Impact of corticofugal fibre involvement in subcortical stroke. 2013

Thanh G Phan, and Sanne van der Voort, and Jian Chen, and Richard Beare, and Henry Ma, and Benjamin Clissold, and John Ly, and Emma Foster, and Eleanor Thong, and Velandai Srikanth
Stroke Unit, Monash Medical Centre, Melbourne, Victoria, Australia.

OBJECTIVE To correlate motor deficit with involvement of corticofugal fibres in patients with subcortical stroke. The descending motor corticofugal fibres originate from the primary motor cortex (M1), dorsal and ventral premotor area (PMdv) and supplementary motor area (SMA). METHODS Retrospective study. METHODS Single tertiary teaching hospital. METHODS 57 patients (57% men) with subcortical infarcts on MRI (2009-2011) were included. The mean age was 64.3±14.4 years. METHODS None. METHODS National Institute of Health Stroke Scale subscores for arm and leg motor deficit at 90 days. RESULTS An area under the receiver operating characteristics curve (AUC) for the volume of overlap with infarct (and M1/PMdv/SMA fibres) and motor outcome was calculated. The AUC for the association with arm motor deficit from M1 fibres involvement was 0.80 (95% CI 0.66 to 0.94), PMdv was 0.76 (95% CI 0.61 to 0.91) and SMA was 0.73 (95% CI 0.58 to 0.88). The AUC for leg motor deficit from M1 fibres involvement was 0.69 (95% CI 0.52 to 0.85), PMdv was 0.67 (95% CI 0.50 to 0.85), SMA was 0.66 (95% CI 0.48 to 0.84). CONCLUSIONS Following subcortical stroke, the correlations between involvement of the corticofugal fibres for upper and lower limbs motor deficit were variable. A poor motor outcome was not universal following subcortical stroke.

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