{
  "abstract": "Background: Corticospinal tract (CST) damage is the main cause of post-stroke motor impairment. Whilst the output of the reticulospinal tract (RST) is reportedly upregulated, its relation to CST damage post-stroke is unclear. We assessed CST integrity using transcranial magnetic stimulation and RST activity using the StartReact paradigm in chronic ischemic stroke and examined their inter-relationship and associations with upper-limb impairment. Methods: We included 80 patients with chronic ischemic stroke and 15 age-matched healthy controls (HCs). CST function was quantified using the resting motor threshold asymmetry index (RMT-AI); RST function was measured by the StartReact effect (visual-auditory minus visual-startle reaction time) during isometric wrist flexion. Impairment was assessed with the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and affected-side grip strength, with FDR-corrected correlations. Results: Higher RMT-AI was associated with lower FMA-UE (r -0.46, p 0.0038) and weaker grip (rho -0.43, p 0.0065). A larger StartReact effect showed the same pattern (rho -0.35, p 0.0095, FMA-UE; rho -0.41, p 0.00195, grip). All correlations remained significant after FDR correction. RMT-AI and the StartReact effect were uncorrelated (r 0.05, p 0.792). The StartReact effect did not differ between sides (p 0.631) or between patients and HCs (p 0.342) but was larger in patients with FMA-UE less than or equal to median than in HCs (p 0.025), without a side difference (p 0.143). Conclusions: Greater impairment was associated with greater CST damage and RST activity, possibly reflecting cortico-reticular fibre damage. CST and RST measures were unrelated, suggesting cortical input to the reticular formation beyond M1. Severely impaired patients showed greater bilateral reticulospinal involvement.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Neurology, Institute of Neurosciences Kolkata, Kolkata, India"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 19,
  "authors": [
    {
      "name": "A. B. Bayen"
    },
    {
      "name": "S. Sarkar"
    },
    {
      "name": "S. Saha"
    },
    {
      "name": "U. Bakshi"
    },
    {
      "name": "C. Das"
    },
    {
      "name": "A. Shobhana"
    },
    {
      "name": "A. Ghosal"
    },
    {
      "name": "S. Mukherjee"
    },
    {
      "name": "S. S. Anand"
    },
    {
      "name": "A. Pal"
    },
    {
      "name": "A. Chatterjee"
    },
    {
      "name": "S. Gangopadhyay"
    },
    {
      "name": "S. Dey"
    },
    {
      "name": "P. Basu"
    },
    {
      "name": "B. Zaaimi"
    },
    {
      "name": "M. R. Baker"
    },
    {
      "name": "S. N. Baker"
    },
    {
      "name": "H. Kumar"
    },
    {
      "affs": [
        0
      ],
      "name": "S. Choudhury"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/d0a8pr96r3k2j.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.26.26365898",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.26.26365898v1.full",
  "id": "d0a8pr96r3k2j",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.26.26365898v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "neurology"
    ],
    [
      "openalex",
      "2742|Stroke Rehabilitation and Recovery"
    ]
  ],
  "openalex": "W7224129485",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.26.26365898v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-26",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/d0a8pr96r3k2j.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:21:54Z",
      "native_id": "10.64898/2026.10.26.26365898",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.26.26365898v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:neurology",
      "subfield": "neurology"
    }
  ],
  "title": "Corticospinal and Reticulospinal-Associated Measures in Chronic Ischemic Stroke: Associations with Upper Limb Function",
  "title_text": "Corticospinal and Reticulospinal-Associated Measures in Chronic Ischemic Stroke: Associations with Upper Limb Function",
  "type": "preprint",
  "updated_at": "2026-10-30T12:21:54Z",
  "url": "https://research.draconitic.com/paper/d0a8pr96r3k2j",
  "venue": "medRxiv",
  "versions": []
}