脳出血後における上肢麻痺の回復と白質の変化の関連性—発症からの時期が異なる2症例による検討

Relationship between recovery of upper limb mobility and changes in white matter after cerebral hemorrhage: Consideration of two cases according to time from onset

要旨：今回，脳出血後に上肢麻痺を呈した2症例に対し，脳卒中後の上肢麻痺に対してエビデンスが確立された介入を麻痺手の状態に合わせて行った．また，得られた上肢機能や使用行動の改善と白質のFractional Anisotropy（以下，FA）の変化の関連性を検討した．結果，2症例ともに上肢機能や使用行動の改善が得られ，FAでは鉤状束のみが両者とも向上した．そのため，上肢機能や使用行動の改善に伴って，運動機能に関わる皮質脊髄路の可塑的変化が生じる可能性は低いと思われた．一方で，報酬系に関わる鉤状束の可塑的変化が生じる可能性が示された．

　In this study, we provided evidence-based practice for two cases with upper limb paralysis after cerebral hemorrhage. The intervention was tailored to the condition of the affected arm. We also investigated the relationship between improved upper limb function, behavior of using the affected arm, and changes in white matter Fractional Anisotropy (FA). As a result, the intervention improved both upper limb function and affected arm behavior in both cases. However, only FA in the uncinate fasciculus was improved. Therefore, it is unlikely that plastic changes in the corticospinal tract related to motor function will occur along with improvement of the upper limb function and behavior of using the affected arm. On the other hand, it was shown that the plastic change of the uncinate fasciculus related to the reward system may occur.