Prenatal infarction of the left middle cerebral artery: A case report of excellent functional outcome

Extensive cortical-subcortical damage of the left hemisphere, most likely d ue to prenatal infarction of the left middle cerebral artery, was accidenta lly detected in a 12-year-old left-handed girl. Since clinical symptoms wer e minimal, the lesion had not been discovered for more than a decade. Metic ulous examination revealed some slowness and somatosensory deficits of the right hand. Yet, independent finger movements were preserved, and functiona l skills such as reaching and grasping were unimpaired, as documented with optoelectronic motion analysis. There were no mirror movements. Transcrania l magnetic stimulation indicated that the right hand was controlled by spar ed cortical areas of the damaged hemisphere. Gait was normal. Neuropsycholo gical examination confirmed regular development of language, intellect, and visuospatial abilities. This case report demonstrates exceptionally good f unctional outcome after early brain damage.