Preservation of Bilateral Corticospinal Projections from Injured Hemisphere After Perinatal Stroke
Background: Perinatal brain injury is a leading cause of developmental disabilities, including cerebral palsy. However, further work is needed to understand early brain development in the presence of brain injury. In this case report, we examine the longitudinal neuromotor development of a term infa...
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MDPI AG
2025-01-01
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| author | Cameron P. Casey Ellen N. Sutter Alina Grimaldo Kellie M. Collins Jose Guerrero-Gonzalez Ryan M. McAdams Douglas C. Dean Bernadette T. Gillick |
| author_facet | Cameron P. Casey Ellen N. Sutter Alina Grimaldo Kellie M. Collins Jose Guerrero-Gonzalez Ryan M. McAdams Douglas C. Dean Bernadette T. Gillick |
| author_sort | Cameron P. Casey |
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| description | Background: Perinatal brain injury is a leading cause of developmental disabilities, including cerebral palsy. However, further work is needed to understand early brain development in the presence of brain injury. In this case report, we examine the longitudinal neuromotor development of a term infant following a significant loss of right-hemispheric brain tissue due to a unilateral ischemic stroke. Our analysis focuses on the integrity and development of the corticospinal tract (CST) from the lesioned hemisphere. This case provides a unique opportunity to evaluate CST development after loss of the majority of the motor cortex. Methods: Evaluations were conducted when the infant was 4 (Visit-1), 18 (Visit 2), and 25 (Visit 3) months old. Assessments included magnetic resonance imaging (MRI) to characterize the lesion and quantify CST structural integrity, single-pulse transcranial magnetic stimulation (spTMS) to evaluate CST functional circuitry, and neuromotor assessments. Results: At Visit 1, bilateral CSTs were identified through diffusion-weighted MRI (dMRI) despite an estimated loss of 92.7% (7.3% retained) of age-typical motor cortex from the right hemisphere. Both hemispheres exhibited bilateral motor-evoked potential in response to stimulation with spTMS, which remained when reassessed at Visits 2 and 3. Longitudinal MRI showed distinct developmental trajectories of CST integrity in each hemisphere, with the lesioned hemisphere exhibiting initial increases in integrity between Visits 1 and 2 followed by a decrease in integrity between Visits 2 and 3. The non-lesioned hemisphere showed increased integrity from Visit 1 to Visit 2, which remained stable at Visit 3. Motor assessments at all visits indicated a high risk of cerebral palsy. Conclusions: This report highlights the utility of MRI and spTMS in studying neuromotor development. The findings reveal preserved functional bilateral CST circuitry despite majority loss of the right-hemispheric motor cortex as well as distinct developmental trajectories in CST integrity between hemispheres. These results underscore the potential for neural plasticity after perinatal brain injury. Clinical Trials Registration: NCT05013736. |
| format | Article |
| id | doaj-art-d605bc9fa8ef4f80821b0c5047d979c6 |
| institution | Kabale University |
| issn | 2076-3425 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | MDPI AG |
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| series | Brain Sciences |
| spelling | doaj-art-d605bc9fa8ef4f80821b0c5047d979c62025-01-24T13:25:55ZengMDPI AGBrain Sciences2076-34252025-01-011518210.3390/brainsci15010082Preservation of Bilateral Corticospinal Projections from Injured Hemisphere After Perinatal StrokeCameron P. Casey0Ellen N. Sutter1Alina Grimaldo2Kellie M. Collins3Jose Guerrero-Gonzalez4Ryan M. McAdams5Douglas C. Dean6Bernadette T. Gillick7Waisman Center, University of Wisconsin-Madison, Madison, WI 53706, USAWaisman Center, University of Wisconsin-Madison, Madison, WI 53706, USAWaisman Center, University of Wisconsin-Madison, Madison, WI 53706, USAWaisman Center, University of Wisconsin-Madison, Madison, WI 53706, USAWaisman Center, University of Wisconsin-Madison, Madison, WI 53706, USADepartment of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706, USAWaisman Center, University of Wisconsin-Madison, Madison, WI 53706, USAWaisman Center, University of Wisconsin-Madison, Madison, WI 53706, USABackground: Perinatal brain injury is a leading cause of developmental disabilities, including cerebral palsy. However, further work is needed to understand early brain development in the presence of brain injury. In this case report, we examine the longitudinal neuromotor development of a term infant following a significant loss of right-hemispheric brain tissue due to a unilateral ischemic stroke. Our analysis focuses on the integrity and development of the corticospinal tract (CST) from the lesioned hemisphere. This case provides a unique opportunity to evaluate CST development after loss of the majority of the motor cortex. Methods: Evaluations were conducted when the infant was 4 (Visit-1), 18 (Visit 2), and 25 (Visit 3) months old. Assessments included magnetic resonance imaging (MRI) to characterize the lesion and quantify CST structural integrity, single-pulse transcranial magnetic stimulation (spTMS) to evaluate CST functional circuitry, and neuromotor assessments. Results: At Visit 1, bilateral CSTs were identified through diffusion-weighted MRI (dMRI) despite an estimated loss of 92.7% (7.3% retained) of age-typical motor cortex from the right hemisphere. Both hemispheres exhibited bilateral motor-evoked potential in response to stimulation with spTMS, which remained when reassessed at Visits 2 and 3. Longitudinal MRI showed distinct developmental trajectories of CST integrity in each hemisphere, with the lesioned hemisphere exhibiting initial increases in integrity between Visits 1 and 2 followed by a decrease in integrity between Visits 2 and 3. The non-lesioned hemisphere showed increased integrity from Visit 1 to Visit 2, which remained stable at Visit 3. Motor assessments at all visits indicated a high risk of cerebral palsy. Conclusions: This report highlights the utility of MRI and spTMS in studying neuromotor development. The findings reveal preserved functional bilateral CST circuitry despite majority loss of the right-hemispheric motor cortex as well as distinct developmental trajectories in CST integrity between hemispheres. These results underscore the potential for neural plasticity after perinatal brain injury. Clinical Trials Registration: NCT05013736.https://www.mdpi.com/2076-3425/15/1/82perinatal strokeTMScase reportmotor developmentcorticospinal tract |
| spellingShingle | Cameron P. Casey Ellen N. Sutter Alina Grimaldo Kellie M. Collins Jose Guerrero-Gonzalez Ryan M. McAdams Douglas C. Dean Bernadette T. Gillick Preservation of Bilateral Corticospinal Projections from Injured Hemisphere After Perinatal Stroke Brain Sciences perinatal stroke TMS case report motor development corticospinal tract |
| title | Preservation of Bilateral Corticospinal Projections from Injured Hemisphere After Perinatal Stroke |
| title_full | Preservation of Bilateral Corticospinal Projections from Injured Hemisphere After Perinatal Stroke |
| title_fullStr | Preservation of Bilateral Corticospinal Projections from Injured Hemisphere After Perinatal Stroke |
| title_full_unstemmed | Preservation of Bilateral Corticospinal Projections from Injured Hemisphere After Perinatal Stroke |
| title_short | Preservation of Bilateral Corticospinal Projections from Injured Hemisphere After Perinatal Stroke |
| title_sort | preservation of bilateral corticospinal projections from injured hemisphere after perinatal stroke |
| topic | perinatal stroke TMS case report motor development corticospinal tract |
| url | https://www.mdpi.com/2076-3425/15/1/82 |
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