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Usefulness of voxel-based lesion mapping for predicting motor recovery in subjects with basal ganglia hemorrhage: A preliminary study with 2 case reports

Kim, Dae Hyun MD; Kyeong, Sunghyon PhD; Cho, Yoona MD; Jung, Tae-min MD; Ahn, Sung Jun MD, PhD; Park, Yoon Ghil MD, PhD

Section Editor(s): Masoomi., Michael

doi: 10.1097/MD.0000000000003838
Research Article: Clinical Case Report

It is important to estimate motor recovery in the early phase after stroke. Many studies have demonstrated that both diffusion tensor tractography (DTT) and motor-evoked potentials (MEP) are valuable predictors of motor recovery, but these modalities do not directly reflect the status of the injured gray matter. We report on 2 subjects with basal ganglia hemorrhage who showed similar DTT and MEP findings, but had markedly different clinical outcomes. Specifically, Subject 1 showed no improvement in motor function, whereas Subject 2 exhibited substantial improvement 7 weeks after onset. To determine if differences in gray matter might lend insight into these different outcomes, we analyzed gray matter lesions of the 2 subjects using a novel voxel-based lesion mapping method. The lesion of Subject 1 mainly included the putamen, thalamus, and Heschl's gyri, indicating extension of the hemorrhage in the posterior direction. In contrast, the lesion of Subject 2 mainly included the putamen, insula, and pallidum, indicating that the hemorrhage extended anterior laterally. These differential findings suggest that voxel-based gray matter lesion mapping may help to predict differential motor recovery in subjects with basal ganglia hemorrhage with similar DTT and MEP findings.

aDepartment of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul

bSeverance Biomedical Science Institute, Yonsei University College of Medicine

cDepartment of Rehabilitation Medicine and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine

dDepartment of Radiology, Yonsei University College of Medicine.

Correspondence: Yoon Ghil Park, Department of Rehabilitation Medicine and Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, South Korea (e-mail:

Abbreviations: AAL = automated anatomical labeling, BGH = basal ganglia hemorrhage, FA = fractional anisotropy, FAC = functional ambulation categories, FACT = fiber assignment continuous tracking, FMA = Fugl–Meyer assessment, FMRIB = functional magnetic resonance imaging of the brain, MBI = modified Barthel index, MEP = motor-evoked potential monitoring, MNI = standardized Montreal Neurological Institute, MRC = medical research council, MRI = magnetic resonance imaging.

Our manuscript has been prepared according to the SQUIRE 2.0 checklist.

The authors have no funding and conflicts of interest to disclose.

This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received January 27, 2016

Received in revised form April 8, 2016

Accepted April 11, 2016

Copyright © 2016 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.