Limits...
Deterioration of pre-existing hemiparesis due to injury of the ipsilateral anterior corticospinal tract.

Jang SH, Kwon HG - BMC Neurol (2013)

Bottom Line: Following this, his right hemiparesis deteriorated whereas his left hemiparesis newly developed.By contrast, the DTT for the left whole CST of the patient showed a complete injury finding.The DTTs for the anterior CST of control subjects passed through the known pathway of the CST from cerebral cortex to medulla and terminated in the anterior funiculus of the upper cervical cord.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namku, Taegu 705-717, Republic of Korea.

ABSTRACT

Background: The anterior corticospinal tract (CST) has been suggested as one of the ipsilateral motor pathways, which contribute to motor recovery following stroke. In this study, we report on a patient who showed deterioration of pre-existing hemiparesis due to an injury of the ipsilateral anterior CST following a pontine infarct, as evaluated by diffusion tensor tractography (DTT).

Case presentation: A 55-year-old male patient showed quadriparesis after the onset of an infarct in the right pontine basis. He had history of an infarct in the left middle cerebral artery territory 7 years ago. Consequently, he showed right hemiparesis before onset of the right pontine infarct. Following this, his right hemiparesis deteriorated whereas his left hemiparesis newly developed. The DTTs for whole CST of the right hemisphere in the patient and both hemispheres in control subjects descended through the known CST pathway. By contrast, the DTT for the left whole CST of the patient showed a complete injury finding. The DTTs for the anterior CST of control subjects passed through the known pathway of the CST from cerebral cortex to medulla and terminated in the anterior funiculus of the upper cervical cord. However, the DTT for right anterior CST in the patient showed discontinuation below the right pontine infarct.

Conclusion: It appeared that the deterioration of the pre-existing right hemiparesis was ascribed to an injury of the right anterior CST due to the right pontine infarct.

Show MeSH

Related in: MedlinePlus

Brain MRI and results of diffusion tensor tractography. A) Brain MRI showing an old infarct in the left middle cerebral artery territory and a new infarct in the right pontine basis (arrow). B) Regions of interest for the whole and anterior corticospinal tract (CST)(yellow-lined circle) and results of diffusion tensor tractography. The whole CST and the anterior CST were constructed in the patient and a normal control subject (yellow: right whole CST, red: left whole CST, green: right anterior CST, blue: left anterior CST).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3672083&req=5

Figure 1: Brain MRI and results of diffusion tensor tractography. A) Brain MRI showing an old infarct in the left middle cerebral artery territory and a new infarct in the right pontine basis (arrow). B) Regions of interest for the whole and anterior corticospinal tract (CST)(yellow-lined circle) and results of diffusion tensor tractography. The whole CST and the anterior CST were constructed in the patient and a normal control subject (yellow: right whole CST, red: left whole CST, green: right anterior CST, blue: left anterior CST).

Mentions: One patient and six right-handed sex-matched control subjects (6 male; mean age: 55.7 years, range: 51–58) with no history of neurologic disease participated in this study. A 55-year-old, right-handed male was consulted to the rehabilitation department of our university hospital for his quadriparesis. Motor function was evaluated using the Medical Research Council score (MRC) [12]: 0, no contraction; 1, palpable contraction but no visible movement; 2, movement without gravity; 3, movement against gravity; 4, movement against a resistance lower than the resistance overcome by the healthy side; 5, movement against a resistance equal to the maximum resistance overcome by the healthy side. The patient was diagnosed as having an infarct in the right pontine basis 3 weeks earlier at the neurology department of the same university hospital. He had history of an infarct in the left middle cerebral artery (MCA) territory 7 years ago. At that time, the motor function of his right extremities had recovered to the extent that he was able to walk with limping gait pattern independently and was able to move his right arm partially. After the onset of the right pontine infarct, his right extremities showed complete weakness (MRC; 0) although his left extremities showed partial weakness (MRC; 2–4). Brain MRI taken 3 weeks after the right pontine infarct showed an old infarct in the left MCA territory, involving the whole CST area at the corona radiata and a new infarct in the right pontine basis involving the CST area (Figure 1-A).


