Disrupted interhemispheric functional connectivity between the bilateral precentral gyri and associated transcriptomic signatures in acute basal ganglia ischemic stroke.

Acute basal ganglia ischemic stroke (BGIS) often leads to motor dysfunction, but the mechanisms of functional reorganization, particularly the underlying molecular basis, remain unclear. This study aimed to investigate the local and global functional reorganization patterns and their molecular correlates in acute BGIS. Resting-state fMRI data were acquired from 59 patients with acute BGIS and 35 age- and sex-matched healthy controls (HCs). Regional homogeneity (ReHo) and seed-based functional connectivity (FC) analyses were used to assess local and global brain connectivity, respectively. We identified a key classification feature using support vector machine (SVM) and logistic regression (LR) models combined with SHapley Additive exPlanations (SHAP) analysis, which was then spatially associated with Allen Human Brain Atlas (AHBA) transcriptomic data via partial least squares (PLS) regression, followed by functional enrichment analysis. Compared with HCs, BGIS patients demonstrated decreased ReHo in the bilateral precentral gyri, along with reduced interhemispheric FC between these two regions. The SVM and LR models effectively distinguished patients from HCs (AUCs = 0.877 and 0.868, respectively), with SHAP analysis identifying this reduced interhemispheric FC as the top discriminative feature. This key FC feature further showed a positive correlation with motor function. Genes spatially associated with this feature were enriched in synaptic function, ion transport, and energy metabolism. These findings highlight impaired interhemispheric FC between the bilateral precentral gyri and its associated transcriptomic signatures in acute BGIS, providing insights into the neurobiological basis of post-stroke motor dysfunction.