Purpose: Hyperintensity along the ipsilateral cortical spinal tract (CST) on a diffusion weighted imaging (DWI) has been reported to may be associated with motor disability after brain infarction and can be misdiagnosed as a new infarction. However, the underlying patho-physiology related to this finding is not clear. The goal of our study was to analyze the diffusion tensor imaging (DTI) changes in patients with this hyperintensity. Materials and methods: Eight patients (50 +/- 10 years) who exhibited hyperintensity on DWI along ipsilateral CST from 3 to 21 days after stroke onset were reviewed as positive group, including 5 patients with serial DTI examinations. Twelve patients without hyperintensity during the matched examination time were classified as reference group. The apparent diffusion coefficient (ADC), fractional anisotropy (FA), and eigenvalues and their ratios (ipsilateral/contralateral value) in cerebral peduncle were measured, their correlation with motor function scale at eight months after stroke onset were evaluated. Results: The serial examinations showed that hyperintensity could eventually disappear. Both the ipsilateral ADC and FA values were significantly decreased (p < 0.05) compared to the contralateral side. The ipsilateral FA significantly correlated with motor function scale in both groups (r = 0.875, 0.738; p = 0.004, 0.006 respectively). Conclusions: The hyperintensity on DWI is a transient pathological process of Wallerian degeneration after ischemic stroke, its diffusion characteristics include concurrent significant decrease of ipsilateral ADC and FA. The ipsilateral FA value has the potential to predict neurological motor function outcome in such patients. (C) 2010 Elsevier Ireland Ltd. All rights reserved.