Individual connectome fingerprints reveal early stabilization and long-term circuit remodeling after stroke

Abstract

Stroke is one of the leading causes of global disability, yet the principles governing how focal brain injury disrupts large-scale neural connectivity over time remain poorly understood. Here, we leverage a longitudinal multimodal dataset to track the evolution of individual-specific connectivity patterns, or brain fingerprints, over the first year after stroke. Despite a persistent shift from healthy architecture, we demonstrate that each patients unique functional connectome fingerprint is remarkably resilient and stabilizes within three weeks. This early global stabilization masks a protracted system-specific reorganization of brain circuits, which is characterized by an initial increase in connectivity within sensory and attention systems, followed by a decline across higher-level association networks. A joint structure-function embedding further shows that recovery involves a gradual shift toward the normative healthy range, driven primarily by functional reconfiguration atop a stable structural lesion. Crucially, a multivariate prediction model reveals that early functional signatures selectively forecast long-term impairment in language, executive function, and attention. Together, our results define the post-stroke brain as a shifting but constrained dynamical system, identifying early-stabilized brain patterns as biomarkers for individual recovery profiles and targets for personalized neurorehabilitation.