Recovery of an Injured Corticoreticulospinal Tract in a Patient With Cerebral Infarct

A 66-year-old right-handed female patient developed absolute weakness of the right lower extremity (Manual Muscle Test [MMT], 0/5), following an infarct in the left supplementary motor area and premotor cortex (Fig. 1A). She underwent conservative management at the neurology department of a university hospital. Two weeks after the infarct, she was transferred to the rehabilitation department of the same university hospital. The weakness of the right lower extremity was similar to that seen at the time of the infarct (MMT, 0/5). She underwent comprehensive rehabilitative management, including neurotropic drugs (pramipexole, amantadine, and venlafaxine), movement therapy, and neuromuscular electrical stimulation of the right knee extensor and ankle dorsiflexor muscles. After rehabilitation for 6 weeks, there was significant motor recovery of her right lower extremity (MMT: hip flexor, 3; knee extensor, 3; and ankle dorsiflexor, 0). At 8 weeks after the onset, she was able to walk independently on an even floor, fitted with an ankle-foot-orthosis