Objectives: We investigated motor function in patients with the appearance of transpontine fibers from the affected corticospinal tract (CST) during motor recovery following putaminal hemorrhage by using diffusion tensor tractography (DTT).
Methods: Among 41 consecutive patients with putaminal hemorrhage, we examined 12 patients with the appearance of transpontine fibers from the affected CST at the chronic stage that were not observed at the early stage. Motor function was evaluated three times after putaminal hemorrhage onset (early stage [first DTT, 12.7 ± 2.2 days], chronic stage [second DTT, 143.9 ± 141.7 days], and final outcome [297 ± 288 days]) by assessing patients’ Motricity Index (MI), Modified Brunnstrom Classification (MBC), and Functional Ambulation Category (FAC).
Results: Motor function at the early stage showed severe impairment with average MI = 5.3, MBC = 0.6, and FAC = 0.0. However, these recovered to average MI = 45.8, MBC = 2.0, and FAC = 2.0 at the chronic stage and MI = 46.1, MBC = 2.2, and FAC = 2.3 at final outcome. Among the 12 patients, only one patient (8.3%) and six patients (50.0%) recovered to a functional state in hand (MBC 5~6) and gait (FAC 3~5) functions, respectively.
Conclusions: We examined the motor function of patients who showed the appearance of transpontine fibers from the affected CST during motor recovery following putaminal hemorrhage. Appearance of transpontine fibers from the affected CST during recovery appeared to be a motor recovery mechanism, although it is related to poor motor function outcome.
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(A) T2-weighted brain magnetic resonance images of one representative patient (47-year-old male) in the right hemisphere at the early (13 days after onset) and chronic (50 days after onset) stages after putaminal hemorrhage. (B) Results of diffusion tensor tractography for the corticospinal tract (CST). In the early stage, the affected (right) CST is discontinued around the hematoma (yellow arrow). However, at the chronic stage, the affected CST is crossed to the unaffected hemisphere via transpontine fibers (white circle) at the pontine level
Demographic characteristics of study patients.
Change in motor function according to time from putaminal hemorrhage onset.
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