Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, Republic of Korea.
NeuroRehabilitation. 2010;26(2):167-71. doi: 10.3233/NRE-2010-0550.
We report on a hemiparetic patient who showed a new motor pathway posterior to the lesion in the midbrain and upper pons, demonstrated by three combined method of diffusion tensor tractography(DTT)/functional MRI(fMRI)/transcranial magnetic stimulation(TMS).
A 21-year-old left hemiparetic male who suffered from tuberous meningitis at the age of 12 months after birth. The evaluations were performed at 20 years after onset. Brain MRI showed focal encephalomalatic lesions~due to infarcts in right anterior thalamus, midbrain and upper pons. DTT, fMRI and TMS were performed simultaneously.
The contralateral primary sensori-motor cortex was activated during either affected or unaffected hand movements. DTT showed that the motor tracts descended along the known pathway of the CST, with the exception of the motor tract of the affected hemisphere, which descended along the posterior portion to the lesion in the right midbrain and the pons, and then rejoined the CST in the mid-pons. The TMS results suggested that the motor tract of the affected hemisphere had the characteristics of a CST.
We believe that the motor function of the affected hand in this patient had been recovered through the pathway posterior to the lesion in the midbrain and upper pons.
我们报告了一例偏瘫患者，通过弥散张量成像（DTI）/功能磁共振成像（fMRI）/经颅磁刺激（TMS）三种联合方法，在中脑和上脑的病变后部发现了新的运动通路，该患者表现出了这种新的运动通路。
一名 21 岁的左侧偏瘫男性，出生后 12 个月因结节性脑膜炎发病。发病 20 年后进行了评估。脑 MRI 显示右侧丘脑前部、中脑和上脑因梗塞导致局灶性脑软化病变。同时进行了 DTT、fMRI 和 TMS 检查。
在患手或健手运动时，对侧初级感觉运动皮层均被激活。DTI 显示，运动束沿着已知的 CST 通路下降，除了患侧半球的运动束沿着右侧中脑和脑桥的后部下降到病变部位，然后在中脑重新加入 CST。TMS 结果表明，患侧半球的运动束具有 CST 的特征。
我们认为该患者患手的运动功能是通过中脑和上脑病变后部的通路恢复的。
