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Neurology 2000;54:1801-1805
© 2000 American Academy of Neurology
Articles

Ipsilateral hemiparesis after putaminal hemorrhage due to uncrossed pyramidal tract

H. Terakawa, MD, K. Abe, MD, M. Nakamura, MD, T. Okazaki, MD, J. Obashi, MD and T. Yanagihara, MD

From the Department of Neurology (Drs. Terakawa, Hakamura, and Okazaki), Osaka Koseinenkin Hospital; the Department of Neurology (Drs. Abe and Yanagihara), Osaka University Graduate School of Medicine; and Department of Neurosurgery (Dr. Obashi), Ohno Memorial Hospital, Japan.

Address correspondence and reprint requests to Dr. Kazuo Abe, Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565, Japan.

OBJECTIVE: Previous case reports supported the presence of the uncrossed pyramidal tract in exceptional patients. However, most of these case reports have not fully discussed involvement of the motor cortex controlling the ipsilateral limbs.

DESIGN AND METHOD: The authors investigated a 62-year-old man who developed right hemiparesis after right putaminal hemorrhage by using MRI, transcranial magnetic stimulation, functional MRI (fMRI), and sensory evoked potentials. He had moderate weakness including the face, spasticity with brisk deep tendon reflexes and Babinski sign, and impaired vibration and position sense, all on the right side.

RESULT: A MRI study showed hemorrhage in the right putamen and the wedge-shaped medulla. A fMRI study during a sequential finger opposition task showed activation in the motor cortex ipsilateral to the finger movements, but not on the contralateral side. Sensory evoked potentials showed cortical response ipsilateral to the side of stimulation.

CONCLUSION: The pyramidal tract and the dorsal column-medial lemniscus pathway did not cross in the medulla in this patient. In view of the presence of the abnormal shape in the medulla and congenital scoliosis, a congenital factor might be responsible for the uncrossed pyramidal tract and dorsal column-medial lemniscus in this patient.

Key words: Ipsilateral hemiparesis—Functional MRI—Ipsilateral innervation




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