Localization of central lesions by correlation of CT findings and neurological deficits

In a prospective study involving 100 patients with lesions in the precentral gyrus or pyramidal tract we sought to correlate clinical findings and the results of an axial computed tomography (CT) to localize the lesion. In 85% of patients the size and location of the lesion visible on CT correlated well with the type and severity of the neurological symptoms and signs. However, in the remaining 15% of patients the CT findings did not correlate well with the patient's neurological deficit, showing that in these patients the anatomy of the central area was variable or distorted by the space-occupying lesion. We suggest that in such patients neurophysiological techniques be used intra-operatively for reliable localization of the motor strip.