Baik Sung-Woon, Kim Gi-Wook, Ko Myoung-Hwan, Seo Jeoung-Hwan, Won Yu-Hui, Park Sung-Hee
Department of Physical Medicine and Rehabilitation, Chonbuk National University Hospital, Jeonju, South Korea.
Research Institue of Clinical Medicine of Chonbuk National University-Biomedical Research Institue of Chonbuk National University Hospital, Jeonju, South Korea.
Front Hum Neurosci. 2020 Jul 10;14:258. doi: 10.3389/fnhum.2020.00258. eCollection 2020.
Schizencephalies are abnormal clefts of the cerebral hemispheres that result from abnormal late neuronal migration and cortical organization. In the present study, we report a different type of unusual motor organization in a patient with a schizencephalic cleft in the right hemisphere and polymicrogyria in the opposite hemisphere. Despite similar brain pathology affecting the sensorimotor cortex, motor organization differed from previously known bilateral congenital brain lesions. We conducted a transcranial magnetic stimulation (TMS) and diffusion tensor image (DTI) study to confirm the motor organization. In this case, ipsilateral corticospinal projections to the paretic hands were observed during TMS of the less affected hemisphere, along with polymicrogyria, similar to the previous study. However, a crossed corticospinal tract to the paretic hand from the more severely affected hemisphere was observed in this case-a pattern of motor organization that has yet to be reported in this patient population. Our findings indicate that motor organization after early brain injury may be affected by the interhemispheric competition of the corticospinal system and bilateral brain lesions, thereby resulting in unilateral hemiparesis.
脑裂畸形是大脑半球的异常裂隙，由晚期神经元迁移异常和皮质组织异常引起。在本研究中，我们报告了一名患者的一种不同类型的异常运动组织，该患者右半球有脑裂畸形，对侧半球有多小脑回。尽管影响感觉运动皮层的脑病理相似，但运动组织与先前已知的双侧先天性脑损伤不同。我们进行了经颅磁刺激（TMS）和弥散张量成像（DTI）研究以确认运动组织情况。在这种情况下，与先前研究相似，在对受累较轻半球进行TMS时，观察到同侧皮质脊髓投射至患侧手，同时伴有多小脑回。然而，在本病例中观察到一条从受累更严重半球至患侧手的交叉皮质脊髓束——这种运动组织模式在该患者群体中尚未见报道。我们的研究结果表明，早期脑损伤后的运动组织可能受皮质脊髓系统的半球间竞争和双侧脑损伤影响，从而导致单侧偏瘫。
