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Jidal M, Horache K, Fikri M, El Kettani N, Jiddane M, Touarsa F. A rare case of ispilateral hemiparesis in a patient with uncrossed pyramidal tract shown by tractography. Radiol Case Rep 2024; 19:3512-3516. [PMID: 38881617 PMCID: PMC11179576 DOI: 10.1016/j.radcr.2024.04.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 04/28/2024] [Indexed: 06/18/2024] Open
Abstract
This article presents a unique case of ipsilateral hemiparesis in a 66-year-old individual, contrary to the conventional understanding of supratentorial strokes causing contralateral neurological deficits. The patient exhibited persistent weakness and sensory abnormalities on the left side of the body following a left occipital infarct. Neuroimaging revealed a chronic stroke in the left occipital lobe, with diffusion tensor imaging demonstrating uncrossed pyramidal tracts at the level of the medulla. The discussion encompasses the anatomical basis of corticospinal tract crossing, historical perspectives, and previous documented cases of ipsilateral strokes. The rarity of complete uncrossed corticospinal tracts without underlying congenital abnormalities or genetic disorders is highlighted. The study underscores the importance of considering such atypical presentations in stroke evaluations and the role of advanced imaging techniques in confirming diagnosis and understanding underlying mechanisms.
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Affiliation(s)
- Manal Jidal
- Neuroradiology Department, Ibn Sina Hospital, Mohammed V University of Rabat, Lamfadel Cherkaoui street, Rabat, Morocco
| | - Kenza Horache
- Neuroradiology Department, Ibn Sina Hospital, Mohammed V University of Rabat, Lamfadel Cherkaoui street, Rabat, Morocco
| | - Meriem Fikri
- Neuroradiology Department, Ibn Sina Hospital, Mohammed V University of Rabat, Lamfadel Cherkaoui street, Rabat, Morocco
| | - Najwa El Kettani
- Neuroradiology Department, Ibn Sina Hospital, Mohammed V University of Rabat, Lamfadel Cherkaoui street, Rabat, Morocco
| | - Mohammed Jiddane
- Neuroradiology Department, Ibn Sina Hospital, Mohammed V University of Rabat, Lamfadel Cherkaoui street, Rabat, Morocco
| | - Firdaous Touarsa
- Neuroradiology Department, Ibn Sina Hospital, Mohammed V University of Rabat, Lamfadel Cherkaoui street, Rabat, Morocco
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Carrasco-Moro R, Martínez-San Millán JS, Pascual JM. Beyond uncal herniation: An updated diagnostic reappraisal of ipsilateral hemiparesis and the Kernohan-Woltman notch phenomenon. Rev Neurol (Paris) 2023; 179:844-865. [PMID: 36907707 DOI: 10.1016/j.neurol.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 03/12/2023]
Abstract
PURPOSE This works comprehensively analyses a modern cohort of patients with ipsilateral hemiparesis (IH) and discusses the pathophysiological theories elaborated to explain this paradoxical neurological sign according to the findings from contemporary neuroimaging and neurophysiological techniques. METHODS A descriptive analysis of the epidemiological, clinical, neuroradiological, neurophysiological, and outcome data in a series of 102 case reports of IH published on since the introduction of CT/MRI diagnostic methods (years 1977-2021) was performed. RESULTS IH mostly developed acutely (75.8%) after traumatic brain injury (50%), as a consequence of the encephalic distortions exerted by an intracranial haemorrhage eventually causing contralateral peduncle compression. Sixty-one patients developed a structural lesion involving the contralateral cerebral peduncle (SLCP) demonstrated by modern imaging tools. This SLCP showed certain variability in its morphology and topography, but it seems pathologically consistent with the lesion originally described in 1929 by Kernohan & Woltman. The study of motor evoked potentials was seldom employed for the diagnosis of IH. Most patients underwent surgical decompression, and a 69.1% experienced some improvement of the motor deficit. CONCLUSIONS Modern diagnostic methods support that most cases in the present series developed IH following the KWNP model. The SLCP is presumably the consequence of either compression or contusion of the cerebral peduncle against the tentorial border, although focal arterial ischemia may also play a contributing role. Some improvement of the motor deficit should be expected even in the presence of a SLCP, provided the axons of the CST were not completely severed.
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Affiliation(s)
- R Carrasco-Moro
- Department of Neurosurgery, Ramón y Cajal U, Comenar Rd., Km. 9.100, Madrid, Spain.
