{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T19:06:09Z","timestamp":1792695969330,"version":"4.5.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The glymphatic system (GS) is a brain-specific waste clearance pathway essential for maintaining cerebral homeostasis. Diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) provides a non-invasive means of evaluating GS function. However, the characteristics of GS impairment in acute ischemic stroke (AIS) and their relationship with clinical function remain incompletely understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Sixty-nine patients with AIS (35 left-sided infarction, 34 right-sided infarction) and 34 healthy controls (HCs) were enrolled. All patients underwent 3.0 T MRI within 72 h of onset. Bilateral DTI-ALPS indices were calculated using an automated ROI algorithm. Neurological and motor functions were assessed with the National Institutes of Health Stroke Scale (NIHSS) and the Fugl-Meyer Assessment-Upper Extremity (FMA-UE). Partial correlation analyses, controlling for age, sex and years of education, examined associations between DTI-ALPS indices and clinical scale scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among right-handed HCs, the left-hemisphere DTI-ALPS index was significantly higher than the right (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.0001), indicating physiological lateralization of GS clearance capacity. Compared with HCs, both the left- and right-sided infarction groups exhibited significantly reduced left hemisphere DTI-ALPS indices (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.05), whereas right hemisphere indices did not differ significantly regardless of infarct side. In the left infarction group, the left hemisphere DTI-ALPS index was negatively correlated with NIHSS scores (\n                      <jats:italic>r<\/jats:italic>\n                      = \u22120.418,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.017) and positively correlated with FMA-UE scores (\n                      <jats:italic>r<\/jats:italic>\n                      = 0.392,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.026). In the right infarction group, the left hemisphere DTI-ALPS index showed a positive correlation with FMA-UE scores (\n                      <jats:italic>r<\/jats:italic>\n                      = 0.513,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.003).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings suggest physiological lateralization of GS function with left hemispheric predominance in right-handed individuals. AIS produces a left-dominant pattern of GS impairment that is independent of infarct laterality. The left hemisphere DTI-ALPS index may represent a promising, lateralization-independent biomarker for upper limb motor function assessment in the acute phase of stroke.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1863013","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T04:51:11Z","timestamp":1779943871000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Lateralized glymphatic system impairment in acute ischemic stroke: a DTI\u2013ALPS study of upper limb motor function"],"prefix":"10.3389","volume":"17","author":[{"given":"Zilong","family":"Zhu","sequence":"first","affiliation":[{"name":"The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing","place":["Jiangsu, China"]},{"name":"Nanjing University of Chinese Medicine, Nanjing","place":["Jiangsu, 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