Affiliations: [a] Department of Rehabilitation Science, Graduate School, Daegu University, Republic of Korea | [b] Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Republic of Korea | [c] Department of Neurosurgery, College of Medicine Yeungnam University, Republic of Korea
Correspondence:
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Corresponding author: Sung Ho Jang, M.D., Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Taegu, 705-717, Republic of Korea. Tel./Fax: +82 53 620 3269; E-mail: strokerehab@hanmail.net, belado@med.yu.ac.kr
Abstract: Little is known about recovery of the corticospinal tract (CST) after injury by transtentorial herniation (TH). We present with a patient who showed recovery of the CST after injury by TH, using diffusion tensor tractography (DTT) and transcranial magnetic stimulation (TMS). A 69-year-old female underwent craniotomy and drainage of an intracerebral hemorrhage in the left corona radiata and basal ganglia. Brain CT showed left TH and brain MRI revealed a leukomalactic lesion at the left cerebral peduncle. The patient presented with complete paralysis of the right extremities at ICH onset, but slowly recovered some function to the point of being able to move the affected extremities against gravity at about 6 months after onset. Three-week DTT showed disruption of the left CST below the cerebral peduncle; however, this disruption was recovered on 1-year DTT. Three-week TMS showed no motor evoked potential for the affected hemisphere; in contrast, motor evoked potentials that were compatible with regenerated CST were obtained from the affected hand muscle at 6 months. Using DTT and TMS in a patient with ICH, we demonstrated recovery of the CST after injury by TH.
Keywords: Diffusion tensor tractography, transcranial magnetic stimulation, transtentorial herniation, corticospinal tract, motor recovery
