Change in connection between corticospinal tract and Broca's area during motor recovery in a patient with an intracerebral hemorrhage

摘要

The present study reported a 42-year-old male patient who underwent conservative management for a spontaneous intracerebral hemorrhage in the left corona radiata and the basal ganglia.The patient presented with complete weakness of the right upper and lower extremities at the onset of intracerebral hemorrhage;however,he showed progressive motor recovery to the level that he was able to extent the affected extremities against some resistance at 5 weeks after onset.The corticospinal tract of the affected (left) hemisphere connected to the left Broca's area at 3 weeks after onset as shown by diffusion tensor tractography.By contrast,this connection had disappeared at 5 weeks after onset as shown by diffusion tensor tractogaphy.Transcranial magnetic stimulation study showed that no motor evoked potential was elicited from the affected (left) hemisphere at 3 weeks after onset,but motor evoked potentials were elicited at 5 weeks after onset.These findings suggest that the connection between the injured corticospinal tract and Broca's area in this patient appears to be a compensation for severe motor weakness;consequently,the connection seems to disappear with motor recovery.