| | | | - J M Pascual
- Department of Neurosurgery, La Princesa U. H, Madrid, Spain
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Kajtazi NI, Bafaquh M, Rizvi T, Sheikh SE, Ghamdi JA, Amoudi RA, Jabbar AA, Shammari KA, Saqqur M, Ghamdi SA, Khoja W, Demchuk A, Senani FA, Luft AR. Ipsilateral weakness caused by ipsilateral stroke: A case series. J Stroke Cerebrovasc Dis 2023; 32:107090. [PMID: 37105128 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/10/2023] [Accepted: 03/19/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION There are few reported cases of ipsilateral weakness following ischemic or hemorrhagic stroke. In these rare cases, ipsilateral weakness is typically the result of damage to uncrossed components of the corticospinal tract (CST) which were recruited in response to previous CST injury. PATIENTS AND METHODS We report a series of six cases of acute ipsilateral weakness or numbness following a hemorrhagic or ischemic stroke from three medical institutions in Saudi Arabia. RESULTS Three of these patients presented with right-sided weakness caused by an ipsilateral right hemispheric stroke, while two exhibited left-sided symptoms and one had only left-sided numbness. In all six cases, the ipsilateral corona radiata, internal capsule, basal ganglia, insula, and thalamus were involved. No concomitant opposite hemisphere or brainstem lesion in none of the patients was evident. Two patients had previous strokes affecting the brainstem and left corona radiata, respectively. Complete stroke workup to reveal the cause of stroke was carried out, however no functional MRI was performed. CONCLUSION Ischemic or hemorrhagic stroke may indeed result in ipsilateral weakness or numbness, though in very rare cases. We assume that the most likely mechanism of their ipsilateral weakness subsequent to the ipsilateral stroke was a functional reorganization favoring CST pathways within the ipsilateral hemisphere.
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Affiliation(s)
- Naim I Kajtazi
- Department of Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia; Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Mohammed Bafaquh
- Department of Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Tanvir Rizvi
- Department of Medical Imaging, Neuroradiology, University of Virginia, United States
| | - Souda El Sheikh
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Juman Al Ghamdi
- Intervention Neuroradiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Razan Al Amoudi
- Intervention Neuroradiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Asma Al Jabbar
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Kareem Al Shammari
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Maher Saqqur
- Department of Neurology, University of Alberta, Canada
| | - Saeed Al Ghamdi
- Department of Neurology, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Waleed Khoja
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Fahmi Al Senani
- Department of Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia; Intervention Neuroradiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Andreas R Luft
- Department of Neurology, Switzerland & Cereneo Center for Neurology and Rehabilitation, University of Zürich, Vitznau, Switzerland
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Filippopulos FM, Brem C, Seelos K, Köglsperger T, Sonnenfeld S, Kellert L, Vollmar C. Uncrossed corticospinal tract in health and genetic disorders: Review, case report, and clinical implications. Eur J Neurol 2021; 28:2804-2811. [PMID: 33949047 DOI: 10.1111/ene.14897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Crossing pathologies of the corticospinal tract (CST) are rare and often associated with genetic disorders. However, they can be present in healthy humans and lead to ipsilateral motor deficits when a lesion to motor areas occurs. Here, we review historical and current literature of CST crossing pathologies and present a rare case of asymmetric crossing of the CST. METHODS Description of the case and systematic review of the literature were based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed database was searched for peer-reviewed articles in English since 1950. All articles on ipsilateral stroke, uncrossed CST, and associated neurologic disorders were screened. Furthermore, a literature review between the years 1850 and 1980 including articles in other languages, books, opinions, and case studies was conducted. RESULTS Only a few descriptions of CST crossing pathologies exist in healthy humans, whereas they seem to be more common in genetic disorders such as horizontal gaze palsy with progressive scoliosis or congenital mirror movements. Our patient presented with aphasia and left-sided hemiparesis. Computed tomographic (CT) scan revealed a perfusion deficit in the left middle cerebral artery territory, which was confirmed by diffusion-weighted magnetic resonance imaging (MRI), so that thrombolysis was administered. Diffusion tensor imaging with fibre tracking revealed an asymmetric CST crossing. CONCLUSIONS The knowledge of CST crossing pathologies is essential if a motor deficit occurs ipsilateral to the lesion side. An ipsilateral deficit should not lead to exclusion or delay of therapeutic options in patients with suspected stroke. Here, a combined evaluation of CT perfusion imaging and MRI diffusion imaging may be of advantage.
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Affiliation(s)
| | - Christian Brem
- Institute of Neuroradiology, University Hospital of the LMU Munich, Munich, Germany
| | - Klaus Seelos
- Institute of Neuroradiology, University Hospital of the LMU Munich, Munich, Germany
| | - Thomas Köglsperger
- Department of Neurology, University Hospital of the LMU Munich, Munich, Germany
| | - Stefan Sonnenfeld
- Department of Neurology, University Hospital of the LMU Munich, Munich, Germany
| | - Lars Kellert
- Department of Neurology, University Hospital of the LMU Munich, Munich, Germany
| | - Christian Vollmar
- Department of Neurology, University Hospital of the LMU Munich, Munich, Germany.,Institute of Neuroradiology, University Hospital of the LMU Munich, Munich, Germany
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Persad AR, Gould L, Norton JA, Meguro K. Uncrossed corticospinal tracts presenting as transient tumor-related symptomatology. Acta Neurochir (Wien) 2021; 163:947-951. [PMID: 33479812 DOI: 10.1007/s00701-020-04672-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 12/04/2020] [Indexed: 12/26/2022]
Abstract
Ipsilateral corticospinal innervation is rare. No prior cases have described ipsilateral tumor-associated symptoms as the presentation of an uncrossed corticospinal tract. Herein, we describe a case associated with a left frontal tumor, presenting with transient ipsilateral hemiparesis and aphasia. Due to the fluctuating symptomatology, we suspected a cerebrovascular cause and initially performed a workup for stroke. Ipsilateral motor innervation was discovered with intraoperative monitoring during the resection of the tumor, and confirmed with postoperative diffusion tensor imaging (DTI). Neurosurgeons should be aware of uncrossed motor system, and include it in the differential of ipsilateral deficit in patients with intracranial tumors.
