Transpontine connection fibers between corticospinal tracts in hemiparetic patients with intracerebral hemorrhage.

OBJECTIVES

A connection of fibers between corticospinal tracts (CSTs) at the pons, originating from the CST of the affected hemisphere, has been observed in hemiparetic patients with stroke. The authors investigated the incidence and the clinical significance of transpontine connection of fibers (TCFs) in hemiparetic patients with intracerebral hemorrhage (ICH), using diffusion tensor tractography (DTT).

SUBJECTS AND METHODS

Forty-two patients with ICH with weakness of the affected extremities at the time of DTI scanning and 41 age-matched control subjects were recruited. TCFs were classified into three types according to severity: type A - no TCF extending to the opposite hemisphere, type B - a TCF crossing to the opposite hemisphere and ending at the subcortical level, and type C - a TCF crossing the pons and ascending to the cortex of the opposite hemisphere.

RESULTS

TCFs originating from the CST in affected and unaffected hemispheres were significantly more prevalent among patients than controls (both p < 0.05). In addition, TCF severity was found to be closely related to motor function reduction in affected extremities (p < 0.05) and to extent of CST injury in affected hemispheres (p < 0.05).

CONCLUSIONS

TCF appears to represent a compensatory mechanism associated with motor weakness or CST injury in patients with ICH.