Hyeok Gyu Kwon1, Sung Ho Jang2

1Department of Physical Therapy, Graduate School of Rehabilitation Science, Daegu University, Daegu 705-717, Republic of Korea
2Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 705-717, Republic of Korea

Abstract
The present study reported a 58-year-old male patient who exhibited complete paralysis of the right extremities at stroke onset. Brain MR images showed an infarct in the left medullary pyramid and a small spared area on the medial side of the infarct. He gained the ability to extend the affected fingers against gravity and to dorsiflex the affected ankle without gravity at 3 months after stroke onset. Diffusion tensor imaging results showed that at 6 months after stroke onset, the corticospinal tract of the affected (left) hemisphere descended through the small spared area of the infarcted medullary pyramid. No motor-evoked potential was elicited from the affected (left) hemisphere at   2 weeks after stroke onset; however, motor-evoked potential was elicited at 6 months as shown by transcranial magnetic stimulation results. The motor function of the affected side of this patient appears to have been recovered via the corticospinal tract that passed through the small spared area within the infarcted medullary pyramid.
Key Words: diffusion tensor tractography; diffusion tensor imaging; corticospinal tract; stroke; medulla

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