Hand Function and Diffusion Tensor Imaging according to Response of Evoked Potentials in Post-stroke Hemiplegic Patients

OBJECTIVE: To investigate the association between evoked potentials and fractional anisotropy (FA) ratio in posterior limb of the internal capsule and hand movement scale (HMS) in post-stroke hemiplegic patients. METHOD: Thirty-six post-stroke hemiplegic patients with a lesion in the internal capsule were included in this study. Diffusion tensor imaging (DTI) was performed with a 3.0 tesla MR at about 1 month after stroke. FA ratio was measured in posterior limb of the internal capsule of the patients. Motor evoked potential (MEP) was obtained by magnetic stimulation of the motor cortex and recorded from the abductor pollicis muscle. Somatosensory evoked potential (SSEP) was obtained by electrical stimulation of the median nerve at the wrist and recorded from the somatosensory cortex. Hand movement scale was obtained at about 1 month and 3 months after stroke. RESULTS: Hand movement scale at about 1 month and 3 months after stroke and FA ratio were reduced significantly in patients who showed no response on MEP. However, no significant differences were observed between the patients who showed SSEP response and those who did not. FA ratio and hand movement scale were highly correlated to each other. CONCLUSION: MEP and FA ratio can be helpful in assessing the hand function at about 1 month and 3 months in post-stroke hemiplegic patients.

Recovery of Hand Motor Function in Patients with Subcortical Hemorrhage

OBJECTIVE: The aim of this study was to find out the factors related to the recovery of hand motor function in patients with subcortical hemorrhage. METHOD: We investigated 21 patients with subcortical hemorrhage prospectively. We used their CT and/or MR imaging for the localization and estimation of the size of lesion. The Hand Movement Scale (HMS) was used for evaluation of the hand function. Proprioception, initial shoulder and hand recovery were also measured every month for at least 6 months during the follow up periods. RESULTS: There are 13 patients with putaminal hemorrhage and 8 patients with thalamic hemorrhage. There is no difference in general characteristics between the two groups. When recovery began within 4 weeks after onset, only thalamic hemorrhage patients showed significantly good recovery. Initial shoulder shrug, especially within 4 weeks after onset, could be one of the prognostic factors of good hand motor recovery. Putaminal hemorrhage patients, who had higher scores on the hand movement scale, showed early recovery of proprioceptive function. CONCLUSION: Among many other factors which can be involved in the recovery of hand function in patients with subcortical hemorrhage, the time of initial hand motor recovery, the time of initial shoulder shrug, and proprioceptive function were most important.