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

Abstract

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. 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. 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). 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.