Dimethyl fumarate (DMF) is an immunomodulatory drug currently approved for the treatment of multiple sclerosis and psoriasis. Its benefits on ischemic stroke outcomes have recently come to attention. To date, only tissue plasminogen activators (tPAs) and clot retrieval methods have been approved by the FDA for the treatment of ischemic stroke. Ischemic conditions lead to inflammation through diverse mechanisms, and recanalization can worsen the state. DMF and the nuclear factor erythroid-derived 2-related factor 2 (Nrf2) pathway it regulates seem to be important in postischemic inflammation, and animal studies have demonstrated that the drug improves overall stroke outcomes. Although the exact mechanism is still unknown, studies indicate that these beneficial impacts are due to the modulation of immune responses, bloodbrain barrier permeability, and hemodynamic adjustments. One major component evaluated before, during, and after tPA therapy in stroke patients is blood pressure (BP). Recent studies have found that DMF may impact BP. Both hypotension and hypertension need correction before treatment, which may delay the appropriate intervention. Since BP management is crucial in managing stroke patients, it is important to consider DMF's role in this matter. That being said, it seems further investigations on DMF may lead to an alternative approach for stroke patients. In this article, we discuss the mechanistic roles of DMF and its potential role in stroke based on previously published literature and laboratory findings.

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BackgroundReinforcement sensitivity theory (RST) is proposed as a neurobiological system that eventually led to emotion and motivation-based constructs of personality. Traditionally segmented into the behavioral activation system (BAS) and the behavioral inhibition system (BIS), RST is commonly used to describe personality and behavior. Although there have been studies linking gray matter alterations with BIS/BAS subscales, the role of white matter (WM) integrity is yet controversial. We aimed to investigate the specific WM tracts associated with BIS/BAS scores.Methods224 healthy participants (mean age=39.14 ± 20.23, 80 (35.7%) females) were evaluated using the BIS/BAS questionnaire from the LEMON database. Diffusion MRI connectometry (dMRI) was used to investigate the WM correlates of BIS/BAS subscales. Multiple regression models with the covariates of age and gender were fitted to address the correlation of local connectomes with BIS/BAS components.ResultsdMRI connectometry revealed that the QA value of the splenium of the corpus callosum, right cerebellum, middle cerebellar peduncle, and superior cerebellar peduncle, had a significant negative correlation with ‌each BIS/BAS subscale. In contrast, the QA value in the body of the corpus callosum, left cingulum, and right cingulum showed a positive correlation with BIS/BAS subscales.ConclusionThe integrity of WM in certain tracts may contribute to behavioral activation and inhibition. This finding expands the findings on the neural networks associated with risk-taking and reward-seeking behaviors.