Gait recovery by activation of the unaffected corticoreticulospinal tract in a stroke patient: A case report

RATIONALE: A 50-year-old man presented with complete paralysis at the onset of a putaminal hemorrhage. PATIENT CONCERNS: The patient presented with complete paralysis of the left upper and lower extremities (Medical Research Council:0/5). DIAGNOSES: Spontaneous intra crebral hemorrhage on putamen. INTERVENTION: He underwent comprehensive rehabilitative therapy from 3 weeks after onset. At 3weeks after onset, he presented with severe weakness of the left extremities. The weakness of his left extremities had recovered as follows at 3 months after onset. Consequently, he was able to walk independently on an even floor. OUTCOMES: On 3-week and 3-month diffusion tensor tractography (DTTs), the right corticospinal tract (CST) and the corticoreticulospinal tract (CRT) showed discontinuations below the lesion. On 3-month DTT, the left CST had become thinner; however, the left CRT had become thicker compared with 3-week DTT (Fig. 1). LESSONS: To the best of our knowledge, this is the first study to demonstrate the activation process of the CRT in the unaffected hemisphere in relation to gait recovery from early to chronic stage of stroke.