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a NMR Research Unit, Institute of Neurology, Queen
Square, London, UK, b Brain Image Analysis Unit, Institute of Psychiatry, De
Crespigny Park, London, UK
Correspondence to: Professor A J Thompson, Institute of Neurology, University Department of Clinical Neurology, Queen Square, London WC1N 3BG, UK.
Received 5 March 1998 and in revised form 22
June 1998;
Accepted 29 June 1998
OBJECTIVES
Recovery from focal motor pathway
lesions may be associated with a functional reorganisation of cortical
motor areas. Previous studies of the relation between structural brain
damage and the functional consequences have employed MRI and CT, which
provide limited structural information. The recent development of
diffusion tensor imaging (DTI) now provides quantitative measures of
fibre tract integrity and orientation. The objective was to use DTI and
functional MRI (fMRI) to determine the mechanisms underlying the
excellent recovery found after a penetrating injury to the right
capsular region.
METHODSDTI and fMRI were performed on the patient
described; DTI was performed on five normal controls.
RESULTSThe injury resulted in a left hemiplegia
which resolved fully over several weeks. When studied 18 months later
there was no pyramidal weakness, a mild hemidystonia, and sensory
disturbance. fMRI activation maps showed contralateral primary and
supplementary motor cortex activation during tapping of each hand;
smaller ipsilateral primary motor areas were activated by the recovered
hand only. DTI disclosed preserved structural integrity and orientation
in the posterior capsular limb by contrast with the disrupted structure in the anterior limb on the injured side.
CONCLUSIONSThe findings suggest that the main
recovery mechanism was a preservation of the integrity and orientation
of pyramidal tract fibres. The fMRI studies do not suggest substantial
reorganisation of the motor cortex, although ipsilateral pathways may
have contributed to the recovery. The initial deficit was probably due
to reversible local factors including oedema and mass effect; permanent
damage to fibre tracts in the anterior capsular limb may account for the persistent sensory deficit. This study shows for the first time the
potential value of combining fMRI and DTI together to investigate
mechanisms of recovery and persistent deficit in an individual patient.
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