Photo Credit: JOSE LUIS

The following is a summary of “Clinical and magnetic resonance imaging features in acute ischemic stroke with early wallerian degeneration: a case-control study,” published in the April 2025 issue of BMC Neurology by Ota et al. 

Wallerian degeneration (WD) following cerebral infarction is detectable on T2-weighted images in advanced stages. Early WD can be identified within 14 days using diffusion-weighted imaging (DWI). 

Researchers conducted a retrospective study to investigate the clinical and imaging characteristics of early WD. 

They retrospectively reviewed clinical and magnetic resonance imaging (MRI) features of 105 acute stroke cases. Early WD factors, including time from symptom onset to MRI, Brunnstrom stage at admission and discharge, ischemic stroke risk factors, classification per the Stop Stroke Study Trial of Org 10,172, infarct location, responsible artery, and MRI slice number for small-artery disease, were evaluated. Data were analyzed using Wilcoxon and chi-squared or Fisher’s exact tests, and MRI signal changes were assessed in specific early WD cases. 

The results showed early WD in 22 (21%) patients, with 15 cases involving small-artery disease. Infarctions were located in the paraventricular corona radiata. Patients with early WD had significantly lower Brunnstrom stage scores at admission (P < 0.001) and discharge (P = 0.0012). In small-artery disease, early WD cases had significantly higher MRI slice numbers (P < 0.001), with the lenticulostriate artery (LSA) as the responsible artery (P = 0.033). In the chronic phase, DWI signals indicating early WD disappeared in all 7 patients. About 9 patients exhibited concurrent high DWI and fluid-attenuated inversion recovery (FLAIR) signals in the descending corticospinal tract. Persistent high FLAIR signals in 2 patients indicated irreversible changes. 

Investigators found that the degree of pyramidal tract damage and paralysis severity were reliable indicators of early WD. Early WD was also observed in small-artery disease, with the LSA as the responsible artery, and DWI and FLAIR imaging reflected the progression from early to chronic WD. 

Source: bmcneurol.biomedcentral.com/articles/10.1186/s12883-025-04179-4