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September 9, 2020
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Teaching NeuroImages: Stroke With Nondecussating Corticospinal Tracts Causing Ipsilateral Weakness
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Lily W. Zhou, MD https://orcid.org/0000-0002-3064-0864, Jason Chew, MBChB, FRCPC, and Thalia S. Field, MHSc, MD, FRCP https://orcid.org/0000-0002-1176-0633Authors Info & Affiliations
January 19, 2021 issue
96 (3) e480-e481
https://doi.org/10.1212/WNL.0000000000010804
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A 43-year-old man presented with left carotid dissection. Examination showed left-sided Horner, left facial weakness, and left pronator drift. MRI brain showed a small left frontal infarct (figure 1), with no other areas of infarction and nondecussating corticospinal tracts on diffusion tensor imaging (figure 2).
Figure 1 CT Angiogram and Diffusion Weighted MRI
CT angiogram showing left carotid dissection with luminal irregularity and mural thickening of the left carotid from C2 up to the carotid canal on sagittal image (panel A, long solid arrow) and reduced opacification at the carotid canal on axial image (panel B, large hollow arrow). Axial MRI head showing restricted diffusion on B1000 diffusion weighted imaging (panel C, short solid arrow) and apparent diffusion coefficient (panel D, short solid arrow) demonstrating left-sided subacute frontal stroke.
Figure 2 Diffusion Tensor Imaging
Coronal reformatted diffusion tensor imaging showing nondecussation of white matter tracts in the caudal medulla (panel A) compared with normal control (panel B, arrow showing decussation).
Several congenital syndromes are associated with nondecussating tracts and mirror movements.1 The prevalence of nondecussating corticospinal tracts in the general population is unknown. Ipsilateral hemiparesis is also reported with previous contralateral infarcts possibly from the disruption of compensating normal uncrossed corticospinal fibres.2 This patient has no baseline impairment and demonstrates nondecussating tracts as an anatomical variant.

Appendix Authors

Footnote

Teaching slides links.lww.com/WNL/B212

References

1.
Sag E, Gocmen R, Yildiz FG, et al. Congenital mirror movements in Gorlin syndrome: a case report with DTI and functional MRI features. Pediatrics 2016;137:e20151771.
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2.
Inatomi Y, Nakajima M, Yonehara T, Ando Y. Ipsilateral hemiparesis in ischemic stroke patients. Acta Neurol Scand 2017;136:31–40.
Crossref
PubMed
Google Scholar

Information & Authors

Information

Published In

Neurology®
Volume 96 • Number 3 • January 19, 2021
Pages: e480-e481
PubMed: 32907963

Copyright

© 2020 American Academy of Neurology.

Publication History

Published online: September 9, 2020
Published in print: January 19, 2021

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Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

Study Funding

No targeted funding reported.

Authors

Affiliations & Disclosures

Lily W. Zhou, MD https://orcid.org/0000-0002-3064-0864
From the Department of Neurology (L.W.Z., T.S.F.), University of British Columbia; and Department of Radiology (J.C.), University of British Columbia, Vancouver, Canada.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
American Academy of Neurology, Founders Award 2019
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
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Jason Chew, MBChB, FRCPC
From the Department of Neurology (L.W.Z., T.S.F.), University of British Columbia; and Department of Radiology (J.C.), University of British Columbia, Vancouver, Canada.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
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Thalia S. Field, MHSc, MD, FRCP https://orcid.org/0000-0002-1176-0633
From the Department of Neurology (L.W.Z., T.S.F.), University of British Columbia; and Department of Radiology (J.C.), University of British Columbia, Vancouver, Canada.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
Servier
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
Bayer Canada (In kind study medication)
Research Support, Government Entities:
1.
Canadian Institutes of Health Research
Research Support, Academic Entities:
1.
Vancouver Coastal Health Research Institute
Research Support, Foundations and Societies:
1.
Heart and Stroke Foundation of Canada Michael Smith Foundation for Health Research Centre for Baycrest Health Innovation (CABHI) Alzheimer’s Society of Canada
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
Canadian Medical Protective Agency - Expert witness
View all articles by this author

Notes

Correspondence Dr. Field [email protected]
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

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