Table_1_Multi-modal fMRI and TMS follow-up study of motor cortical stroke caused by hyaluronic acid filler: A case report.DOCX

BackgroundBlindness and stroke resulting from hyaluronic acid (HA) fillers are not frequently reported complications. Reports on stroke recovery after HA injection are limited. In the current study, the recovery process, task-based functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), and neurophysiological changes of a patient with monocular blindness and ipsilateral motor cortical stroke after forehead injection of HA are explored.
Case-reportThe study comprised a 34-year-old female patient who presented with left eye blindness and a stroke after receiving an HA injection a month before admission. The lesion was mainly limited to the left precentral gyrus, and the patient had pure arm monoparesis. For 3 weeks, the patient received conventional rehabilitation treatments and ten sessions of repetitive transcranial magnetic stimulation (rTMS) intervention. Clinical assessments, neurophysiological evaluation, task-based fMRI, and DTI examinations were conducted to assess her motor improvement and the possible neuro mechanism.
Clinical rehabilitation impactThe patient's right upper limb motor function was almost completely restored after receiving rehabilitation therapy. However, the vision in her left eye did not show significant improvement. The neurophysiological evaluation showed partial recovery of the ipsilesional motor evoked potentials (MEPs). DTI results showed that the ipsilesional corticospinal tract (CST) was intact. Task-based fMRI results indicated that the activation pattern of the affected hand movement was gradually restored to normal.
ConclusionA case of good motor recovery after stroke due to HA injection with a lesion mainly restricted to the precentral gyrus but without CST damage is presented in the current study. Further studies should be conducted to explore the efficacy and the mechanisms of rehabilitation and neuromodulation approaches to motor cortical stroke.

研究背景：由透明质酸（hyaluronic acid, HA）填充剂引发的失明与脑卒中并非高发并发症，目前关于HA注射后脑卒中康复的相关报道较为有限。本研究针对1例前额部HA注射后出现单眼失明及同侧运动皮层脑卒中的患者，对其康复过程、任务态功能磁共振成像（functional magnetic resonance imaging, fMRI）、弥散张量成像（diffusion tensor imaging, DTI）及神经生理学变化展开探索。
病例报告：本研究纳入1例入院前1个月接受HA注射后出现左眼失明及脑卒中的34岁女性患者。其病灶主要局限于左侧中央前回，表现为单纯上肢单瘫。患者接受了为期3周的常规康复治疗及10次重复经颅磁刺激（repetitive transcranial magnetic stimulation, rTMS）干预。研究通过临床评估、神经生理学检查、任务态fMRI及DTI检查，对其运动功能改善情况及潜在神经机制进行分析。
临床康复效果：患者接受康复治疗后，右侧上肢运动功能基本完全恢复，但左眼视力未出现显著改善。神经生理学检查显示病灶侧运动诱发电位（motor evoked potentials, MEPs）部分恢复。DTI结果提示病灶侧皮质脊髓束（corticospinal tract, CST）结构完整。任务态fMRI结果显示，患侧手部运动的激活模式逐渐恢复正常。
结论：本研究报告1例HA注射引发脑卒中后运动功能良好恢复的病例，该患者病灶主要局限于中央前回，未累及皮质脊髓束。未来应开展进一步研究，探索针对运动皮层脑卒中的康复及神经调控手段的疗效与作用机制。