Prognosis of the Ipsilesional Corticospinal Tracts with Preserved Integrities at the Early Stage of Cerebral...

This study examined the prognosis of the ipsilesional corticospinal tracts (CSTs) with preserved integrities at the early stage of cerebral infarction using follow-up diffusion tensor tractography (DTT). Thirty-one patients with a supratentorial infarction were recruited. DTT, Motricity Index (MI), modified Brunnstrom classification (MBC), and functional ambulation category (FAC) were performed twice at the early and chronic stages. The patients were classified into two groups based on the integrity of the ipsilesional CST on the second DTT: Group A (24 patients; 77.4%)—preserved integrity and Group B (7 patients; 22.6%)—disrupted integrity. No significant differences in MI, MBC, and FAC were observed between groups A and B at the first and second evaluations, except for FAC at the first evaluation (p > 0.05). MI, MBC, and FAC at the second evaluation were significantly higher than at the first evaluation in both groups A and B (p < 0.05). On the second DTT, one patient (4.2%) in group A showed a false-positive result, whereas five patients (71.4%) in group B had false-negative results. Approximately 20% of patients showed disruption of the ipsilesional CST at the chronic stage. However, the clinical outcomes in hand and gait functions were generally good. Careful interpretation considering the somatotopy of the ipsilesional CST is needed because of the high false-negative results on DTT at the chronic stage.