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Background and Purpose: Fewer women than men tend to be enrolled in clinical trials of intracerebral hemorrhage. It is unclear whether this reflects lower prevalence of intracerebral hemorrhage in women, selection bias, or poor recruitment efforts. We undertook this study to examine differences between men and women in the reasons for exclusion from the iDEF trial (Intracerebral Hemorrhage Deferoxamine). Methods: The screen failure log included 29 different reasons for exclusion. Chi-square statistics were used to evaluate the differences in reasons for exclusion between men and women. Results: A total of 38.2% of participants in iDEF were women. Three thousand nine hundred eighty-two women (45.7%) and 4736 men (54.3%) were screen failures ( P P =0.1). Patients or families declined participation in 1.26% of women versus 1.31% of men ( P =0.9). More women than men failed screening because of age>80 (22.40% versus 12.61%; adjusted P =0.0007) and preexisting do-not-resuscitate/do-not-intubate (3.69% versus 2.83%; adjusted P =0.067). Conclusions: Lower rates of women enrollment in the iDEF trial may be attributed to older age. Inability to obtain consent or declining participation was similar between women and men, arguing against selection bias. Our findings should be confirmed in other intracerebral hemorrhage trials to determine best strategies to improve women’s representation in future trials.

Background and Purpose— A decrease in fractional anisotropy (FA) of the ipsilesional corticospinal tract (CST) distal to stroke lesions in the subacute (eg, 30 days) and chronic phase has been correlated with poor motor outcomes, but it is unclear whether FA values obtained within the acute stroke phase (here defined as 80 hours after onset) can predict later outcome. Methods— Fifty-eight patients underwent an assessment of motor impairment in the acute phase and at 3 months using the upper extremity Fugl-Meyer assessment. FA values, obtained within 80 hours after stroke onset, were determined in 2 regions of interest: cerebral peduncle and a stretch of the CST caudal to each stroke lesion (nearest-5-slices). Results— The FA laterality index for the cerebral peduncle-regions of interest was a poor predictor of 3-month outcome ( R 2 =0.044; P =0.137), whereas the slope over the FA laterality index of the nearest-5-slices showed a relatively weak but significant prediction ( R 2 =0.11; P =0.022) with the affected side having lower FA values. Initial upper extremity Fugl-Meyer ( R 2 =0.69; P R 2 =0.71; P Conclusions— FA reductions of the CST can be detected near the ischemic lesion in the acute stroke phase, but offer minimal predictive value to motor outcomes at 3 months.

Introduction: Lesion load of the Corticospinal Tract (CST-LL) can predict 64% of the variance in 3-months outcome of acute stroke patients. Voxel-based lesion symptom mapping (VLSM) studies have revealed brain voxels associated with motor impairment. A combined VLSM- CST-LL approach may give particular weight to voxels that are both part of an impairment map and the descending motor tracts. Hypothesis: A combined VLSM-wCST-LL model can predict acute motor outcome better than weighted CST-LL alone. Methods: We derived the VLSM map from a group of 50 chronic patients with variable motor deficits relating voxels of patients’ lesions to Upper Extremity Fugl-Meyer (UE-FM) scores. A correction for multiple comparisons was applied at FDR Results: The VLSM analysis determined that voxels of lesions in the precentral gyrus, premotor regions, the corona radiata region, and within the descending motor tracts were significantly related to chronic motor impairment. VLSM-CST-LL applied to a group of acute stroke patients with motor impairment predicted 85% of the variance at 3 months motor outcome. AIC results confirmed with 99% certainty that VLSM is the best fit model. Conclusions: VLSM-weighted CST-LL is the superior fit model compared to the weighted CST-LL model for predicting 3 months outcome.

Background: A decrease in fractional anisotropy (FA) of the ipsilesional corticospinal tract (CST) distal to ischemic stroke lesions in chronic stroke patients has been associated with poor motor outcome, but in the acute phase no clear FA trends have been observed or used to make outcome predictions. Methods: This study followed 40 patients with first-ever ischemic stroke, measuring motor impairment with the Upper Extremity Fugl-Meyer (UE-FM) acutely and at 3 months. Images obtained Results: Asymmetry between ipsilesional and contralesional CST FA values was significant different between patients with bad motor outcome and good outcome, with lower FA of the ipsilesional CST in the bad outcome group. No such asymmetry was seen for the cerebral peduncle ROI using either FA or ADC values. The FA laterality index for the nearest slice ROI was a significant but modest predictor of 3-month motor outcome (R2=0.186, p=.02), with the best predictive value offered by the combination of this imaging variable and the initial motor impairment (R2=0.696, p=.01). Conclusion: FA changes of the CST can be detected near the ischemic lesion in the acute phase after stroke, but these changes offer only modest predictive value for eventual motor outcome.

We previously showed that a combined variable of lesion site and size, the Arcuate Fasciculus lesion load (AF-LL), predicted speech fluency in chronic aphasic patients. In the current study, we compare the correlations between speech fluency and naming measures with two lesion markers in a large group of patients: the previously established structural lesion marker (i.e., AF-LL) and a new functional lesion marker (i.e., the functional grey matter lesion load (fGM-LL)). fGM-LL was constructed from functional brain imaging of overt speaking tasks in a group of twelve healthy elderly control participants. High-resolution structural brain images were acquired to reconstruct the arcuate fasciculus (AF) as a structural map. In addition to these two canonical maps, a combined AF-fGM was derived from summing fGM and AF maps. Each canonical map was overlaid with lesion masks of 50 chronic aphasic patients with varying degrees of impairment in speech production to calculate a functional and structural lesion load value for each patient. Lesion loads were then regressed with measures of speech fluency and naming. We found that both AF-LL and fGM-LL independently predicted speech fluency and naming ability (p