Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyungdong, Namku, Taegu, Republic of Korea.
NeuroRehabilitation. 2012;30(4):303-6. doi: 10.3233/NRE-2012-0759.
The ipsilateral motor pathway from the unaffected motor cortex to the affected extremity is one of the mechanisms of motor recovery following stroke. We report on a stroke patient who showed the ipsilateral motor pathway without the contralateral motor pathway on functional MRI and diffusion tensor tractography. A 53-year-old left hemiparetic patient with an infarct in the right middle cerebral artery territory was evaluated. During a period of three months after onset, motor function of the affected (left) hand had recovered slowly, to the extent that the patient was able to overcome gravity. FMRI showed that only the unaffected (left) primary sensorimotor cortex was activated by movements of the unaffected (right) hand or of the affected (left) hand. On diffusion tensor tractography, the corticospinal tract of the left hemisphere originated from the primary sensori-motor cortex and descended through the known corticospinal tract pathway. By contrast, the right corticospinal tract showed a disruption with Wallerian degeneration to the upper medulla. We conclude that the motor function of the affected (left) hand appeared to be controlled only by the ipsilateral motor pathway from the left motor cortex to the left hand. Motor function of the affected hand appeared to have been reorganized to the ipsilateral motor pathway from the unaffected motor cortex to the affected hand.
患侧运动通路是中风后运动功能恢复的机制之一，其来自于未受损大脑皮质对患侧肢体的支配。本文报告了一例中风患者，其功能磁共振成像（fMRI）和弥散张量成像（DTI）均显示患侧运动通路而无对侧运动通路。该患者为 53 岁左偏瘫，右侧大脑中动脉区域梗死。发病 3 个月期间，患手的运动功能缓慢恢复，以至于患者能够克服重力。fMRI 显示，只有未受损（左）手的初级感觉运动皮质在未受损（右）手或患手运动时被激活。在弥散张量成像上，左侧皮质脊髓束起源于初级感觉运动皮质，并沿已知的皮质脊髓束通路下降。相比之下，右侧皮质脊髓束在上颈髓显示中断，伴有华勒氏变性。综上，患手的运动功能似乎仅由左侧大脑皮质至患手的同侧运动通路控制。患手的运动功能似乎已重新组织到来自未受损运动皮质至患手的同侧运动通路。
