Significance of rehabilitative management during the critical period for motor recovery in intracerebral hemorrhage: a case report.

OBJECTIVE The majority of motor recovery following stroke is known to occur within 3-6 months after onset; this period is therefore regarded as critical for motor recovery in stroke patients. We report here a case of a patient with intracerebral haemorrhage who showed changes in the affected motor function and in the damaged corticospinal tract (CST) at the primary motor cortex (M1) during rehabilitative management. CASE DESCRIPTION A 51-year-old woman underwent decompressive craniectomy and removal of haematoma due to a rupture of an arteriovenous malformation. Brain magnetic resonance imaging revealed a leukomalactic lesion at the fronto-parietal cortex centred on the precentral knob. Diffusion tensor imaging data were acquired 4 times (5, 8, 11 and 18 weeks after onset) and she started rehabilitation for right hemiplegia at 5 weeks after onset. RESULTS We found close relationships between changes in the CST branch from M1 on diffusion tensor tractography, the state of motor weakness, and the rehabilitative management: the CST branch from M1 was observed concurrently with motor recovery and the process of rehabilitation. CONCLUSION This case report indicates the importance of active and comprehensive rehabilitative management during the critical period for motor recovery in stroke patients.