Prognostic factors for motor outcome in patients with compressed corticospinal tract by intracerebral hematoma

Abstract

Little is known about prognostic factors associated with motor outcome when the corticospinal tract (CST) was compressed by hematoma. Using diffusion tensor tractography (DTT), we attempted to investigate prognostic factors for motor outcome in patients whose affected CST was compressed by hematoma. The study included 51 consecutive severe hemiparetic patients with a hematoma involving the corona radiata and basal ganglia. Integrities of the affected CSTs were preserved to the cerebral cortex and were found to be compressed by a hematoma on DTT. Patients were classified into four groups according to the region which the CST was originated from the precentral gyrus (type A), postcentral gyrus (type B), posterior parietal cortex (type C), and premotor cortex (type D). We measured the ratios of DTT parameters between affected/unaffected hemispheres.The motor function of the affected extremities at 6-month after onset was better with the following order: DTT type A, type B, type C, and type D patients. The 6-month motor function for DTT type A patients was higher than that of DTT type D patients (p=0.008). The fractional anisotropy ratio between the affected and unaffected CST was positively correlated with the 6-month motor function of the affected extremities (Pearson's correlation coefficient, p=0.025, r=0.313). We found that motor outcome differed according to the originated area of the affected CST and the degree of injury of the affected CST in patients whose affected CST was compressed by hematoma.