Isolated corticospinal tract in a patient with intracerebral hemorrhage A diffusion tensor tractography and transcranial magnetic stimulation study

摘要

Diffusion tensor tractography allows visualization of the corticospinal tract (CST) in three dimensions. Transcranial magnetic stimulation offers a unique advantage in that it can distinguish between the corticospinal tract and the non-CST by analyzing the characteristics of a motor-evoked potential. A 15 year-old female showed right hemiparesis, due to intracerebral hemorrhage in the left corona radiata, and the posterior limb of the internal capsule. Diffusion tensor tractography revealed that the tracts of both hemispheres originated from the precentral gyrus, and descended through the known CST pathway. Specifically, the tract of the affected hemisphere descended through an isolated area in the leukomalactic lesion at the posterior limb level. In addition, the characteristics of the motor-evoked potential obtained from the right hand when stimulating the hot spot of the left motor cortex corresponded to a CST. In conclusion, we report on a patient with intracerebral hemorrhage who showed an isolated CST in a leukomalactic lesion. This result suggests the importance of saving the adjacent area or penumbra around a hematoma after an intracerebral hemorrhage.