Recovery of an injured medial lemniscus pathway in a patient with intracerebral haemorrhage.

Abstract

OBJECTIVE: We describe here a patient with intracerebral haemorrhage who showed recovery of an injured medial lemniscus and its related thalamocortical pathway on follow- up diffusion tensor tractography. CASE REPORT: A 48-year-old man presented with right hemiplegia following a spontaneous intracerebral haemorrhage in the left corona radiata and basal ganglia. He underwent conservative management for intracerebral haemorrhage and comprehensive rehabilitative therapy. RESULTS: The kinesthetic sensation score (maximum score 24 points) of the Nottingham Sensory Assessment improved from 6 points (at 2 weeks after injury) to 10 points (at 6 weeks) and to 18 points (at 12 weeks). For the left thalamocortical pathway, a discontinuation at the left midbrain below the haematoma was observed on the 2-week diffusion tensor tractography. The 6-week diffusion tensor tractography showed that the integrity of the left thalamocortical pathway had been restored to the left primary motor cortex, and the 12-week diffusion tensor tractography showed restoration to the left primary somatosensory cortex. The fibre number of the left thalamocortical pathway showed an increase (470 at 2 weeks after injury, 1,080 at 6 weeks, and 1,626 at 12 weeks). CONCLUSION: This patient underwent recovery of an injured thalamocortical pathway over a period of 10 weeks after the second week following intracerebral haemorrhage, in terms of restoration of discontinued integrity and increased fibre number in the thalamocortical pathway.