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Yang H, Zhou H, Miao J. Uncrossed corticospinal tracts in a patient with ichthyosis and hemiparesis: a case report. BMC Neurol 2020; 20:120. [PMID: 32252685 PMCID: PMC7132884 DOI: 10.1186/s12883-020-01698-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 03/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Anomalies of pyramidal tract decussation are rare phenomena that can be caused by ectodermal dysplasia. Herein, we describe a patient with ichthyosis who exhibited ipsilateral hemiparesis after stroke and whose neuroimaging results showed evidence of motor control being provided by the ipsilateral motor cortex. Case presentation A 24-year-old right-handed man presented with skin abnormalities, sudden-onset left hemiparesis, and dysarthria. He exhibited a mild-to-moderate left-sided weakness (grade 4 on the Medical Research Council scale). Magnetic resonance imaging revealed an acute infarct in the left corona radiata. Diffusion tensor imaging revealed uncrossed corticospinal tracts. Next-generation sequencing identified heterozygous FLG mutations. The patient was diagnosed with cerebral infarction and ichthyosis vulgaris and was treated with aspirin (100 mg/d). His symptoms gradually dissipated. Conclusions This case suggests that pyramidal decussation anomalies can be associated with ichthyosis. Patients with ichthyosis should therefore be evaluated for nerve involvement.
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Affiliation(s)
- Huijia Yang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, 130021, China
| | - Hongwei Zhou
- Department of Radiology, The First Hospital of Jilin University, Changchun, 130021, China
| | - Jing Miao
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, 130021, China.
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Li M, Xia M, Chen W, Wang J, Yin Y, Guo C, Li C, Tang X, Zhao H, Tan Q, Chen Y, Jia Z, Liu X, Feng H. Lithium treatment mitigates white matter injury after intracerebral hemorrhage through brain-derived neurotrophic factor signaling in mice. Transl Res 2020; 217:61-74. [PMID: 31951826 DOI: 10.1016/j.trsl.2019.12.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 01/04/2023]
Abstract
Intracerebral hemorrhage (ICH), a subtype of stroke with high morbidity and mortality, occurs mainly in the basal ganglia and causes white matter injury (WMI), resulting in severe motor dysfunction and poor prognosis in patients. The preservation of the white matter around the hematoma is crucial for motor function recovery, but there is currently no effective treatment for WMI following ICH. Lithium has been widely used for the treatment of bipolar disorder for decades. Although the protective effects of lithium on neurodegenerative diseases and cerebral trauma have been studied in recent years, whether it can be used to alleviate WMI after ICH remains to be researched. The results of this study revealed that ICH caused significant functional and pathological abnormalities in mice. After LiCl was administered to mice with ICH, behavioural performance and electrophysiological functions were improved and ICH-induced white matter pathological injury, including myelin sheath and axonal degeneration, was ameliorated. Furthermore, LiCl treatment decreased the death of mature oligodendrocytes (OLGs) in ICH mice, which may have been attributed to the enhanced expression of brain-derived neurotrophic factor (BDNF) regulated by the LiCl-induced inhibition of glycogen synthase kinase-3β (GSK-3β). The decreased death of OLGs was closely associated with decreased destruction of the myelin sheath and alleviated degradation of the axons. In summary, this study suggests that the protective effect of lithium on WMI after ICH might be related to an increased level of BDNF and that LiCl treatment may be a potential therapeutic method to palliate WMI after ICH.
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Affiliation(s)
- Mingxi Li
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, PR China
| | - Min Xia
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, PR China
| | - Weixiang Chen
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, PR China
| | - Jie Wang
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, PR China
| | - Yi Yin
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, PR China
| | - Chao Guo
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, PR China
| | - Chengcheng Li
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, PR China
| | - Xiaoqin Tang
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, PR China
| | - Hengli Zhao
- Department of Neurology, The Second Medical Central, Chinese PLA (People's Liberation Army) General Hospital, Beijing, PR China
| | - Qiang Tan
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, PR China
| | - Yujie Chen
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, PR China; State Key Laboratory of Trauma, Burn, and Combined Injury, Third Military Medical University (Army Medical University), Chongqing, PR China; Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, PR China
| | - Zhengcai Jia
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, PR China
| | - Xin Liu
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, PR China; Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, PR China.
| | - Hua Feng
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, PR China; State Key Laboratory of Trauma, Burn, and Combined Injury, Third Military Medical University (Army Medical University), Chongqing, PR China; Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, PR China.
