title: Natural history and prognostic value of corticospinal tract Wallerian degeneration in intracerebral hemorrhage.
abstract: BACKGROUND
  The purpose of this study was to define the incidence, imaging characteristics, natural history, and prognostic implication of corticospinal tract Wallerian degeneration (CST-WD) in spontaneous intracerebral hemorrhage (ICH) using serial MR imaging.
  
  
  RESULTS
  Consecutive ICH patients with supratentorial ICH prospectively underwent serial MRIs at 2, 7, 14, and 21 days. MRIs were analyzed by independent raters for the presence and topographical distribution of CST-WD on diffusion-weighted imaging (DWI). Baseline demographics, hematoma characteristics, ICH score, and admission National Institute of Health Stroke Score (NIHSS) were systematically recorded. Functional outcome at 3 months was assessed by the modified Rankin Scale (mRS) and the motor-NIHSS. Twenty-seven patients underwent 93 MRIs; 88 of these were serially obtained in the first month. In 13 patients (48%), all with deep ICH, CST-WD changes were observed after a median of 7 days (interquartile range, 7 to 8) as reduced diffusion on DWI and progressed rostrocaudally along the CST. CST-WD changes evolved into T2-hyperintense areas after a median of 11 days (interquartile range, 6 to 14) and became atrophic on MRIs obtained after 3 months. In univariate analyses, the presence of CST-WD was associated with poor functional outcome (ie, mRS 4 to 6; P=0.046) and worse motor-NIHSS (5 versus 1, P=0.001) at 3 months.
  
  
  CONCLUSIONS
  Wallerian degeneration along the CST is common in spontaneous supratentorial ICH, particularly in deep ICH. It can be detected 1 week after ICH on DWI and progresses rostrocaudally along the CST over time. The presence of CST-WD is associated with poor motor and functional recovery after ICH.
authors.affiliation: Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA.
authors.forename: Chitra
authors.initials: C
authors.lastname: Venkatasubramanian
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Kleinman
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Fischbein
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Olivot
authors.forename: Alisa D
authors.initials: AD
authors.lastname: Gean
authors.forename: Irina
authors.initials: I
authors.lastname: Eyngorn
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Snider
authors.forename: Michael
authors.initials: M
authors.lastname: Mlynash
authors.forename: Christine A C
authors.initials: CA
authors.lastname: Wijman
mesh_terms: D000368:Aged; D002140:California / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy; D038524:Diffusion Magnetic Resonance Imaging; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006406:Hematoma / Q000473:pathology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011712:Pyramidal Tracts / Q000473:pathology*; D020127:Recovery of Function; D012720:Severity of Illness Index; D013997:Time Factors; D014855:Wallerian Degeneration / Q000473:pathology* / Q000503:physiopathology
keywords: diffusion‐weighted imaging; intracerebral hemorrhage; magnetic resonance imaging; natural history; prognosis; wallerian degeneration
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