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Updated: Jun 26, 2026
Determining the Functional Status of the Corticospinal Tract Within One Week of Stroke
Published on: February 22, 2020
Corticospinal tract pre-wallerian degeneration: a novel outcome predictor for pediatric stroke on acute MRI
Trish Domi1, Gabrielle deVeber, Manohar Shroff
1Children's Stroke Program, The Hospital for Sick Children and Institute for Medical Science, University of Toronto, Toronto, ON, Canada.
Insights
Diffusion MRI (DWI) of descending corticospinal tracts (DCST) predicts motor deficits in childhood stroke. Abnormal DCST-DWI signals in children indicate poor motor outcomes and guide treatment decisions.
Area of Science:
- Pediatric neurology
- Neuroradiology
- Neuroscience
Background:
- Pre-Wallerian degeneration in descending corticospinal tracts (DCST) on diffusion MRI (DWI) is a known predictor of poor outcomes in neonatal arterial ischemic stroke.
- This specific DWI signal in DCST has not been previously investigated in older children.
Purpose of the Study:
- To investigate the presence and significance of DCST-DWI signal abnormalities in children with arterial ischemic stroke.
- To determine if DCST-DWI signal predicts motor deficits and long-term outcomes in this pediatric population.
Main Methods:
- A cohort of children (1 month to 18 years) with arterial ischemic stroke and available acute DWI scans were retrospectively analyzed.
- DCST-DWI variables were quantified using validated software, and correlations with motor deficits assessed by the Pediatric Stroke Outcome Measure were examined.
Main Results:
- Abnormal DCST-DWI signal was detected in 69% of children, strongly correlating with motor deficits (85%).
- Specific DCST variables (location, percentage, length, volume) significantly predicted hemiparesis (P<0.003).
- Unexpectedly, abnormal DWI signal in the contralesional DCST was observed in 7 children, all with severe hemiparesis; this signal increased over time and outlasted infarct changes.
Conclusions:
- DCST-DWI signal is an acute predictor of motor outcomes in childhood stroke, aiding in clinical management.
- The identification of contralesional DCST signal abnormality is a novel finding that predicts severe hemiparesis.
Background And Purpose:
In neonatal arterial ischemic stroke, pre-Wallerian degeneration in descending corticospinal tracts (DCST) on diffusion MRI (DWI) predicts poor outcome. This signal has not been studied in older children.
Methods:
A consecutive arterial ischemic stroke cohort (1 month to 18 years) with acute DWI and >12 months of follow-up were enrolled (SickKids Children's Stroke Program). DCST-DWI variables were quantified with a validated software technique and correlations to the Pediatric Stroke Outcome Measure were sought.
Results:
Abnormal DCST-DWI signal was detected in 20 of 29 children (69%), with 85% having motor deficits on Pediatric Stroke Outcome Measure. DCST variables correlated with hemiparesis included: (1) any abnormal signal within the course of the DCST; (2) midbrain location; (3) percentage of peduncle; (4) vertical length; and (5) relative volume affected (all P<0.003). Unexpectedly, abnormal DWI signal was detected in the contralesional DCST in 7 children, all with severe hemiparesis. DCST signal abnormality increased over time, outlasted infarct DWI changes, and was difficult to appreciate on visual inspection.
Conclusions:
DCST-DWI signal is an acute predictor of motor outcome in childhood stroke and can help guide management. Previously unrecognized contralesional DCST signal predicts severe hemiparesis.
