Objective Involvement of gray matter in the pathology of subcortical stroke was already recognized in animal studies.But the detection of cortical gray matter structure changes under modem magnetic resonance imaging techniques was initially performed and could optimalized for longitudinal observation in vivo.We investigated the relation between the lesion occurring in cortical gray matter remote from the primary middle cerebral arteryterritorial subcortical ischemic lesions.Methods Voxel-based morphometry (VBM) approach was introduced for quantifing longitudinalchanges of normal appeared gray matter (GM) volume.Fifteen patients with first ever subcortical stroke underwent high resolution structural T1-weighted MR images and were clinically assessed.Results The relations between the percent changes in gray matter volume andclinical scores were analysed.VBM analysis showed diffuse corticalregions of significantly decreasingand increasing GM volume over time.The percent changes of gray matter volume within ipsilateral supplementary motor areas(SMA) and ipsilateral insula were negatively correlated with percent changes in the Fugl-Meyer scale (FM).The percent changes in contralateral cerebellum anterior lobe and contralateral SMA was positive correlated with percent changes in the NIHSS and FMS.Conclusions Secondary changes of the cortical gray matter distal to a primary lesion can be detected by VBM approch quantitatively.There are aggressive and compensational of structuralreformation inmotor related brain regions may hamper or assist functional recovery after a subcortical cerebral infarct.