Influence of stroke infarct location on functional outcome measured by the modified rankin scale.
OBJECTIVE
In the early days after ischemic stroke, information on structural brain damage from MRI supports prognosis of functional outcome. It is rated widely by the modified Rankin Scale that correlates only moderately with lesion volume. We therefore aimed to elucidate the influence of lesion location from early MRI (days 2-3) on functional outcome after 1 month using voxel-based lesion symptom mapping.


METHODS
We analyzed clinical and MRI data of patients from a prospective European multicenter stroke imaging study (I-KNOW). Lesions were delineated on fluid-attenuated inversion recovery images on days 2 to 3 after stroke onset. We generated statistic maps of lesion contribution related to clinical outcome (modified Rankin Scale) after 1 month using voxel-based lesion symptom mapping.


RESULTS
Lesion maps of 101 patients with middle cerebral artery infarctions were included for analysis (right-sided stroke, 47%). Mean age was 67 years, median admission National Institutes of Health Stroke Scale was 11. Mean infarct volumes were comparable between both sides (left, 37.5 mL; right, 43.7 mL). Voxel-based lesion symptom mapping revealed areas with high influence on higher modified Rankin Scale in regions involving the corona radiata, internal capsule, and insula. In addition, asymmetrically distributed impact patterns were found involving the right inferior temporal gyrus and left superior temporal gyrus.


CONCLUSIONS
In this group of patients with stroke, characteristic lesion patterns in areas of motor control and areas involved in lateralized brain functions on early MRI were found to influence functional outcome. Our data provide a novel map of the impact of lesion localization on functional stroke outcome as measured by the modified Rankin Scale.
From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.). b.cheng@uke.de.
Bastian
B
Cheng
From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.).
Nils Daniel
ND
Forkert
From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.).
Melissa
M
Zavaglia
From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.).
Claus C
CC
Hilgetag
From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.).
Amir
A
Golsari
From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.).
Susanne
S
Siemonsen
From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.).
Jens
J
Fiehler
From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.).
Salvador
S
Pedraza
From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.).
Josep
J
Puig
From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.).
Tae-Hee
TH
Cho
From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.).
Josef
J
Alawneh
From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.).
Jean-Claude
JC
Baron
From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.).
Leif
L
Ostergaard
From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.).
Christian
C
Gerloff
From the Department of Neurology (B.C., A.G., C.G., G.T.), Department of Computational Neuroscience (N.D.F., M.Z., C.H.), and Department of Neuroradiology (S.S., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P., J.P.); Department of Neurology, Hospices Civils de Lyon, Lyon, France (T.-H.C.); Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France (J.-C.B.); Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom (J.A., J.-C.B.); and Department of Neuroradiology, Aarhus University Hospital and Center of Functionally Integrative Neuroscience/MINDLab, Aarhus University, Aarhus, Denmark (L.O.).
Götz
G
Thomalla
D000367:Age Factors; D000368:Aged; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors
magnetic resonance imaging; stroke