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Patra DP, Narayan V, Savardekar A, Dossani RH, Cajavilca C, Javalkar V, Gonzalez-Toledo E, Cuellar HH. Acute Supratentorial Ischemic Stroke with Ipsilateral Hemiparesis: Pathomechanism and Management Challenges. World Neurosurg 2018; 119:1-5. [PMID: 30071337 DOI: 10.1016/j.wneu.2018.07.172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Supratentorial stroke manifesting as ipsilateral hemiparesis is rare. Multiple pathophysiologic mechanisms are possible for this unusual phenomenon and has been previously described. Its implication in therapeutic decision making in a patient with an acute emergent condition has never been discussed. We describe our experience with a patient with this unusual presentation. CASE DESCRIPTION A 44-year-old woman presented with acute-onset right hemiparesis and left facial weakness. Evaluation with computed tomography angiography showed right M3 segment occlusion. Her National Institutes of Health Stroke Scale score on arrival was 9. Urgent magnetic resonance imaging was performed, which showed ongoing ischemia in the right frontotemporal cortex. She underwent endovascular thrombectomy, and complete revascularization was achieved. Postoperatively, the patient experience complete neurologic recovery. Further diffusion tractography imaging showed near-complete nondecussation of corticospinal fibers. CONCLUSIONS Discordance between clinical and initial computed tomography angiography findings in a patient with acute ischemic stroke poses a management challenge. Additional imaging to correlate clinical findings in equivocal cases may help in decision making but may significantly delay intervention, and therefore its utility during the short therapeutic window period needs careful consideration. Considering the risks and benefits, timely intervention should be balanced judiciously against appropriate intervention to achieve a positive patient outcome.
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Affiliation(s)
- Devi Prasad Patra
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Vinayak Narayan
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Amey Savardekar
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Rimal Hanif Dossani
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Christian Cajavilca
- Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Vijaykumar Javalkar
- Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Eduardo Gonzalez-Toledo
- Department of Radiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Hugo H Cuellar
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA; Department of Radiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
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Lin CW, Lo CP, Tu MC. Horizontal gaze palsy with progressive scoliosis: a case report with magnetic resonance tractography and electrophysiological study. BMC Neurol 2018; 18:75. [PMID: 29843650 PMCID: PMC5972445 DOI: 10.1186/s12883-018-1081-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Horizontal gaze palsy with progressive scoliosis (HGPPS) is a rare autosomal recessive congenital anomaly characterized by horizontal gaze limitation and progressive scoliosis. We investigated the underlying pathogenesis by incorporating diffusion tensor imaging and an electrophysiological study. Case presentation A 55-year-old female patient presented to our clinic due to a chronic history of eye movement limitation since childhood. Her eye problem was followed by a progressive scoliotic change in her torso during junior high school. Neurological examinations revealed remarkable conjugate horizontal but not vertical gaze palsy. Her pupils were isocoric, with a prompt response to light reflex and convergence. Her vision, including visual acuity and field, were normal. No pathological signs of muscle tone, muscle power, deep tendon reflex or coordination were revealed. There was no associated family history, and no diseases involving other systems were noted. On reviewing her past medical history, X-rays revealed scoliotic changes of her thoracic and lumbar spine. Brain magnetic resonance imaging showed a midline cleavage at the tegmentum (split pons sign) and butterfly configuration of the medulla, consistent with HGPPS. Color-coded diffusion tensor imaging in our patient revealed absence of decussation of the superior cerebellar peduncle. In tractography, the pontocerebellar tracts and fibers within the inferior cerebellar peduncle, deemed to be primarily dorsal spinocerebellar and vestibulocerebellar tracts, appeared to be agenetic. The tegmentum was compromised secondary to dorsal displacement of the corticospinal tracts. Of note, the bilateral corticospinal tracts remained uncrossed at the level presumed to be the pyramidal decussation. A somatosensory evoked potential study also revealed predominantly ipsilateral cortical sensory responses. Conclusions Our study confirmed that a compromised tegmentum secondary to dorsal displacement of the corticospinal tracts and poorly-developed afferent fibers within the pontocerebellar tracts and inferior cerebellar peduncle to be the main neuroanatomical anomalies responsible for the clinical presentations of HGPPS. In addition, the uncrossed nature of the majority of pyramidal and proprioceptive sensory systems was confirmed. Electronic supplementary material The online version of this article (10.1186/s12883-018-1081-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chi-Wei Lin
- Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Chung-Ping Lo
- Department of Radiology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Min-Chien Tu
- Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan. .,School of Medicine, Tzu Chi University, Hualien, Taiwan.
