresis in all hemispheric ischemic strokes and motivate further prospective
studies of this problem.

Langue : ANGLAIS