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Images in Neurology |

Evaluation of Functional Cortex for the Diseased Hand in a Patient After Hemispherectomy

Jakob Rath; Robert Schmidhammer, MD; Thomas Steinkellner; Nicolaus Klinger, MSc (FH); Alexander Geissler, MSc; Roland Beisteiner, MD, MA
Arch Neurol. 2008;65(12):1664-1665. doi:10.1001/archneur.65.12.1664.
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A 27-year-old man presented with increased motor deficits of the paretic left arm. The patient had an infarction of the right middle cerebral artery territory at 2 years of age and underwent functional hemispherectomy at 11 years (owing to intractable generalized epilepsy). The patient was transferred for reevaluation of his left arm's motor functions and possibly new central motor deficits. History revealed considerable recovery of hand motor function after the stroke and worsened hemiparesis after hemispherectomy, but secondary improvement of hand function after physiotherapy and orthopedic surgical procedures. On examination, the patient had spastic hemiparesis but voluntary control and sustained weak motor function of the hemiparetic left arm. Active fist clenching and full extension-flexion of the elbow joint were possible. Motility was somehow limited owing to contractures. Anatomical magnetic resonance imaging (MRI) showed no pathological findings in the remaining left hemisphere.

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Figure.

Functional echoplanar imaging originals (t > 12) showing activation in 3 slices covering the hand motor area (top row is most superior slice). A, Contralateral healthy hand activation shown in blue. B, Ipsilateral paretic hand activation shown in orange. C, Activation in both hands.

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