Deterioration of pre-existing hemiparesis due to injury of the ipsilateral anterior corticospinal tract.

Jang SH, Kwon HG - BMC Neurol (2013)

Brain MRI and results of diffusion tensor tractography. A) Brain MRI showing an old infarct in the left middle cerebral artery territory and a new infarct in the right pontine basis (arrow). B) Regions of interest for the whole and anterior corticospinal tract (CST)(yellow-lined circle) and results of diffusion tensor tractography. The whole CST and the anterior CST were constructed in the patient and a normal control subject (yellow: right whole CST, red: left whole CST, green: right anterior CST, blue: left anterior CST).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3672083&req=5

Figure 1: Brain MRI and results of diffusion tensor tractography. A) Brain MRI showing an old infarct in the left middle cerebral artery territory and a new infarct in the right pontine basis (arrow). B) Regions of interest for the whole and anterior corticospinal tract (CST)(yellow-lined circle) and results of diffusion tensor tractography. The whole CST and the anterior CST were constructed in the patient and a normal control subject (yellow: right whole CST, red: left whole CST, green: right anterior CST, blue: left anterior CST).
Mentions: One patient and six right-handed sex-matched control subjects (6 male; mean age: 55.7 years, range: 51–58) with no history of neurologic disease participated in this study. A 55-year-old, right-handed male was consulted to the rehabilitation department of our university hospital for his quadriparesis. Motor function was evaluated using the Medical Research Council score (MRC) [12]: 0, no contraction; 1, palpable contraction but no visible movement; 2, movement without gravity; 3, movement against gravity; 4, movement against a resistance lower than the resistance overcome by the healthy side; 5, movement against a resistance equal to the maximum resistance overcome by the healthy side. The patient was diagnosed as having an infarct in the right pontine basis 3 weeks earlier at the neurology department of the same university hospital. He had history of an infarct in the left middle cerebral artery (MCA) territory 7 years ago. At that time, the motor function of his right extremities had recovered to the extent that he was able to walk with limping gait pattern independently and was able to move his right arm partially. After the onset of the right pontine infarct, his right extremities showed complete weakness (MRC; 0) although his left extremities showed partial weakness (MRC; 2–4). Brain MRI taken 3 weeks after the right pontine infarct showed an old infarct in the left MCA territory, involving the whole CST area at the corona radiata and a new infarct in the right pontine basis involving the CST area (Figure 1-A).

Bottom Line: Following this, his right hemiparesis deteriorated whereas his left hemiparesis newly developed.By contrast, the DTT for the left whole CST of the patient showed a complete injury finding.The DTTs for the anterior CST of control subjects passed through the known pathway of the CST from cerebral cortex to medulla and terminated in the anterior funiculus of the upper cervical cord.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namku, Taegu 705-717, Republic of Korea.

ABSTRACT

Background: The anterior corticospinal tract (CST) has been suggested as one of the ipsilateral motor pathways, which contribute to motor recovery following stroke. In this study, we report on a patient who showed deterioration of pre-existing hemiparesis due to an injury of the ipsilateral anterior CST following a pontine infarct, as evaluated by diffusion tensor tractography (DTT).

Case presentation: A 55-year-old male patient showed quadriparesis after the onset of an infarct in the right pontine basis. He had history of an infarct in the left middle cerebral artery territory 7 years ago. Consequently, he showed right hemiparesis before onset of the right pontine infarct. Following this, his right hemiparesis deteriorated whereas his left hemiparesis newly developed. The DTTs for whole CST of the right hemisphere in the patient and both hemispheres in control subjects descended through the known CST pathway. By contrast, the DTT for the left whole CST of the patient showed a complete injury finding. The DTTs for the anterior CST of control subjects passed through the known pathway of the CST from cerebral cortex to medulla and terminated in the anterior funiculus of the upper cervical cord. However, the DTT for right anterior CST in the patient showed discontinuation below the right pontine infarct.

Conclusion: It appeared that the deterioration of the pre-existing right hemiparesis was ascribed to an injury of the right anterior CST due to the right pontine infarct.

Show MeSH
Related in: MedlinePlus