Demonstration of motor recovery process in a patient with intracerebral hemorrhage

Abstract

OBJECTIVES: Little is known about the mechanism of motor recovery for patients with intracerebral hemorrhage (ICH). We attempted to demonstrate the motor recovery mechanism in a hemiparetic patient with ICH using diffusion tensor tractography (DTT), transcranial magnetic stimulation (TMS), and functional MRI (fMRI). SUBJECTS: A 37-year-old female patient and twelve age-matched control subjects were evaluated. The patient presented with complete paralysis of the left extremities, which occurred at the onset of a spontaneous ICH in the left corona radiata and basal ganglia. Over the 16 month period following onset, motor function of the affected extremities slowly recovered to a nearly normal state. Three longitudinal evaluations (at 1 month, 4 months, and 16 months from onset) were conducted for the patient. RESULTS: DTT showed that the origin of the corticospinal tract (CST) had changed from the posterior parietal cortex, primary sensory cortex, and primary motor cortex. Additionally, TMS and fMRI demonstrated the recovery process of the damaged lateral CST. CONCLUSIONS: It seems that, in this patient, the affected motor function was recovered through the normalization process of the damaged lateral CST of the affected hemisphere. We conclude that this may be one of various motor recovery mechanisms for patients with ICH. Process of the damaged lateral CST.