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Peri-Infarct Reorganization of an Injured Corticoreticulospinal Tract in a Patient with Cerebral Infarct

A 50-year-old man presented with complete paralysis of the left upper and lower extremities [Medical Research Council (MRC):0/5] at the onset of an infarct in the right middle cerebral artery (MCA) territory. At four-weeks after onset, he was administered comprehensive rehabilitative therapy until 10 weeks after onset. He presented with severe weakness of the left extremities (shoulder abductor, 0; finger extensors, 0; hip flexor, 2−; knee extensor, 2;− and ankle dorsiflexor, 0). The weakness of his left leg showed good recovery for six-weeks until 10 weeks after onset (shoulder abductor, 4; finger extensors, 0; hip flexor, 4−; knee extensor, 4−; and ankle dorsiflexor, 1). On four-week diffusion tensor tractography (DTT) for the corticoreticulospinal tract (CRT), the right CRT showed discontinuation at the corona radiata level and was connected to the corpus callosum (1). However, the right discontinued CRT was restored to the premotor cortex through the lateral ventricular wall on 10-week DTT (Fig. 1). His motor recovery occurred mainly in the proximal muscles, which are responsible for the CRT. In comparison with the result of the previous study, which reported that the CRT was located at an average of 21·94 mm lateral from the midline at the corona radiata level, it appears that the right CRT was injured completely at the onset of MCA infarct. On four-week DTT, the discontinuation of the right (affected) CRT was restored through the intact lateral ventricular wall and connected to the right premotor cortex. According to the result of a previous study, because the lateral ventricular wall is not the location of the CRT in normal subjects (2), we believe that the motor function of the affected leg had been recovered by peri-infarct reorganization of the injured CRT into the medial area (the lateral ventricular wall) following a MCA infarct. To the best of our knowledge, this is the first study to report on peri-infarct reorganization of the CRT (3).