Usefulness of voxel-based lesion mapping for predicting motor recovery in subjects with basal ganglia hemorrhage: A preliminary study with 2 case reports

• Published in: Medicine (Baltimore) Vol. 95; no. 23; p. e3838
• Main Authors: Kim, Dae Hyun, Kyeong, Sunghyon, Cho, Yoona, Jung, Tae-min, Ahn, Sung Jun, Park, Yoon Ghil
• Format: Journal Article
• Language: English
• Published: United States The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved 01.06.2016; Wolters Kluwer Health
• Subjects: Adult; Basal Ganglia Hemorrhage - diagnosis; Basal Ganglia Hemorrhage - physiopathology; Brain Mapping - methods; Clinical Case Report; Diffusion Tensor Imaging - methods; Evoked Potentials, Motor - physiology; Follow-Up Studies; Humans; Male; Middle Aged; Motor Activity - physiology; Pyramidal Tracts - diagnostic imaging; Pyramidal Tracts - physiopathology; Recovery of Function - physiology
• ISSN: 0025-7974; 1536-5964; 1536-5964
• DOI: 10.1097/MD.0000000000003838

It is important to estimate motor recovery in the early phase after stroke. Many studies have demonstrated that both diffusion tensor tractography (DTT) and motor-evoked potentials (MEP) are valuable predictors of motor recovery, but these modalities do not directly reflect the status of the injured gray matter. We report on 2 subjects with basal ganglia hemorrhage who showed similar DTT and MEP findings, but had markedly different clinical outcomes. Specifically, Subject 1 showed no improvement in motor function, whereas Subject 2 exhibited substantial improvement 7 weeks after onset. To determine if differences in gray matter might lend insight into these different outcomes, we analyzed gray matter lesions of the 2 subjects using a novel voxel-based lesion mapping method. The lesion of Subject 1 mainly included the putamen, thalamus, and Heschl's gyri, indicating extension of the hemorrhage in the posterior direction. In contrast, the lesion of Subject 2 mainly included the putamen, insula, and pallidum, indicating that the hemorrhage extended anterior laterally. These differential findings suggest that voxel-based gray matter lesion mapping may help to predict differential motor recovery in subjects with basal ganglia hemorrhage with similar DTT and MEP findings.