A Clinical Case of Corticospinal Tract Reorganization of Supplementary Motor Area in a Child After Acute Hypoxic Brain Injury

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Abstract

We present clinical observation of a 3-year-old child during recovery after acute hypoxic brain injury (freshwater drowning). Using diagnostic transcranial magnetic stimulation and magnetic resonance tractography with reconstruction of the corticospinal tract (CST) originated from the primary motor cortex and supplementary motor area (SMA), we determined that hypoxic brain injury induced activation of CST from the SMA. The period of reorganization was associated with the development of epileptiform patterns, that confirms the transient hyperexcitability of cortical neurons. Our findings indicate no recovery of motor function after acute hypoxic brain injury when CST originated only from SMA.

About the authors

Daria S. Kanshina

Research Institute of Emergency Pediatric Surgery and Traumatology

Author for correspondence.
Email: dr.d.kanshina@gmail.com
ORCID iD: 0000-0002-5142-9400

Cand. Sci. (Med.), Functional Diagnostics Doctor, Neurologist, Senior Researcher

Russian Federation, Moscow

Ilya A. Melnikov

Research Institute of Emergency Pediatric Surgery and Traumatology

Email: melnikov_ia@doctor-roshal.ru
ORCID iD: 0000-0002-2910-3711

Cand. Sci. (Med.), Radiologist, Senior Researcher, Head, CT-MRI Department

Russian Federation, Moscow

Maksim V. Ublinsky

Research Institute of Emergency Pediatric Surgery and Traumatology

Email: maxublinsk@mail.ru
ORCID iD: 0000-0002-4627-9874

Cand. Sci. (Biol.), Senior Researcher

Russian Federation, Moscow

Sergey S. Nikitin

Medical Genetic Research Center named after N.P. Bochkov

Email: nikitin-s@bk.ru
ORCID iD: 0000-0003-3292-2758

D. Sci. (Med.), Professor, Head, Department of Genetics of Neurological Diseases, Institute of Higher and Additional Professional Education

Russian Federation, Moscow

Svetlana A. Valliulina

Research Institute of Emergency Pediatric Surgery and Traumatology

Email: vsa64@mail.ru
ORCID iD: 0000-0002-1622-0169

D. Sci. (Med.), Professor, Director for Medical and Economic Issues, Head, Rehabilitation Department

Russian Federation, Moscow

Tolibdzhon A. Akhadov

Research Institute of Emergency Pediatric Surgery and Traumatology

Email: akhadov@mail.ru
ORCID iD: 0000-0002-3235-8854

D. Sci. (Med.), Professor, Head, Radiology Department

Russian Federation, Moscow

Maria A. Surma

National Medical and Surgical Center named after N.I. Pirogov

Email: maria_fnc@mail.ru
ORCID iD: 0000-0002-3692-2109

Neurologist, Doctor of Functional Diagnostics

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. MR tractogram with CST reconstruction of patient S. on day 56 from injury.

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3. Fig. 2. MR tractogram of patient S. in 6 months from injury. Predominance of CST originating from right SMA (blue).

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4. Fig. 3. EEG monitoring in patient S. during the awake stage in 6 months from injury.

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5. Fig. 4. Patient S., evaluation 1 year from injury.

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6. Fig. 5. Sleep EEG in patient S. 1 year from injury.

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Copyright (c) 2023 Kanshina D.S., Melnikov I.A., Ublinsky M.V., Nikitin S.S., Valliulina S.A., Akhadov T.A., Surma M.A.

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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