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Inatomi Y, Nakajima M, Yonehara T, Ando Y. Ipsilateral hemiparesis in ischemic stroke patients. Acta Neurol Scand 2017; 136:31-40. [PMID: 27666559 DOI: 10.1111/ane.12690] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate clinical characteristics of ipsilateral hemiparesis in ischemic stroke patients. MATERIALS AND METHODS Patients with acute ischemic stroke were prospectively examined. Ipsilateral hemiparesis was defined as hemiparesis ipsilateral to recent stroke lesions. Patients with ipsilateral hemiparesis were examined with functional neuroimaging studies including transcranial magnetic stimulation (TMS) and functional MRI. RESULTS Of 8360 patients, ipsilateral hemiparesis was detected in 14 patients (0.17%, mean age 71±6 years, eight men). Lesions responsible for the recent strokes were located in the frontal cortex in three patients, corona radiata in seven, internal capsule in one, and pons in three. These lesions were located along the typical route of the corticospinal tract in all but one patient. Thirteen patients also had a past history of stroke contralateral to the recent lesions; 12 of these had motor deficits contralateral to past stroke lesions. During TMS, ipsilateral magnetic evoked potentials were evoked in two of seven patients and contralateral potentials were evoked in all seven. Functional MRI activated cerebral hemispheres ipsilaterally in eight of nine patients and contralaterally in all nine. CONCLUSIONS Most patients with ipsilateral hemiparesis had a past history of stroke contralateral to the recent one, resulting in motor deficits contralateral to the earlier lesions. Moreover, functional neuroimaging findings indicated an active crossed corticospinal tract in all of the examined patients. Both findings suggest the contribution of the uncrossed corticospinal tract contralateral to stroke lesions as a post-stroke compensatory motor system.
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Affiliation(s)
- Y. Inatomi
- Department of Neurology; Saiseikai Kumamoto Hospital; Kumamoto Japan
| | - M. Nakajima
- Department of Neurology; Graduate School of Medical Sciences; Kumamoto University; Kumamoto Japan
| | - T. Yonehara
- Department of Neurology; Saiseikai Kumamoto Hospital; Kumamoto Japan
| | - Y. Ando
- Department of Neurology; Graduate School of Medical Sciences; Kumamoto University; Kumamoto Japan
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Ku J, Mendelsohn D, Chew J, Shewchuk J, Dong C, Akagami R. Ipsilateral Motor Innervation Discovered Incidentally on Intraoperative Monitoring: A Case Report. Neurosurgery 2017; 80:E194-E200. [DOI: 10.1093/neuros/nyw074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 11/11/2016] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE: Lesions in the corticospinal tract above the decussation at the medullary pyramids almost universally produce contralateral deficits. Rare cases of supratentorial lesions causing ipsilateral motor deficits have been reported previously, but only ever found secondary to stroke or congenital pyramidal tract malformations.
CLINICAL PRESENTATION: Herein, we report a case of ipsilateral corticospinal tract innervation discovered incidentally with intraoperative monitoring during a microsurgical resection of a vestibular schwannoma. Intraoperative monitoring with electrical transcranial stimulation of the frontal scalp triggered motor-evoked potentials in the ipsilateral arms. The uncrossed pathways were later confirmed with MRI tractography using diffusion tensor imaging.
CONCLUSION: To the best of our knowledge, this is the first case of isolated ipsilateral motor innervation of the corticospinal tract discovered incidentally during a neurosurgical procedure. Given the increasing use of intraoperative monitoring, this case underscores the importance of cautious interpretation of seemingly discordant neurophysiological findings. Once technical issues have been ruled out, ipsilateral motor innervation may be considered as a possible explanation and neurosurgeons should be aware of the existence of this rare anatomic variant.
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Affiliation(s)
- Jerry Ku
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Univer-sity of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel Mendelsohn
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Univer-sity of British Columbia, Vancouver, British Columbia, Canada
| | - Jason Chew
- Division of Neuroradiology, Department of Radi-ology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason Shewchuk
- Division of Neuroradiology, Department of Radi-ology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles Dong
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Univer-sity of British Columbia, Vancouver, British Columbia, Canada
| | - Ryojo Akagami
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Univer-sity of British Columbia, Vancouver, British Columbia, Canada
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Xu Y, Liu L. Ipsilateral hemiparesis and contralateral lower limb paresis caused by anterior cerebral artery territory infarct. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2016; 21:256-9. [PMID: 27356659 PMCID: PMC5107294 DOI: 10.17712/nsj.2016.3.20150701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Ipsilateral hemiparesis is rare after a supratentorial stroke, and the role of reorganization in the motor areas of unaffected hemisphere is important for the rehabilitation of the stroke patients. In this study, we present a patient who had a subclinical remote infarct in the right pons developed ipsilateral hemiparesis and contralateral lower limb paresis caused by a new infarct in the left anterior cerebral artery territory. Our case suggests that the motor areas of the unaffected hemisphere might be reorganized after stroke, which is important for the rehabilitation of stroke patients.
