Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, Korea.
J Rehabil Med. 2012 Mar;44(3):280-4. doi: 10.2340/16501977-0931.
The majority of motor recovery following stroke is known to occur within 3-6 months after onset; this period is therefore regarded as critical for motor recovery in stroke patients. We report here a case of a patient with intracerebral haemorrhage who showed changes in the affected motor function and in the damaged corticospinal tract (CST) at the primary motor cortex (M1) during rehabilitative management.
A 51-year-old woman underwent decompressive craniectomy and removal of haematoma due to a rupture of an arteriovenous malformation. Brain magnetic resonance imaging revealed a leukomalactic lesion at the fronto-parietal cortex centred on the precentral knob. Diffusion tensor imaging data were acquired 4 times (5, 8, 11 and 18 weeks after onset) and she started rehabilitation for right hemiplegia at 5 weeks after onset.
We found close relationships between changes in the CST branch from M1 on diffusion tensor tractography, the state of motor weakness, and the rehabilitative management: the CST branch from M1 was observed concurrently with motor recovery and the process of rehabilitation.
This case report indicates the importance of active and comprehensive rehabilitative management during the critical period for motor recovery in stroke patients.
据知,中风后大多数运动功能的恢复发生在发病后 3-6 个月内;因此,这一时期被认为是中风患者运动恢复的关键时期。我们在此报告一例脑出血患者,在康复治疗期间,其受影响的运动功能和受损的皮质脊髓束(CST)在初级运动皮层(M1)处发生了变化。
一名 51 岁女性因动静脉畸形破裂而行去骨瓣减压术和血肿清除术。脑部磁共振成像显示额顶叶皮层的白质软化病变,以中央前回小结为中心。弥散张量成像数据采集了 4 次(发病后 5、8、11 和 18 周),并在发病后 5 周开始进行右侧偏瘫的康复治疗。
我们发现弥散张量追踪图上 M1 的 CST 分支的变化、运动无力的状态与康复管理之间存在密切关系:M1 的 CST 分支与运动恢复和康复过程同时出现。
该病例报告表明,在中风患者运动恢复的关键时期,积极全面的康复治疗非常重要。