Ipsilateral motor pathway confirmed by combined brain mapping of a patient with hemiparetic stroke: a case report.
This study investigated the motor control pathway using both functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS) in a patient with left hemiparesis with an infarction on the posterior limb of the right internal capsule. fMRI was performed using the blood oxygen level-dependent technique at 1.5 T with a standard head coil. The motor activation task consisted of hand grasp-release movements in 1-Hz cycles. TMS was performed using a butterfly coil; the intersection of the wings (center of the coil) was applied tangentially to the scalp 1.0 cm apart. Stimulation was performed at 100% of maximal output. Motor evoked potentials (MEPs) from both abductor pollicis brevis (APB) muscles were obtained simultaneously. fMRI showed that the unaffected (left) primary sensorimotor cortex (SM1) was activated by movements of the unaffected (right) hand. Conversely, the bilateral SM1 were activated by movements of the affected (left) hand. Brain mapping using TMS showed that ipsilateral MEPs were obtained at the affected (left) APB muscle when the unaffected (left) motor cortex was stimulated. We concluded that the ipsilateral motor pathway from the unaffected motor cortex to the affected hand was present in this patient.
Department of Physical Medicine & Rehabilitation, School of Medicine Sungkyunkwan University, Samsung Medical Center, Taegu, South Korea.
Yun-Hee
YH
Kim
Sung Ho
SH
Jang
Woo Mok
WM
Byun
Bong Soo
BS
Han
Kang-Hee
KH
Lee
Sang Ho
SH
Ahn
D000203:Activities of Daily Living; D000328:Adult; D001931:Brain Mapping / Q000379:methods*; D002544:Cerebral Infarction / Q000150:complications; D017352:Echo-Planar Imaging / Q000295:instrumentation / Q000379:methods; D004525:Efferent Pathways / Q000503:physiopathology*; D019054:Evoked Potentials, Motor; D006225:Hand / Q000503:physiopathology; D018737:Hand Strength; D006801:Humans; D020772:Internal Capsule; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods; D008280:Magnetics / Q000295:instrumentation; D015225:Magnetoencephalography / Q000295:instrumentation / Q000379:methods; D008297:Male; D009044:Motor Cortex / Q000503:physiopathology; D009068:Movement; D010291:Paresis / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology* / Q000534:rehabilitation; D020127:Recovery of Function; D020521:Stroke / Q000150:complications*