Demonstration of Injury of the Corticospinal Tract in a Patient with Suspected Motor Conversion Disorder.

A 54-year-old, right-handed woman presented with a 4-year history of quadriparesis. While arguing with other people, she suddenly showedweakness of the right upper and lower extremities. She underwent evaluation and conservative management with the suspicion of a cerebral infarct at the neurology department of a university hospital. However, no lesion was detected, except for a meningioma in the left posterior horn of the lateral ventricle (Fig. 1A). For precise diagnosis, she underwent thorough evaluation at 2 other university hospitals; following evaluation including conventional brain magnetic resonance imaging and electromyography, a conversation disorder was suspected. Subsequently, at approximately 3.5 years after onset, her right-sided weakness became slowly aggravated and spread to the left side. At 4 years after the onset of right-sided weakness, shewas admitted to the rehabilitation department of the first university hospital for rehabilitation, and she showed quadriparesis (manual muscle test: shoulder abductor, 2/4; elbow flexor, 2/4, finger extensor; 2/4, hip flexor; 1/4, knee extensor, 1/4; ankle dorsiflexor, 1/4). Diffusion tensor imaging data were obtained at 4 years after onset using a 6-channel head coil on a 1.5 T. For analysis of the corticospinal tracts (CSTs), the seed region of interest was placed on the anterior pontomedullary junction. The target regions of interest were placed in the primary motor cortex based