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完全性脊髓损伤后的广泛神经恢复:病例报告及皮质可塑性作用假说

Extensive neurological recovery from a complete spinal cord injury: a case report and hypothesis on the role of cortical plasticity.

机构信息

Department of Neurology, Johns Hopkins University School of Medicine Baltimore, MD, USA ; International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger, Inc. Baltimore, MD, USA ; F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute Baltimore, MD, USA.

出版信息

Front Hum Neurosci. 2013 Jun 25;7:290. doi: 10.3389/fnhum.2013.00290. eCollection 2013.


DOI:10.3389/fnhum.2013.00290
PMID:23805087
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3691521/
Abstract

Neurological recovery in patients with severe spinal cord injury (SCI) is extremely rare. We have identified a patient with chronic cervical traumatic SCI, who suffered a complete loss of motor and sensory function below the injury for 6 weeks after the injury, but experienced a progressive neurological recovery that continued for 17 years. The extent of the patient's recovery from the severe trauma-induced paralysis is rare and remarkable. A detailed study of this patient using diffusion tensor imaging (DTI), magnetization transfer imaging (MTI), and resting state fMRI (rs-fMRI) revealed structural and functional changes in the central nervous system that may be associated with the neurological recovery. Sixty-two percent cervical cord white matter atrophy was observed. DTI-derived quantities, more sensitive to axons, demonstrated focal changes, while MTI-derived quantity, more sensitive to myelin, showed a diffuse change. No significant cortical structural changes were observed, while rs-fMRI revealed increased brain functional connectivity between sensorimotor and visual networks. The study provides comprehensive description of the structural and functional changes in the patient using advanced MR imaging technique. This multimodal MR imaging study also shows the potential of rs-fMRI to measure the extent of cortical plasticity.

摘要

严重脊髓损伤(SCI)患者的神经恢复极为罕见。我们发现了一名患有慢性颈创伤性 SCI 的患者,该患者在受伤后 6 周内完全丧失了损伤以下的运动和感觉功能,但经历了持续 17 年的逐渐神经恢复。该患者从严重创伤性瘫痪中恢复的程度非常罕见和显著。使用弥散张量成像(DTI)、磁化传递成像(MTI)和静息状态 fMRI(rs-fMRI)对该患者进行了详细研究,结果显示中枢神经系统的结构和功能发生了变化,这些变化可能与神经恢复有关。观察到 62%的颈髓白质萎缩。DTI 衍生的量值对轴突更敏感,显示出局灶性变化,而 MTI 衍生的量值对髓鞘更敏感,显示出弥漫性变化。未观察到明显的皮质结构变化,而 rs-fMRI 显示感觉运动和视觉网络之间的大脑功能连接增加。该研究使用先进的磁共振成像技术全面描述了患者的结构和功能变化。这项多模态磁共振成像研究还表明 rs-fMRI 具有测量皮质可塑性程度的潜力。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/120b/3691521/f68f99404301/fnhum-07-00290-g0006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/120b/3691521/6dcf1fa4b023/fnhum-07-00290-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/120b/3691521/e4dc66d02bea/fnhum-07-00290-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/120b/3691521/cbff12308f6b/fnhum-07-00290-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/120b/3691521/bd26a9989d6e/fnhum-07-00290-g0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/120b/3691521/fcffaf27e82b/fnhum-07-00290-g0005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/120b/3691521/f68f99404301/fnhum-07-00290-g0006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/120b/3691521/6dcf1fa4b023/fnhum-07-00290-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/120b/3691521/e4dc66d02bea/fnhum-07-00290-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/120b/3691521/cbff12308f6b/fnhum-07-00290-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/120b/3691521/bd26a9989d6e/fnhum-07-00290-g0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/120b/3691521/fcffaf27e82b/fnhum-07-00290-g0005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/120b/3691521/f68f99404301/fnhum-07-00290-g0006.jpg

相似文献

[1]
Extensive neurological recovery from a complete spinal cord injury: a case report and hypothesis on the role of cortical plasticity.

Front Hum Neurosci. 2013-6-25

[2]
Alterations in Cortical Sensorimotor Connectivity following Complete Cervical Spinal Cord Injury: A Prospective Resting-State fMRI Study.

PLoS One. 2016-3-8

[3]
Sensorimotor cortical plasticity during recovery following spinal cord injury: a longitudinal fMRI study.

Neurorehabil Neural Repair. 2007

[4]
Motor recovery at 6 months after admission is related to structural and functional reorganization of the spine and brain in patients with spinal cord injury.

Hum Brain Mapp. 2016-6

[5]
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Brain Sci. 2017-2-17

[6]
Sensorimotor cortical activation in patients with cervical spinal cord injury with persisting paralysis.

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[7]
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[8]
Axonal integrity predicts cortical reorganisation following cervical injury.

J Neurol Neurosurg Psychiatry. 2012-4-6

[9]
Alteration of Resting-State Brain Sensorimotor Connectivity following Spinal Cord Injury: A Resting-State Functional Magnetic Resonance Imaging Study.

J Neurotrauma. 2015-9-15

[10]
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Lancet Neurol. 2013-7-2

引用本文的文献

[1]
Altered brain network centrality in patients with cervical spondylotic myelopathy: insights from resting-state fMRI.

Front Neurol. 2025-8-13

[2]
The Reorganization of Subcortical Network Reflects Sensory-Motor Abilities in Patients after Spinal Cord Injury.

Brain Topogr. 2025-7-16

[3]
Brain Network Alterations in Chronic Spinal Cord Injury: Multilayer Community Detection Approach.

Neurotrauma Rep. 2024-11-6

[4]
Diffusion Weighted Magnetic Resonance Imaging of Spinal Cord Injuries After Instrumented Fusion Stabilization.

J Neurotrauma. 2024-9

[5]
A shift of brain network hub after spinal cord injury.

Front Mol Neurosci. 2023-10-17

[6]
Importance of brain alterations in spinal cord injury.

Sci Prog. 2021

[7]
Phase-locking of resting-state brain networks with the gastric basal electrical rhythm.

PLoS One. 2021

[8]
Tissue bridges predict recovery after traumatic and ischemic thoracic spinal cord injury.

Neurology. 2019-9-20

[9]
Inconsistency between cortical reorganization and functional connectivity alteration in the sensorimotor cortex following incomplete cervical spinal cord injury.

Brain Imaging Behav. 2020-12

[10]
Assessing cortical plasticity after spinal cord injury by using resting-state functional magnetic resonance imaging in awake adult mice.

Sci Rep. 2018-9-26

本文引用的文献

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Involvement of spinal sensory pathway in ALS and specificity of cord atrophy to lower motor neuron degeneration.

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