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Mechanisms of arm paresis in middle cerebral artery distribution stroke: Pilot study

Mechanisms of arm paresis in middle cerebral artery distribution stroke: Pilot study. Vishnumurthy S. Hedna, MD; Sandip Jain, MD; Omid Rabbani, MD; Stephen E. Nadeau, MD. Aim

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Mechanisms of arm paresis in middle cerebral artery distribution stroke: Pilot study

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  1. Mechanisms of arm paresis in middle cerebral artery distribution stroke: Pilot study Vishnumurthy S. Hedna, MD; Sandip Jain, MD; Omid Rabbani, MD; Stephen E. Nadeau, MD

  2. Aim • Determine if upper-limb (UL) paresis after nonlacunar ischemic middle cerebral artery (MCA) distribution stroke is caused by infarction of posterior periventricular white matter (PVWM), where corticospinal fibers serving movement descent, and caused by infarction of arm-hand region of precentral gyrus (ahPCG). • Relevance • Developing effective neurobiological adjuvants to rehabilitation of paresis caused by stroke depends on understanding mechanisms of paresis.

  3. Method • Blinded, retrospective analysis of computed tomography and magnetic resonance imaging from convenience sample of 64 prospectively evaluated subjects with UL paresis resulting from MCA distribution stroke.

  4. Results • 96.5% had PVWM involvement. • 53% had minimal or no ahPCG involvement. • 56% with no UL function had very minimal infarction (<25%) of ahPCG. • Degree of paresis was statistically associated with presence or absence of detectable posterior PVWM damage but not with extent of ahPCG involvement.

  5. Conclusion • Preliminary findings suggest that posterior PVWM involvement may be major, if not principal, determinant of paresis in all hemispheric ischemic strokes. • Results motivate further prospective studies.

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