Corticospinal tract compression by hematoma in a patient with intracerebral hemorrhage: a diffusion tensor tractography and functional MRI study.
The purpose of this study was to demonstrate corticospinal tract compression that was due to a hematoma by using diffusion tensor tractography (DTT) and functional MRI (fMRI) in a patient with an intracerebral hemorrhage (ICH). A 23-year-old right-handed woman presented with severe paralysis of her right extremities at the onset of a spontaneous ICH. Over the first three days from onset, the motor function of the affected upper and lower extremities rapidly recovered to the extent that she was able to overcome applied resistance to the affected limbs, and her limbs regained normal function 3 weeks after onset. The tract of the right hemisphere originated from the primary sensori-motor cortex (SM1) and it passed through the known corticospinal tract pathway. However, the tract of the left hemisphere was similar to that of the right hemisphere except that it was displaced to the antero-medial side by the hematoma at the cerebral peduncle. Only the contralateral SM1 area centered on the precentral knob was activated during affected (right) or unaffected (left) hand movements, respectively. In conclusion, fMRI and DTT demonstrated a corticospinal tract compression due to hematoma in this patient. We conclude that the combined use of these two modalities appears to improve the accuracy of investigating the state of the corticospinal tract.
Jang
Sung-Ho
SH
Department of Physical Medicine and Rehabilitation, School of Medicine, Yeungnam University, Namgu, Daegu 705-717, Korea.
Kwon
Yong-Hyun
YH
Lee
Mi Young
MY
Ahn
Sang Ho
SH
Kim
Joong Hwi
JH
Jeong
Dong-Hoon
DH
Choi
Byung Yeun
BY
Lee
Dong Gyu
DG
D000328:Adult; D002543:Cerebral Hemorrhage / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006406:Hematoma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D011712:Pyramidal Tracts / Q000473:pathology*; D013117:Spinal Cord Compression / Q000150:complications / Q000175:diagnosis* / Q000473:pathology