Role of neuroimaging in promoting long-term recovery from ischemic stroke

Human ischemic stroke is an acute disorder followed by a recovery period which may be of varying duration and mechanism. Imaging has created a means to explore the stroke process in vivo, particularly its underlying pathophysiology and recovery mechanisms. Evidence from multicenter studies has shown that, in the acute phase, arterial recanalization and reperfusion of ischemic brain tissue are the most important determinants of recovery. This is followed by functional and structural changes in the perilesional tissue and in large-scale bihemispheric networks that continue with different dynamics for weeks to months. Proof-of-principle studies have revealed that the behavioral gains induced by rehabilitation are paralleled by changes in functional representations. This is supported by data from neuroimaging and electrophysiological studies early after stroke which have shown that dedicated training can induce changes in cerebral functional representations. Accordingly, there is clear evidence that neuroimaging has a significant potential for monitoring the hemodynamic, functional, and structural factors determining recovery from stroke. New imaging methods may provide relevant biomarkers for treatment decisions and therapeutic monitoring. By combining neuroimaging with electrophysiological measures, opportunities exist to develop neuroscience-based strategies in rehabilitation.