title: Shape of the Central Sulcus and Disability After Subcortical Stroke: A Motor Reserve Hypothesis.
abstract: OBJECTIVE
  Both brain and cognitive reserves modulate the clinical impact of chronic brain diseases. Whether a motor reserve also modulates the relationships between stroke and disability is unknown. We aimed to determine whether the shape of the central sulcus, a marker of the development of underlying motor connections, is independently associated with disability in patients with a positive history of small subcortical ischemic stroke.
  
  
  METHODS
  Shapes of central sulci were reconstructed from high-resolution magnetic resonance imaging and ordered without supervision according to a validated algorithm in 166 patients with a positive history of small subcortical ischemic stroke caused by CADASIL (Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy), a severe monogenic cerebral small vessel disease affecting young patients. Ordinal logistic regression modeling was used to test the relationships between modified Rankin scale, a disability scale strongly weighted toward motor disability, and sulcal shape.
  
  
  RESULTS
  Modified Rankin scale was strongly associated with sulcal shape, independent of age, sex, and level of education (proportional odds ratio =1.19, 95% confidence interval =1.06-1.35; P=0.002). Results remained significant after further adjustment for brain atrophy, volume of lacunes, and volume of white matter hyperintensities of presumed vascular origin.
  
  
  CONCLUSIONS
  The severity of disability in patients with a positive history of small subcortical ischemic stroke caused by a severe cerebral small vessel disease is related to the shape of the central sulcus, independently of the main determinants of disability. These results support the concept of a motor reserve that could modulate the clinical severity in patients with a positive history of small subcortical ischemic stroke.
authors.affiliation: From the Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, F-75205 Paris, France and AP-HP, Lariboisière Hospital, Department of Neurology, F-75475 Paris, France, and DHU NeuroVasc Sorbonne Paris Cité, Paris, France (E.J., F.D.G., H.C.); UNATI, Neurospin, I2BM, CEA, Saclay, France (Z.Y.S., E.D., J.-F.M.); CATI Multicenter Neuroimaging Platform, cati-neuroimaging.com, France (Z.Y.S., E.D., J.-F.M.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (M. Duering, M. Dichgans); Munich Cluster of Systems Neurology (SyNergy), Munich, Germany (M. Duering, M. Dichgans); and Department of Neurology, Medical University of Graz, Austria (S.R.).
authors.forename: Eric
authors.initials: E
authors.lastname: Jouvent
authors.affiliation: From the Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, F-75205 Paris, France and AP-HP, Lariboisière Hospital, Department of Neurology, F-75475 Paris, France, and DHU NeuroVasc Sorbonne Paris Cité, Paris, France (E.J., F.D.G., H.C.); UNATI, Neurospin, I2BM, CEA, Saclay, France (Z.Y.S., E.D., J.-F.M.); CATI Multicenter Neuroimaging Platform, cati-neuroimaging.com, France (Z.Y.S., E.D., J.-F.M.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (M. Duering, M. Dichgans); Munich Cluster of Systems Neurology (SyNergy), Munich, Germany (M. Duering, M. Dichgans); and Department of Neurology, Medical University of Graz, Austria (S.R.).
authors.forename: Zhong Yi
authors.initials: ZY
authors.lastname: Sun
authors.affiliation: From the Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, F-75205 Paris, France and AP-HP, Lariboisière Hospital, Department of Neurology, F-75475 Paris, France, and DHU NeuroVasc Sorbonne Paris Cité, Paris, France (E.J., F.D.G., H.C.); UNATI, Neurospin, I2BM, CEA, Saclay, France (Z.Y.S., E.D., J.-F.M.); CATI Multicenter Neuroimaging Platform, cati-neuroimaging.com, France (Z.Y.S., E.D., J.-F.M.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (M. Duering, M. Dichgans); Munich Cluster of Systems Neurology (SyNergy), Munich, Germany (M. Duering, M. Dichgans); and Department of Neurology, Medical University of Graz, Austria (S.R.).
authors.forename: François
authors.initials: F
authors.lastname: De Guio
authors.affiliation: From the Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, F-75205 Paris, France and AP-HP, Lariboisière Hospital, Department of Neurology, F-75475 Paris, France, and DHU NeuroVasc Sorbonne Paris Cité, Paris, France (E.J., F.D.G., H.C.); UNATI, Neurospin, I2BM, CEA, Saclay, France (Z.Y.S., E.D., J.-F.M.); CATI Multicenter Neuroimaging Platform, cati-neuroimaging.com, France (Z.Y.S., E.D., J.-F.M.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (M. Duering, M. Dichgans); Munich Cluster of Systems Neurology (SyNergy), Munich, Germany (M. Duering, M. Dichgans); and Department of Neurology, Medical University of Graz, Austria (S.R.).
