OBJECTIVE Damage to the spinal cord is known to be associated with a posterior shift of the motor cortical upper limb representation, i.e. towards the somatosensory cortex. Due to missing pre-traumatic data, knowledge resulted from comparing findings between patients and healthy subjects. Here, we present a case of transient spinal cord injury resulting in a left-sided hemiparesis for 4 weeks. By chance, this patient had a pre-lesional navigated transcranial magnetic stimulation (nTMS) motor mapping 2 years before. Hence, nTMS mapping was repeated during the acute (after 1 day), sub-acute (after 10 days) and chronic (after 2 years) phase to trace the cortical reorganization following this incident. METHODS Acute clinical work-up included magnetic resonance imaging and navigated transcranial magnetic stimulation (nTMS). Motor mapping was performed with 110% of the abductor pollicis brevis muscle (APB) resting motor threshold (rMT). Amplitudes and latencies of the motor-evoked potential (MEPs) were recorded and analyzed. In addition, motor function was evaluated by the Medical Research Council (MRC) scale, a standard Purdue Pegboard test and by a reaction time (RT) task. RESULTS MRI revealed no aberrant findings. nTMS mapping, however, showed a posterior shift of the APB representation from the anatomical hand knob towards the somatosensory cortex in the acute in comparison to the pre-lesional phase. Concomitantly, there was an increase of rMT (6%). Within 10 days, there was an incomplete reversal of the posterior shift in parallel with improvement of the clinical motor function. Long-term follow-up revealed a complete restitution of nTMS cortical mapping and motor function. CONCLUSION The present case report thoroughly documents a rapid cortical reorganization within a few days after a transient spinal shock. Our data adds further evidence to the literature suggesting a posterior shift of motor cortical representation following spinal cord injury. For the first time, 52 cortical reorganization was shown idiosyncratically in a single patient arising from the fortuitous fact of having a pre - lesional nTMS map.

中文翻译：

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亚急性脊髓功能障碍后的快速运动皮层重组

目的 已知脊髓损伤与运动皮层上肢表现的后移有关，即朝向躯体感觉皮层。由于缺少创伤前数据，知识是通过比较患者和健康受试者的发现而产生的。在这里，我们介绍一例暂时性脊髓损伤导致左侧偏瘫 4 周。偶然地，该患者在 2 年前进行了病灶前导航经颅磁刺激 (nTMS) 运动测绘。因此，在急性（1 天后）、亚急性（10 天后）和慢性（2 年后）阶段重复 nTMS 映射，以追踪此事件后的皮质重组。方法 急性临床检查包括磁共振成像和导航经颅磁刺激 (nTMS)。用 110% 的拇短展肌 (APB) 静息运动阈值 (rMT) 进行运动映射。记录和分析运动诱发电位 (MEP) 的幅度和潜伏期。此外，运动功能通过医学研究委员会 (MRC) 量表、标准 Purdue Pegboard 测试和反应时间 (RT) 任务进行评估。结果 MRI 未发现异常结果。然而，nTMS 映射显示，与损伤前阶段相比，急性期 APB 表征从解剖手柄向体感皮层后移。同时，rMT 增加（6%）。在 10 天内，随着临床运动功能的改善，后移不完全逆转。长期随访显示 nTMS 皮质映射和运动功能完全恢复。结论 本病例报告彻底记录了短暂性脊髓休克后几天内的快速皮质重组。我们的数据为文献增加了进一步的证据，表明脊髓损伤后运动皮层表现的后移。52 皮层重组首次在单个患者中被特殊显示，这是由于具有病灶前 nTMS 图的偶然事实。