Objectives

We report a 61-year-old woman who developed left hemiparesis following a right frontal stroke. She underwent rehabilitation and regained function of the left side of her body. Three years after her first stroke, she developed a large left subdural hematoma and again presented with left hemiparesis.

Materials and Methods

Prior to the cranioplasty, an fMRI scan involving left and right hand movement, arm movement, and foot peddling were conducted in order to determine whether the patient showed ipsilateral activation for the motor tasks, thus explaining the left hemiparesis following the left subdural hematoma. Diffusion tensor imaging (DTI) tractography was also collected to visualize the motor and sensory tracts.

Results

The fMRI results revealed activation in the expected contralateral left primary motor cortex (M1) for the right-sided motor tasks, and bilateral M1 activation for the left-sided motor tasks. Intraoperative neurophysiology confirmed these findings, whereby electromyography revealed left-sided (i.e., ipsilateral) responses for four of the five electrode locations. The DTI results indicated that the corticospinal tracts and spinothalamic tracts were within normal limits and showed no displacement or disorganization.

Conclusions

These results suggest that there may have been reorganization of the M1 following her initial stroke, and that the left hemisphere may have become involved in moving the left side of the body thereby leading to left hemiparesis following the left subdural hematoma. The findings suggest that cortical reorganization may occur in stroke patients recovering from hemiparesis, and specifically, that components of motor processing subserved by M1 may be taken over by ipsilateral regions.

中文翻译：

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脑卒中后恢复运动的半球形运动皮层的非典型组织的功能磁共振成像，DTI和神经生理学检查。

目标

我们报告了一名61岁的女性，她在右额中风后发展为左偏瘫。她接受了康复，恢复了身体左侧的功能。第一次中风三年后，她发展为左硬膜下大血肿，并再次出现左偏瘫。

材料和方法

在颅骨成形术之前，进行了包括左手和右手运动，手臂运动和脚踩踏板的功能磁共振成像扫描，以确定患者是否针对运动任务显示了同侧激活，从而解释了左硬膜下血肿后的左偏瘫。还收集了弥散张量成像（DTI）图像，以可视化运动和感觉束。

结果

功能磁共振成像结果显示预期的对侧左侧主要运动皮层（M1）激活，用于右侧运动任务，而两侧M1激活，用于左侧运动任务。术中神经生理学证实了这些发现，肌电图显示了五个电极位置中的四个电极的左侧（即同侧）反应。DTI结果表明，皮质脊髓束和脊髓丘脑束在正常范围内，没有移位或混乱。

结论

这些结果表明，M1初次卒中后可能已经重组，并且左半球可能参与了身体左侧的移动，从而导致了左硬膜下血肿引起的左半轻瘫。这些发现表明，从偏瘫患者中恢复过来的中风患者可能会发生皮质重组，特别是，由M1支持的运动处理成分可能被同侧区域所接管。