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Cerebrovascular disease
Short report
The contribution of lesion location to upper limb deficit after stroke
  1. Chang-hyun Park1,2,
  2. Nancy Kou1,
  3. Nick S Ward1,3,4
  1. 1Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, UK
  2. 2Department of Neurology, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
  3. 3The National Hospital for Neurology and Neurosurgery, London, UK
  4. 4UCLPartners Centre for Neurorehabilitation, UCL Institute of Neurology, London, UK
  1. Correspondence to Dr Nick S Ward, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, 33 Queen Square (Box 146), London WC1N 3BG, UK; n.ward{at}ucl.ac.uk

Abstract

Background Motor deficit after stroke is related to regional anatomical damage.

Objective To examine the influence of lesion location on upper limb motor deficit in chronic patients with stroke.

Methods Lesion likelihood maps were created from T1-weighted structural MRI in 33 chronic patients with stroke with either purely subcortical lesions (SC, n=19) or lesions extending to any of the cortical motor areas (CM, n=14). We estimated lesion likelihood maps over the whole brain and applied multivoxel pattern analysis to seek the contribution weight of lesion likelihood to upper limb motor deficit. Among 5 brain regions of interest, the brain region with the greatest contribution to motor deficit was determined for each subgroup.

Results The corticospinal tract was most likely to be damaged in both subgroups. However, while damage in the corticospinal tract was the best indicator of motor deficit in the SC patients, motor deficit in the CM patients was best explained by damage in brain areas activated during handgrip.

Conclusions Quantification of structural damage can add to models explaining motor outcome after stroke, but assessment of corticospinal tract damage alone is unlikely to be sufficient when considering patients with stroke with a wide range of lesion topography.

  • STROKE
  • MRI
  • ANATOMY
  • IMAGE ANALYSIS

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/jnnp-2015-312738

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    Footnotes

    • Contributors The following persons have contributed to the present manuscript as authors according to the ICMJE guidelines for authorship: C-hP, NK and NSW.

    • Funding This work has been supported by The Wellcome Trust (number 088414).

    • Competing interests None declared.

    • Ethics approval Joint Ethics Committee of the Institute of Neurology, UCL and National Hospital for Neurology and Neurosurgery, UCL Hospitals NHS Foundation Trust, London, UK.

    • Provenance and peer review Not commissioned; externally peer reviewed.