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April 21, 2015; 84 (16) Article

Acute infarcts cause focal thinning in remote cortex via degeneration of connecting fiber tracts

Marco Duering, Ruthger Righart, Frank Arne Wollenweber, Vera Zietemann, Benno Gesierich, Martin Dichgans
First published March 25, 2015, DOI: https://doi.org/10.1212/WNL.0000000000001502
Marco Duering
From the Institute for Stroke and Dementia Research (M.D., R.R., F.A.W., V.Z., B.G., M.D.), Klinikum der Universität München, Ludwig-Maximilians University, Munich; German Center for Neurodegenerative Diseases (DZNE, Munich) (R.R., M.D.), Munich; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Munich, Germany. R.R. is currently with the Department of Neurology, Technische Universität München, Munich, Germany.
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Ruthger Righart
From the Institute for Stroke and Dementia Research (M.D., R.R., F.A.W., V.Z., B.G., M.D.), Klinikum der Universität München, Ludwig-Maximilians University, Munich; German Center for Neurodegenerative Diseases (DZNE, Munich) (R.R., M.D.), Munich; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Munich, Germany. R.R. is currently with the Department of Neurology, Technische Universität München, Munich, Germany.
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Frank Arne Wollenweber
From the Institute for Stroke and Dementia Research (M.D., R.R., F.A.W., V.Z., B.G., M.D.), Klinikum der Universität München, Ludwig-Maximilians University, Munich; German Center for Neurodegenerative Diseases (DZNE, Munich) (R.R., M.D.), Munich; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Munich, Germany. R.R. is currently with the Department of Neurology, Technische Universität München, Munich, Germany.
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Vera Zietemann
From the Institute for Stroke and Dementia Research (M.D., R.R., F.A.W., V.Z., B.G., M.D.), Klinikum der Universität München, Ludwig-Maximilians University, Munich; German Center for Neurodegenerative Diseases (DZNE, Munich) (R.R., M.D.), Munich; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Munich, Germany. R.R. is currently with the Department of Neurology, Technische Universität München, Munich, Germany.
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Benno Gesierich
From the Institute for Stroke and Dementia Research (M.D., R.R., F.A.W., V.Z., B.G., M.D.), Klinikum der Universität München, Ludwig-Maximilians University, Munich; German Center for Neurodegenerative Diseases (DZNE, Munich) (R.R., M.D.), Munich; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Munich, Germany. R.R. is currently with the Department of Neurology, Technische Universität München, Munich, Germany.
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Martin Dichgans
From the Institute for Stroke and Dementia Research (M.D., R.R., F.A.W., V.Z., B.G., M.D.), Klinikum der Universität München, Ludwig-Maximilians University, Munich; German Center for Neurodegenerative Diseases (DZNE, Munich) (R.R., M.D.), Munich; and Munich Cluster for Systems Neurology (SyNergy) (M.D.), Munich, Germany. R.R. is currently with the Department of Neurology, Technische Universität München, Munich, Germany.
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Citation
Acute infarcts cause focal thinning in remote cortex via degeneration of connecting fiber tracts
Marco Duering, Ruthger Righart, Frank Arne Wollenweber, Vera Zietemann, Benno Gesierich, Martin Dichgans
Neurology Apr 2015, 84 (16) 1685-1692; DOI: 10.1212/WNL.0000000000001502

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Abstract

Objective: To study remote effects distant from acute ischemic infarcts by measuring longitudinal changes of cortical thickness in connected brain regions as well as changes in microstructural integrity in connecting fiber tracts.

Methods: Thirty-two patients (mean age 71 years) underwent a standardized protocol including multimodal MRI and clinical assessment both at stroke onset and 6 months after the event. Cortex connected to acute infarcts was identified by probabilistic diffusion tensor tractography starting from the acute lesion. Changes of cortical thickness were measured using the longitudinal stream of FreeSurfer. Microstructural damage in white matter tracts was assessed by changes of mean diffusivity.

Results: We found focal cortical thinning specifically in areas connected to acute infarcts (p < 0.001). Thinning was more pronounced in regions showing a high probability of connectivity to infarcts. Microstructural damage in white matter tracts connecting acute infarcts with distant cortex significantly correlated with thickness changes in that region (ρ = −0.39, p = 0.028). There was no indication of an influence of cavitation status or infarct etiology on the observed changes in cortex and white matter.

Conclusions: These findings identify secondary degeneration of connected white matter tracts and remote cortex as key features of acute ischemic infarcts. Our observations may have implications for the understanding of structural and functional reorganization after stroke.

GLOSSARY

FLAIR=
fluid-attenuated inversion recovery;
MD=
mean diffusivity;
ROI=
region of interest

Footnotes

  • ↵* These authors contributed equally to this work.

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at Neurology.org

  • Received October 15, 2014.
  • Accepted in final form January 14, 2015.
  • © 2015 American Academy of Neurology
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