authors.forename: Edouard
authors.initials: E
authors.lastname: Duchesnay
authors.affiliation: From the Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, F-75205 Paris, France and AP-HP, Lariboisière Hospital, Department of Neurology, F-75475 Paris, France, and DHU NeuroVasc Sorbonne Paris Cité, Paris, France (E.J., F.D.G., H.C.); UNATI, Neurospin, I2BM, CEA, Saclay, France (Z.Y.S., E.D., J.-F.M.); CATI Multicenter Neuroimaging Platform, cati-neuroimaging.com, France (Z.Y.S., E.D., J.-F.M.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (M. Duering, M. Dichgans); Munich Cluster of Systems Neurology (SyNergy), Munich, Germany (M. Duering, M. Dichgans); and Department of Neurology, Medical University of Graz, Austria (S.R.).
authors.forename: Marco
authors.initials: M
authors.lastname: Duering
authors.affiliation: From the Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, F-75205 Paris, France and AP-HP, Lariboisière Hospital, Department of Neurology, F-75475 Paris, France, and DHU NeuroVasc Sorbonne Paris Cité, Paris, France (E.J., F.D.G., H.C.); UNATI, Neurospin, I2BM, CEA, Saclay, France (Z.Y.S., E.D., J.-F.M.); CATI Multicenter Neuroimaging Platform, cati-neuroimaging.com, France (Z.Y.S., E.D., J.-F.M.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (M. Duering, M. Dichgans); Munich Cluster of Systems Neurology (SyNergy), Munich, Germany (M. Duering, M. Dichgans); and Department of Neurology, Medical University of Graz, Austria (S.R.).
authors.forename: Stefan
authors.initials: S
authors.lastname: Ropele
authors.affiliation: From the Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, F-75205 Paris, France and AP-HP, Lariboisière Hospital, Department of Neurology, F-75475 Paris, France, and DHU NeuroVasc Sorbonne Paris Cité, Paris, France (E.J., F.D.G., H.C.); UNATI, Neurospin, I2BM, CEA, Saclay, France (Z.Y.S., E.D., J.-F.M.); CATI Multicenter Neuroimaging Platform, cati-neuroimaging.com, France (Z.Y.S., E.D., J.-F.M.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (M. Duering, M. Dichgans); Munich Cluster of Systems Neurology (SyNergy), Munich, Germany (M. Duering, M. Dichgans); and Department of Neurology, Medical University of Graz, Austria (S.R.).
authors.forename: Martin
authors.initials: M
authors.lastname: Dichgans
authors.affiliation: From the Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, F-75205 Paris, France and AP-HP, Lariboisière Hospital, Department of Neurology, F-75475 Paris, France, and DHU NeuroVasc Sorbonne Paris Cité, Paris, France (E.J., F.D.G., H.C.); UNATI, Neurospin, I2BM, CEA, Saclay, France (Z.Y.S., E.D., J.-F.M.); CATI Multicenter Neuroimaging Platform, cati-neuroimaging.com, France (Z.Y.S., E.D., J.-F.M.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (M. Duering, M. Dichgans); Munich Cluster of Systems Neurology (SyNergy), Munich, Germany (M. Duering, M. Dichgans); and Department of Neurology, Medical University of Graz, Austria (S.R.).
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Mangin
authors.affiliation: From the Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, F-75205 Paris, France and AP-HP, Lariboisière Hospital, Department of Neurology, F-75475 Paris, France, and DHU NeuroVasc Sorbonne Paris Cité, Paris, France (E.J., F.D.G., H.C.); UNATI, Neurospin, I2BM, CEA, Saclay, France (Z.Y.S., E.D., J.-F.M.); CATI Multicenter Neuroimaging Platform, cati-neuroimaging.com, France (Z.Y.S., E.D., J.-F.M.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (M. Duering, M. Dichgans); Munich Cluster of Systems Neurology (SyNergy), Munich, Germany (M. Duering, M. Dichgans); and Department of Neurology, Medical University of Graz, Austria (S.R.). hugues.chabriat@aphp.fr.
authors.forename: Hugues
authors.initials: H
authors.lastname: Chabriat
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001284:Atrophy / Q000473:pathology / Q000503:physiopathology; D001931:Brain Mapping; D046589:CADASIL / Q000473:pathology* / Q000503:physiopathology; D002540:Cerebral Cortex / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000502:physiology; D020521:Stroke / Q000473:pathology* / Q000503:physiopathology; D066127:White Matter / Q000473:pathology* / Q000503:physiopathology
keywords: CADASIL; central sulcus; cerebral cortex; motor reserve; stroke