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Affiliation(s)
- Yongfeng Xu
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Hangzhou, China
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Kannepalli NRVL, Yadav R, Vazhayil V, Somanna S, Pal PK. Ipsilateral Hemichorea-hemiballism in a Case of Postoperative Stroke. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2016; 6:359. [PMID: 27127720 PMCID: PMC4825330 DOI: 10.7916/d8c53kqr] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 03/20/2016] [Indexed: 12/20/2022]
Abstract
Background Ipsilateral hemiballismus refers to the rare occurrence of hemiballism developing on the same side of a brain lesion. Case report We describe a rare case of postoperative ipsilateral hemiballism in a patient who underwent pituitary adenoma resection and experienced a right internal cerebral artery territory infarct. We review the literature on hemichorea hemiballismus (HCHB) and explore various mechanisms for its occurrence. Discussion Only three cases of ipsilateral hemiballism have been described, and the exact pathophysiology remains unknown. A dominant left hemisphere with corpus callosal connections to the right basal ganglia is the most probable explanation for this unusual event.
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Affiliation(s)
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Vikas Vazhayil
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Sampath Somanna
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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Deterioration of pre-existing hemiparesis due to an ipsilateral internal capsule infarction after a contralateral stroke. J Neurol Sci 2015; 354:140-1. [DOI: 10.1016/j.jns.2015.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 05/02/2015] [Accepted: 05/12/2015] [Indexed: 11/19/2022]
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Yamada S, Okita Y, Shofuda T, Yoshioka E, Nonaka M, Mori K, Nakajima S, Kanemura Y. Ipsilateral hemiparesis caused by putaminal hemorrhage in a patient with horizontal gaze palsy with progressive scoliosis: a case report. BMC Neurol 2015; 15:25. [PMID: 25885466 PMCID: PMC4356136 DOI: 10.1186/s12883-015-0286-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 02/25/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Horizontal gaze palsy with progressive scoliosis (HGPPS) is an autosomal recessive disorder caused by mutations in the ROBO3 gene, resulting in a critical absence of crossing fibers in the brainstem. CASE PRESENTATION We present a patient with ipsilateral hemiparesis caused by putaminal hemorrhage who had a history of horizontal gaze paralysis and scoliosis since childhood. Diffusion tensor imaging (DTI) tractography confirmed the presence of uncrossed corticospinal tracts. Sequence analysis of the entire ROBO3 coding regions revealed a novel nonsense mutation. CONCLUSION We report the first known HGPPS case with intracranial hemorrhage and ROBO3 mutation showing an absence of major crossing pathways by DTI.
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Affiliation(s)
- Shuhei Yamada
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City, 540-0006, Japan.
| | - Yoshiko Okita
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City, 540-0006, Japan.
| | - Tomoko Shofuda
- Division of Stem Cell Research, Institute for Clinical Research, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City, 540-0006, Japan.
| | - Ema Yoshioka
- Division of Stem Cell Research, Institute for Clinical Research, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City, 540-0006, Japan.
| | - Masahiro Nonaka
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City, 540-0006, Japan.
| | - Kosuke Mori
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City, 540-0006, Japan.
| | - Shin Nakajima
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City, 540-0006, Japan.
| | - Yonehiro Kanemura
- Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City, 540-0006, Japan. .,Division of Regenerative Medicine, Institute for Clinical Research, Osaka National Hospital, National Hospital Organization, 2-1-14 Hoenzaka, Chuo-ku, Osaka City, 540-0006, Japan.
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Miyata H, Miyata M, Ohama E. Pyramidal tract abnormalities in the human fetus and infant with trisomy 18 syndrome. Neuropathology 2013; 34:219-26. [DOI: 10.1111/neup.12081] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 10/28/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Hajime Miyata
- Department of Neuropathology; Research Institute for Brain and Blood Vessels - Akita; Akita Japan
- Department of Neuropathology; Institute of Neurological Sciences; Faculty of Medicine; Tottori University; Yonago Japan
| | - Mio Miyata
- Department of Neurology; Igarashi Memorial Hospital; Akita Japan
- Department of Neuropathology; Institute of Neurological Sciences; Faculty of Medicine; Tottori University; Yonago Japan
| | - Eisaku Ohama
- Kurashiki Heisei Hospital; Kurashiki Japan
- Department of Neuropathology; Institute of Neurological Sciences; Faculty of Medicine; Tottori University; Yonago Japan
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Alurkar A, Karanam LSP, Atre A, Nirhale S, Nayak S, Oak S. Ipsilateral Stroke with Uncrossed Pyramidal Tracts and Underlying Right Internal Carotid Artery Stenosis Treated with Percutaneous Transluminal Angioplasty and Stenting. Neuroradiol J 2012; 25:237-42. [DOI: 10.1177/197140091202500215] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Accepted: 03/26/2012] [Indexed: 11/17/2022] Open
Abstract
We present a unique case of ipsilateral stroke in a 55-year-old right-handed hypertensive man with proven uncrossed pyramidal tract demonstrated by tractography. Diffusion-weighted imaging disclosed small acute ischemic infarcts in the right corona radiata with MR angiography showing narrowing of the right internal carotid artery. Significant carotid stenosis of right internal carotid artery (ICA) was detected on digital subtraction angiography as the underlying cause and subsequently treated with percutananeous transluminal angioplasty and stenting with good outcome. The presence of uncrossed pyramidal tract was confirmed by diffusion tensor imaging tractography. To our knowledge there are few reports of ipsilateral stroke with proven uncrossed pyramidal tracts described in the literature. This is the first documented report of ipsilateral stroke with uncrossed fibre tracts due to underlying critical stenosis of the ICA treated successfully with a good recovery.
