Department of Physical Therapy, College of Health Sciences, Dankook University, 119, Dandae-ro, Dongnam-gu, Cheonan-si, Chungnam, 330-714, Republic of Korea.
Professor, Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Republic of Korea.
J Stroke Cerebrovasc Dis. 2020 Jul;29(7):104857. doi: 10.1016/j.jstrokecerebrovasdis.2020.104857. Epub 2020 May 12.
Gait disturbance due to injuries of the descending motor pathway, including corticospinal tract (CST), corticoreticular pathway (CRP), and medial and lateral vestibulospinal tracts (VSTs), are commonly encountered disabling sequelae of pontine hemorrhage. We investigated relations between changes in the CST, CRP, and medial and lateral VST and corresponding changes in gait function in patients with pontine hemorrhage.
Nine consecutive stroke patients with pontine hemorrhage, and 6 age-matched normal subjects were recruited. Four patients were allocated to group A (can't walk independently) and 5 to group B (can walk independently). Diffusion tensor imaging (DTI) data were acquired twice at acute to subacute stage and chronic stage after stroke onset. Diffusion tensor tractography (DTT) was used to reconstruct CST, CRP, medial and lateral VST.
The CRP shows a significantly different between groups A and B in both initial and follow up DTT (p > 0.05). In contrast, CST, medial VST and lateral VST did not show a significant difference (p > 0.05). Regarding DTI parameters of CRPs in group A, percentages of patients with fractional anisotropy (FA) and mean diffusivity (MD) values more than two standard deviation from normal were higher by follow up DTI than by initial DTI, however, the CRPs in group B only showed increased abnormal range of MD.
The CST does not play an essential role in recovery of independent walking and vestibulospinal tracts may not crucially affect recovery of independent walking in patients with pontine hemorrhage. In contrast, and intact CRP or changes of the CRP integrity appear to be related to the recovery of gait function.
由于下行运动通路（包括皮质脊髓束 [CST]、皮质网状束 [CRP] 和内侧及外侧前庭脊髓束 [VST]）损伤导致的步态障碍是桥脑出血常见的致残后遗症。我们研究了桥脑出血患者 CST、CRP 和内侧及外侧 VST 的变化与步态功能变化之间的关系。
纳入了 9 例连续的桥脑出血患者和 6 例年龄匹配的正常对照者。其中 4 例患者被分配到 A 组（不能独立行走），5 例患者被分配到 B 组（可以独立行走）。在发病后急性期至亚急性期和慢性期，采集 2 次扩散张量成像（DTI）数据。采用扩散张量纤维束成像（DTT）重建 CST、CRP、内侧及外侧 VST。
A 组和 B 组患者在初始 DTT 和随访 DTT 中，CRP 均存在显著差异（p＞0.05）。相反，CST、内侧 VST 和外侧 VST 之间无显著差异（p＞0.05）。在 A 组中，CRP 的 DTI 参数中，FA 和 MD 值的百分比高于正常范围 2 个标准差的患者，随访 DTI 高于初始 DTI，而 B 组中只有 MD 值的异常范围增加。
CST 在独立行走的恢复中不起关键作用，前庭脊髓束可能对桥脑出血患者独立行走的恢复没有关键影响。相比之下，完整的 CRP 或 CRP 完整性的变化似乎与步态功能的恢复有关。
