A case report of a mild neurologic deficit with extensive poststroke damage to the subdominant brain hemisphere: analysis of data obtained from magnetic resonance tractography, functional magnetic resonance imaging, and electroencephalography

The severity of damage to different brain areas, including the cortex, can vary significantly in the associated neurologic deficit and reduction in the quality of life, often regardless of the lesion volume. The localization of the abnormalities plays a large part. Lesions of the dominant and subdominant hemispheres can differ greatly in both clinical features and effects on the patient’s quality of life. In this case report, a patient admitted for rehabilitation after two ischemic strokes underwent neurological and neuropsychological examination, complex instrumental diagnostics using electroencephalography, magnetic resonance imaging, computed tomography perfusion, magnetic resonance tractography, and functional magnetic resonance imaging. The patient had minimal left-sided hemiparesis, impaired regulation of voluntary activity, mild decrease in neurodynamic indicators, mildly impaired concentration, and a critical view of his condition. Neuroimaging findings demonstrated extensive postinfarction damage to the right subdominant hemisphere of the brain in the middle cerebral artery circulation. A nonconformity between the brain damage volume and the severity of its clinical signs was observed. Based on functional examination data, the dominant hemisphere was determined, and restructuring the functional centers was suggested. This clinical case was compared with similar ones, and their relationship with the data was analyzed. Information that expands the knowledge of the topography of the altered zones involved in motor and speech functions and the ability to perform arithmetic counting was obtained.