Corticospinal tract recovery in a patient with traumatic transtentorial herniation

Transtentorial herniation is one of the causes of motor weakness in traumatic brain injury. In this study, we report on a patient who underwent decompressive craniectomy due to traumatic intracerebral hemorrhage. Brain CT images taken after surgery showed intracerebral hemorrhage in the left fronto-temporal lobe and left transtentorial herniation. The patient presented with severe paralysis of the right extremities at the time of intracerebral hemorrhage onset, but the limb motor function recovered partially at 6 months after onset and to nearly normal level at 27 months. Through diffusion tensor tractography, the left corticospinal tract was disrupted below the cerebral peduncle at 1 month after onset and the disrupted left corticospinal tract was reconstructed at 27 months. These findings suggest that recovery of limb motor function in a patient with traumatic transtentorial herniation can come to be true by recovery of corticospinal tract.