The contribution of lesion location to upper limb deficit after stroke

BACKGROUND: Motor deficit after stroke is related to regional anatomical damage. OBJECTIVE: To examine the influence of lesion location on upper limb motor deficit in chronic patients with stroke. METHODS: Lesion likelihood maps were created from T1-weighted structural MRI in 33 chronic patients with stroke with either purely subcortical lesions (SC, n=19) or lesions extending to any of the cortical motor areas (CM, n=14). We estimated lesion likelihood maps over the whole brain and applied multivoxel pattern analysis to seek the contribution weight of lesion likelihood to upper limb motor deficit. Among 5 brain regions of interest, the brain region with the greatest contribution to motor deficit was determined for each subgroup. RESULTS: The corticospinal tract was most likely to be damaged in both subgroups. However, while damage in the corticospinal tract was the best indicator of motor deficit in the SC patients, motor deficit in the CM patients was best explained by damage in brain areas activated during handgrip. CONCLUSIONS: Quantification of structural damage can add to models explaining motor outcome after stroke, but assessment of corticospinal tract damage alone is unlikely to be sufficient when considering patients with stroke with a wide range of lesion topography.