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Diffusion in Chronic Stroke and Small Vessel Disease 

Diffusion in Chronic Stroke and Small Vessel Disease
Diffusion in Chronic Stroke and Small Vessel Disease

Michael O’Sullivan

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date: 19 January 2021

Much attention has focused on the role of diffusion MRI in acute stroke, where it has contributed to major advances in treatment. However, diffusion techniques may also have much to tell us about how the brain adapts and recovers. The starting point of this chapter is the transition from the acute reduction in diffusion after stroke, when diffusion “pseudonormalizes” and a lesion on DWI would no longer be considered “acute”. It covers the continuing evolution of changes within the lesion and what these might imply, secondary changes that occur in parts of the brain remote from the stroke, and the potential importance of diffusion changes in predicting the capacity for reorganization and recovery. The second part of the chapter turns to small vessel disease and aspects of this that are distinct from stroke, but are still thought to reflect chronic ischemia. Diffusion MRI has helped establish a link between alterations in white matter structure and cognitive impairment, consistent with a progressive disconnection mechanism of cognitive decline. Diffusion MRI also provides surrogate markers with which to evaluate much-needed new treatments, as well as the potential to assess novel therapies for stroke including the use of stem cells.

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