Yonsei Med J.  2006 Feb;47(1):135-139. 10.3349/ymj.2006.47.1.135.

Corticospinal Tract Compression by Hematoma in a Patient with Intracerebral Hemorrhage: A Diffusion Tensor Tractography and Functional MRI Study

• Jang SH
• Kwon YH
• Lee MY
• Ahn SH
• Kim JH
• Jeong DH
• Choi BY
• Lee DG

• KMID: 1715884
• DOI: http://doi.org/10.3349/ymj.2006.47.1.135

Abstract

The purpose of this study was to demonstrate corticospinal tract compression that was due to a hematoma by using diffusion tensor tractography (DTT) and functional MRI (fMRI) in a patient with an intracerebral hemorrhage (ICH). A 23-year-old right-handed woman presented with severe paralysis of her right extremities at the onset of a spontaneous ICH. Over the first three days from onset, the motor function of the affected upper and lower extremities rapidly recovered to the extent that she was able to overcome applied resistance to the affected limbs, and her limbs regained normal function 3 weeks after onset. The tract of the right hemisphere originated from the primary sensori-motor cortex (SM1) and it passed through the known corticospinal tract pathway. However, the tract of the left hemisphere was similar to that of the right hemisphere except that it was displaced to the antero-medial side by the hematoma at the cerebral peduncle. Only the contralateral SM1 area centered on the precentral knob was activated during affected (right) or unaffected (left) hand movements, respectively. In conclusion, fMRI and DTT demonstrated a corticospinal tract compression due to hematoma in this patient. We conclude that the combined use of these two modalities appears to improve the accuracy of investigating the state of the corticospinal tract.

Keyword

Functional MRI; diffusion tensor tractography; corticospinal tract; stroke

MeSH Terms

Spinal Cord Compression/complications/*diagnosis/pathology
Pyramidal Tracts/*pathology
*Magnetic Resonance Imaging
Humans
Hematoma/complications/*diagnosis/pathology
Female
Diffusion Magnetic Resonance Imaging/*methods
Cerebral Hemorrhage/complications/*diagnosis/pathology
Adult

Figure

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  Fig. 1 T2-weighted images showing a hematoma in the left cerebral peduncle. T2-weighted images showing a hematoma in the left mid to lateral portion of the cerebral peduncle.

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  Fig. 2 Results of 3-D diffusion tensor tractography. The tract from the right hemisphere originated in the primary sensori-motor cortex, and it consecutively passed through the corona radiata, the posterior limb of the internal capsule, the cerebral peduncle of the midbrain, the basis pontis, and the anterior medulla along the known corticospinal tract pathway. The tract of the left hemisphere followed a similar course except that it was displaced to the antero-medial side due to the hematoma at the cerebral peduncle, and it was also smaller than the right hemisphere tract (red arrow).

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  Fig. 3 Functional MRI showing that the contralateral primary sensorimotor cortex became activated during the right (affected) or left hand movements. An additional activation of the left supplementary motor area occurred during the right hand movements.

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