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Affiliation(s)
- A. Alurkar
- King Edward Memorial Hospital; Pune, India
| | | | - A. Atre
- King Edward Memorial Hospital; Pune, India
| | - S. Nirhale
- King Edward Memorial Hospital; Pune, India
| | - S. Nayak
- King Edward Memorial Hospital; Pune, India
| | - S. Oak
- King Edward Memorial Hospital; Pune, India
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Ipsilateral hemiparesis and spontaneous horizontal nystagmus caused by middle cerebral artery territory infarct in a patient with agenesis of the corpus callosum. Neurol Sci 2011; 33:1165-8. [DOI: 10.1007/s10072-011-0871-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 11/21/2011] [Indexed: 10/14/2022]
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Five new consanguineous families with horizontal gaze palsy and progressive scoliosis and novel ROBO3 mutations. J Neurol Sci 2009; 276:22-6. [DOI: 10.1016/j.jns.2008.08.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2008] [Revised: 08/17/2008] [Accepted: 08/19/2008] [Indexed: 11/30/2022]
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Amoiridis G, Tzagournissakis M, Christodoulou P, Karampekios S, Latsoudis H, Panou T, Simos P, Plaitakis A. Patients with horizontal gaze palsy and progressive scoliosis due to ROBO3 E319K mutation have both uncrossed and crossed central nervous system pathways and perform normally on neuropsychological testing. J Neurol Neurosurg Psychiatry 2006; 77:1047-53. [PMID: 16772357 PMCID: PMC2077731 DOI: 10.1136/jnnp.2006.088435] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Horizontal gaze palsy and progressive scoliosis (HGPPS) is caused by mutations of the ROBO3 gene, which encodes a receptor associated with axonal guidance during development. Although there is evidence for uncrossed cuneatal and corticospinal tracts in HGPPS, it is unclear whether other central nervous system pathways are involved. OBJECTIVE To study two patients with HGPPS homozygotic for the ROBO3 E319K mutation using a variety of neurophysiological and neuropsychological tests. METHODS A battery of neuropsychological tests was applied to assess various cognitive and perceptual functions. The corticospinal, somatosensory and auditory pathways were evaluated using appropriate neurophysiological tests. To access motor pathways to the neck muscles, electromyographic recordings were obtained from the sternocleidomastoideus and splenius capitis muscle during active head rotation. RESULTS Both patients performed normally on manual dexterity, complex sensory and visuospatial functions, reading and general intelligence tests. Motor evoked potentials in both patients showed uncrossed corticospinal tracts for the extremities, although in one patient, electromyography indicated pyramidal tract crossing for the neck muscles. Although somatosensory evoked potentials showed uncrossed somatosensory fibres subserving proprioception and light touch, right median nerve somatosensory evoked potential in one patient indicated a partial lemniscal crossing. Sympathetic skin response and blink reflex showed a midline crossing of the spinothalamic and quintothalamic tracts. Brain stem auditory evoked potentials indicated a lack of crossing in the level of the trapezoid body. CONCLUSIONS Our patients with the ROBO3 E319Kappa mutation show normal perceptual and cognitive functions and have both crossed and uncrossed motor, sensory and auditory pathways.
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Affiliation(s)
- G Amoiridis
- Department of Neurology, University of Crete, PO Box 2208, 71003 Heraklion, Greece.
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MacDonald DB, Stigsby B, Al Zayed Z. A comparison between derivation optimization and Cz′–FPz for posterior tibial P37 somatosensory evoked potential intraoperative monitoring. Clin Neurophysiol 2004; 115:1925-30. [PMID: 15261872 DOI: 10.1016/j.clinph.2004.03.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2004] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare P37 derivation optimization to Cz'-FPz. METHODS After induction in 120 patients, monitoring derivations optimized by mapping FPz, Cz, Cz', Pz, C4', C2', C1' and C3'-mastoid to determine the P37 and N37 maximums for use as inputs 1 and 2 were compared to Cz'-FPz. This was repeated later in 35 surgeries. RESULTS Eleven optimal derivations occurred and usually differed between sides. Input 1 was Cz', Pz, Cz, iCi', or Ci' and input 2 was Cc', FPz, Ci' or Pz. Even the most frequent Cz'-Cc' derivation was optimal for both sides of an individual in only 17% and this was true for Cz'-FPz in only 4%. Optimization produced higher amplitudes than Cz'-FPz (P<0.001). The ratio was [squareroot of 2] : 1 in 61% of patients and > or =2:1 in 28%, approximately halving or quartering averaging times. Optimization assessed decussation, disclosing non-decussation in one patient while Cz'-FPz did not. Alterations of P37 topography that reduced initially optimal derivation amplitude and made a different derivation optimal were demonstrated by repeat optimization in 13 of 35 patients, preventing misinterpretation in one. While also affected, Cz'-FPz neither detected nor adjusted for potentially misleading topographic changes. CONCLUSIONS Higher amplitudes, decussation assessment and topographic adjustment make P37 derivation optimization superior to Cz'-FPz for monitoring this highly variable potential.
