Longitudinal changes of BOLD-CSF coupling and its association with the clinical assessments in subcortical ischemic...

Stroke is a leading cause of long-term disability globally, with motor deficits being the most prevalent and disabling consequence. However, the neural mechanisms underlying post-stroke motor recovery remain poorly understood. This longitudinal study aimed to explore dynamic changes in BOLD-CSF coupling in patients with ischemic subcortical stroke receiving antiplatelet plus citicoline therapy, and evaluate its association with motor function.

Resting-state fMRI was performed on eighteen patients before treatment and one month post-treatment, while twenty healthy controls completed a single scan. Global and motor region-specific (precentral gyrus, supplementary motor area (SMA)) BOLD-CSF coupling coefficients were computed, with motor and neurological functions assessed via Fugl-Meyer Assessment, Neurological Deficit Scale, and Modified Barthel Index.

At baseline, stroke patients exhibited significant alterations in global BOLD-CSF coupling, as well as in regional coupling within the precentral gyrus and supplementary motor area (SMA), compared with healthy controls. Following targeted treatment, stroke patients showed significant improvements in these disrupted global and regional BOLD-CSF coupling measures relative to baseline. By contrast, no significant changes in BOLD-CSF coupling were detected in subregions of the inferior frontal gyrus. Notably, regional BOLD-CSF coupling in the precentral gyrus and SMA strongly correlated with clinical scores.

These findings indicate that antiplatelet plus citicoline therapy promotes BOLD-CSF coupling restoration, and regional BOLD-CSF coupling in the SMA and precentral gyrus may serve as a neuroimaging biomarker for post-stroke motor recovery.