Wallerian degeneration (WD) after ischaemic stroke is a well known phenomenon following a stereotypical time course. Whereas conventional magnetic resonance imaging fails to detect signal intensity changes until four weeks after stroke, diffusion tensor imaging (DTI) reveals changes related to WD only after days. DTI was used to monitor the time course of Wallerian degeneration of the pyramidal tract from the early subacute to the late chronic stage of ischaemic stroke in two patients. A progressive decrease of fractional anisotropy was found along the pyramidal tract in the cerebral peduncle below the primary lesion resulting from progressive changes in the principal diffusivities, as well as a slight increase in the orientationally averaged diffusivity in the chronic phase. These signal changes reflect the progressive disintegration of fibre structures resulting from WD.