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Affiliation(s)
- D B MacDonald
- Section of Neurophysiology, Department of Neurosciences, King Faisal Specialist Hospital and Research Center MBC 76, P.O. Box 3354, Riyadh 11211, Saudi Arabia.
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MacDonald DB, Streletz LJ, Al-Zayed Z, Abdool S, Stigsby B. Intraoperative neurophysiologic discovery of uncrossed sensory and motor pathways in a patient with horizontal gaze palsy and scoliosis. Clin Neurophysiol 2004; 115:576-82. [PMID: 15036053 DOI: 10.1016/j.clinph.2003.10.029] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2003] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To report the intraoperative neurophysiologic discovery of clinically unsuspected non-decussation of the somatosensory and motor pathways. METHODS We performed somatosensory evoked potential (SEP) and transcranial electric stimulation (TES) muscle motor evoked potential (MEP) monitoring during scoliosis surgery for a 16 year old patient with familial horizontal gaze palsy and progressive scoliosis. Our routine procedures included optimizing tibial cortical SEP monitoring derivations through saggital and coronal (C4', C2', Cz', C1', C3'-mastoid) P37 mapping, which surprisingly indicated non-decussation. Consequently, we also obtained coronal median nerve SEPs and simultaneous bilateral muscle recordings to lateralized TES (C3-Cz, C4-Cz) intraoperatively and focal hand area transcranial magnetic stimulation (TMS) postoperatively. RESULTS For each nerve, tibial P37/N37 distribution was contralateral/ipsilateral and median N20 ipsilateral. For each hemisphere, ipsilateral TES MEPs had lower thresholds and TMS MEPs were exclusively ipsilateral. Accurate monitoring required reversed montages. Reevaluation of an MRI (previously reported normal) disclosed a ventral midline cleft of the medulla. CONCLUSIONS The results indicate uncrossed dorsal column-medial lemniscal and corticospinal pathways due to brain-stem malformation with absent internal arcuate and pyramidal decussations. SIGNIFICANCE Simultaneous bilateral recording to unilateral stimulation demonstrates SEP/MEP hemispheric origin and is important for accurate interpretation and monitoring because decussation anomalies exist.
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Affiliation(s)
- D B MacDonald
- Section of Neurophysiology, Department of Neurosciences, King Faisal Specialist Hospital & Research Center, MBC 76, P.O. Box 3354, Riyadh, 11211, Saudi Arabia.
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Derakhshan I. Why nondominant hand movements cause bilateral cortical activation in emission imaging. Stroke 2003; 34:3-4; author reply 3-4. [PMID: 12511737 DOI: 10.1161/01.str.0000044952.74952.f7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kato H, Izumiyama M, Koizumi H, Takahashi A, Itoyama Y. Near-infrared spectroscopic topography as a tool to monitor motor reorganization after hemiparetic stroke: a comparison with functional MRI. Stroke 2002; 33:2032-6. [PMID: 12154258 DOI: 10.1161/01.str.0000021903.52901.97] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Motor functional recovery from stroke can occur, but the mechanisms underlying this restorative process remain to be elucidated. We used near-infrared spectroscopic (NIRS) topography in comparison with functional MRI (fMRI) to evaluate the compensatory motor activation of cortical regions in patients who recovered from hemiparesis after cortical cerebral infarction. METHODS We examined 6 right-handed patients who suffered cerebral infarction of the middle cerebral artery territory with minimal or mild residual contralateral hemiparesis (4 men and 2 women, 59 to 79 years old, all had left hemiparesis). Both fMRI and NIRS were studied during a hand movement task at chronic stages. Five right-handed, normal subjects (3 men and 2 women, 44 to 81 years old) served as controls. RESULTS fMRI and NIRS detected very similar cerebral cortical activation, although NIRS detected only superficial activation. The spatial resolution of NIRS was less than that of fMRI, but NIRS provided a dynamic profile of activation. Normal subjects activated predominantly the contralateral primary sensorimotor cortex and supplementary motor areas during each hand movement. All the stroke patients exhibited the normal activation pattern during normal hand movement. On affected hand movement, the stroke patients showed extended activation not only in the contralateral motor cortex but also in the ipsilateral motor cortex (primary motor cortex and supplementary motor areas). CONCLUSIONS Both fMRI and NIRS studies provided evidence for the contribution of ipsilateral motor cortical compensation or reorganization to the recovery from poststroke hemiparesis. The result demonstrated that NIRS was a unique tool to monitor poststroke alterations in cortical motor functions.
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Affiliation(s)
- Hiroyuki Kato
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan.
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