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脑出血患者经胼胝体和脑桥纤维实现运动功能恢复。

Motor recovery via transcallosal and transpontine fibers in a patient with intracerebral hemorrhage.

作者信息

Chang Min Cheol, Jung Young Jin, Jang Sung Ho

机构信息

From the Department of Physical Medicine and Rehabilitation (MCC, SHJ) and Department of Neurosurgery (YJJ), College of Medicine, Yeungnam University, Taegu, Republic of Korea.

出版信息

Am J Phys Med Rehabil. 2014 Aug;93(8):708-13. doi: 10.1097/PHM.0000000000000076.

Abstract

Little is known about the motor recovery mechanisms via transcallosal or tranpontine fibers in stroke patients. In the current study, an attempt was made to demonstrate motor recovery via transcallosal and transpontine fibers in a patient with intracerebral hemorrhage using diffusion tensor tractography and transcranial magnetic stimulation. A 39-yr-old male patient presented with complete weakness of the right extremities at the onset of a left midbrain hemorrhage. His motor weakness had shown slow recovery for 4 mos to the point that he was able to grasp and release using the right hand. Diffusion tensor tractography and transcranial magnetic stimulation were performed at 2 wks and 4 mos after onset. Discontinuation of the left corticospinal tract below the left midbrain was observed on the 2-wk diffusion tensor tractography and no motor evoked potential was elicited in the right hand on the 2-wk transcranial magnetic stimulation study. Four-month diffusion tensor tractography showed that the discontinuation of the left corticospinal tract had not been restored; however, a new neural pathway was observed, which originated from the left primary motor cortex and descended to the left corticospinal tract at the pons through the transcallosal and transpontine fibers. In the 4-mo transcranial magnetic stimulation study, the latency of motor evoked potential obtained at the right hand by stimulation of the left motor cortex was delayed by 9 msecs, compared with the opposite motor evoked potential, which seems to be compatible with transcallosal and transpontine conduction time. The results suggest that the motor function of the affected extremities in this patient was recovered through the transcallosal and transpontine fibers from the left motor cortex.

摘要

关于中风患者经胼胝体或脑桥纤维的运动恢复机制,人们了解甚少。在本研究中,尝试使用弥散张量纤维束成像和经颅磁刺激,来证明一名脑出血患者通过胼胝体和脑桥纤维实现的运动恢复。一名39岁男性患者,在左中脑出血发作时出现右上肢完全无力。其运动无力在4个月内缓慢恢复,直至能够用右手抓握和松开。在发病后2周和4个月时进行了弥散张量纤维束成像和经颅磁刺激。2周的弥散张量纤维束成像显示左中脑下方的左侧皮质脊髓束中断,2周的经颅磁刺激研究中右手未引出运动诱发电位。4个月的弥散张量纤维束成像显示左侧皮质脊髓束的中断未恢复;然而,观察到一条新的神经通路,它起源于左侧初级运动皮层,通过胼胝体和脑桥纤维下行至脑桥处的左侧皮质脊髓束。在4个月的经颅磁刺激研究中,刺激左侧运动皮层在右手获得的运动诱发电位潜伏期,与对侧运动诱发电位相比延迟了9毫秒,这似乎与胼胝体和脑桥传导时间相符。结果表明,该患者患侧肢体的运动功能是通过来自左侧运动皮层的胼胝体和脑桥纤维恢复的。

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