• Sung Ho Jang, Chul Hoon Chang, Young Jin Jung, and You Sung Seo.
• Department of Physical Medicine and Rehabilitation.
• Medicine (Baltimore). 2018 Dec 1; 97 (50): e13401.

RationaleA few studies using diffusion tensor tractography (DTT) have demonstrated recovery of injured corticoreticulospinal tract (CRT) in patients with intracerebral hemorrhage and infarct. However, no study reported on a patient who showed peri-infarct reorganization of an injured CRT following a middle cerebral artery territory infarct.Patient ConcernsA 56-year-old right-handed male patient was diagnosed as spontaneous subarachnoid hemorrhage (SAH) and intraventricular hemorrhage (IVH) and underwent clipping for a ruptured anterior communicating artery aneurysm and right frontal extraventricular drainage for IVH at the department of neurosurgery of a university hospital. After onset, he presented with complete weakness of both legs.DiagnosesThe patient was diagnosed as spontaneous SAH and IVH.InterventionsClinical assessment and DTT were performed at 1, 3, 6, and 20 months after onset.OutcomesThe weakness of both legs showed slow recovery for 10 months until 11 months after onset (medical research council: 6 months; 3/3 and 11 months; 4/4). As a result, he was able to walk independently on an even floor at 6 months and on stairs at 11 months after onset. The discontinued both CRTs on 1-month DTT were restored to the cerebral cortex on 3-month DTT, and then thickened consecutively on 6-month and 20-month DTTs.LessonsThe recovery process of injured CRTs concurrent with recovery of leg weakness was demonstrated in a patient with SAH using DTT. This study has important implications in terms of regaining gait function by the recovery of bilaterally injured CRTs which was facilitated by the long-term rehabilitation.

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