A case of porencephaly with mirror movements: pathophysiological investigation by using long-latency long-loop reflex and dipole tracing method

We report a 42-year-old left-handed woman with congenital right hemiparesis and bilateral mirror movements in the hands. She had a porencephaly of the left hemisphere and the brain MRI demonstrated cortical and subcortical defect of the left hemisphere from Brodmann's area 6 to 40 including the left motor cortex. By electrical stimulation of the left median nerve at the wrist, N20 of the somatosensory evoked potential was recorded in the right postcentral gyrus by using the dipole tracing method. Long-loop reflexes from the bilateral thenar muscles were recorded and their latencies were almost the same. The stimulation of the right median nerve did not evoke N20, nor long-loop reflex. These electrophysiological findings suggest that the reorganization of the motor system made the right motor cortex to innervate bilateral hands, and caused bilateral mirror movements. In other words, the mirror movements managed to relieve the paralysis of the right hand though the damage of the left motor cortex was present. In the previous literature we are able to find hypotheses regarding the mechanism of mirror movements in congenital hemiparesis. Here we discussed about the reorganization of the motor system in the damaged brain.