Extensive neurological recovery from a complete spinal cord injury: a case report and hypothesis on the role of cortical plasticity

Abstract

Neurological recovery in patients with severe spinal cord injury (SCI) is extremely rare. We have identified a patient with chronic cervical traumatic SCI, who suffered a complete loss of motor and sensory function below the injury for 6 weeks after the injury, but experienced a progressive neurological recovery that continued for 17 years. The extent of the patient's recovery from the severe trauma-induced paralysis is rare and remarkable. A detailed study of this patient using diffusion tensor imaging (DTI), magnetization transfer imaging (MTI), and resting state fMRI (rs-fMRI) revealed structural and functional changes in the central nervous system that may be associated with the neurological recovery. Sixty-two percent cervical cord white matter atrophy was observed. DTI-derived quantities, more sensitive to axons, demonstrated focal changes, while MTI-derived quantity, more sensitive to myelin, showed a diffuse change. No significant cortical structural changes were observed, while rs-fMRI revealed increased brain functional connectivity between sensorimotor and visual networks. The study provides comprehensive description of the structural and functional changes in the patient using advanced MR imaging technique. This multimodal MR imaging study also shows the potential of rs-fMRI to measure the extent of cortical plasticity.

Reduction of motion-related artifacts in resting state fMRI using aCompCor

“…Resting state functional connectivity (rs-FC) measures the temporal synchrony of spontaneous, low-frequency fluctuations in blood oxygen level dependent (BOLD) signals in functional Magnetic Resonance Imaging (fMRI) and has proven to be a powerful tool to examine the intrinsic functional organization of the brain in health (Barber et al, 2012; Biswal et al, 1995; Fox et al, 2005) and disease (Choe et al, 2013; Repovs et al, 2011; Rombouts et al, 2005). Rs-FC data are known to be contaminated by physiological effects including cardiac and respiratory events as well as other nuisances including the effects of head motion.…”

Intrinsic Visual-Motor Synchrony Correlates With Social Deficits in Autism

“…One method for measuring the temporal congruity of spontaneous activity in distributed brain regions is functional magnetic resonance imaging measured at rest (rs-fMRI) (14). rs-fMRI recently revealed increased intrinsic visual-motor synchrony in a chronic spinal cord injury patient, which may reflect cortical reorganization following dorsal column transection and the patient's self-reported over-reliance on visual feedback while walking (15). Does intrinsic visual-motor synchrony also relate to social skill and imitation ability in children with ASD?…”

Advances in Spinal Functional Magnetic Resonance Imaging in the Healthy and Injured Spinal Cords

“…Recently, functional magnetic resonance imaging (fMRI)-derived outcome measures have been proposed as such potential imaging biomarkers (10–12). The term fMRI, when used by itself, conventionally refers more specifically to task-activated fMRI (task-fMRI), which incorporates explicit motor or sensory tasks into its imaging paradigm to elicit neural activity.…”

“…This has strong clinical appeal, as it allows the use of an identical imaging protocol for all individuals, regardless of their degree of physical limitations. Consequently, several groups have begun to explore the potential of rsfMRI-derived outcome measures to serve as imaging biomarkers that can be used to study plastic changes in the spinal cord after injury (12). …”