Deterioration of pre-existing hemiparesis due to injury of the ipsilateral anterior corticospinal tract

BMC Neurology, 2013 · DOI: 10.1186/1471-2377-13-53 · Published: May 29, 2013

Neurology Medical Imaging Neurorehabilitation

Simple Explanation

The corticospinal tract (CST) is the major neuronal pathway that mediates voluntary movements in the human brain. The CST is generally divided into the crossed lateral CST and the uncrossed anterior CST. The anterior CST is considered to be one of the ipsilateral motor pathways from the unaffected motor cortex to the affected extremities, which contribute to motor recovery following stroke incidents. Diffusion tensor tractography (DTT) allows for the visualization and investigation of neural tracts in three dimensions.

Study Duration

Not specified

Participants

1 patient and 6 control subjects

Evidence Level

Level 4; Case Report

Key Findings

1
Deterioration of pre-existing right hemiparesis was ascribed to the injury of the right anterior CST following the new right pontine infarct.
2
The DTT for right anterior CST in the patient showed discontinuation below the right pontine infarct.
3
The DTT for left whole CST of the patient showed a Wallerian degeneration to the left pons with discontinuation.

Research Summary

This case report describes a patient who experienced deterioration of pre-existing hemiparesis due to an injury of the ipsilateral anterior corticospinal tract following a pontine infarct. Diffusion tensor tractography (DTT) was used to evaluate the whole and anterior CSTs, revealing a discontinuation of the right anterior CST below the pontine infarct. The study suggests that the anterior corticospinal tract plays a role in motor function and that its injury can lead to deterioration of motor skills.

Practical Implications

Diagnostic Implications

DTT can be used to visualize and assess the integrity of the anterior CST in patients with motor deficits.

Therapeutic Implications

Understanding the role of the anterior CST in motor recovery may help in designing targeted rehabilitation strategies.

Prognostic Implications

The extent of injury to the anterior CST, as visualized by DTT, might be a predictor of motor recovery potential.

Study Limitations

1
DTI could lead to both false positive and negative throughout the white matter of brain because of complex fiber configurations
2
Because it is a case report, the results of this study are limited to generalizations.
3
Further studies to overcome these limitations should be encouraged.

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