Rationale: We report on a patient with traumatic brain injury who showed motor recovery concurrent with recovery of injured corticofugal tracts (CFTs), diagnosed by diffusion tensor tractography (DTT). Patient concerns: Four weeks after onset, when the patient started rehabilitation, he showed severe weakness of both upper and lower extremities [Motricity Index (MI, full score: 100/100): 9/30]. Diagnoses: A 29-year-old male patient underwent conservative management for traumatic hemorrhages in both frontal lobes and right thalamus resulting from a car accident. Interventions: The patient participated in a comprehensive rehabilitative management program, including movement therapy, dopaminergic drugs for improvement of apraxia (pramipexole: 2.5mg, amantadine: 300mg, ropinirole: 0.75 mg, and levodopa: 500mg), and neuromuscular electrical stimulation therapy of the right elbow extensors, finger extensors, both knee extensors, and ankle dorsiflexors. Outcomes: After 2 months' intensive rehabilitation, his motor weakness rapidly recovered to the point that he was able to move all 4 extremities against some resistance (MI: 75/75). The right supplementary motor area (SMA)-CFT showed narrowing and partial tearing in the upper portion on 1-month DTT, and became thicker on 3-month DTT. Compared to the 12 normal control subjects, the fractional anisotropy (FA) values of the right corticospinal tract and both dorsal premotor cortex-CFT were more than 1 standard deviation lower than those of normal control subjects on both 1- and 3-month DTTs. Lessons: Although the tract volume of the right SMA-CFT was more than 1 standard deviation lower than normal control subjects on 1-month DTT, it increased to within 1 standard deviation on 3-month DTT. Recovery of the injured SMA-CFT concurrent with motor recovery was demonstrated in a patient with traumatic brain injury.
<b><i>Objectives:</i></b> Little is known about optic radiation (OR) injury in intracerebral hemorrhage (ICH). We attempted to investigate OR injury in patients with ICH by diffusion tensor imaging (DTI). <b><i>Methods:</i></b> Forty-three consecutive patients with putaminal hemorrhage and 40 normal healthy control subjects were recruited. DTI data were acquired at the beginning of rehabilitation (average 34 days after onset). DTI-Studio software was used to reconstruct the OR. Fractional anisotropies (FA) and fiber numbers of the ORs were measured. FA values and fiber numbers of affected ORs were described as abnormal when they were more than 2.5 SD lower than those of normal controls. <b><i>Results:</i></b> Thirty (70%) of the 43 patients showed an OR abnormality in the affected hemisphere. In 13 (30%) patients, the affected OR was disrupted or nonreconstructable. On the other hand, of the 20 patients with preserved OR integrity, 14 (33%) had a low FA value and 3 (7%) a low FA and fiber number. The other 13 (30%) of the 43 patients had no abnormal OR findings. <b><i>Conclusion:</i></b> Seventy percent of patients showed any abnormality of OR in the affected hemisphere on DTI. This result suggests that patients with putaminal hemorrhage are at high risk of OR injury.
A 50-year-old female patient underwent conservative management for a right corona radiata infarct at the Department of Neurology in a university hospital (Figure 1A).She had no history of diabetes, hypertension, or heart disease.The patient received a loading dose of clopidogrel (300 mg/day), followed by 75 mg/day plus 100 mg/day aspirin.She was transferred to the rehabilitation department of the same hospital 2 weeks after infarct onset.Prior to this presentation, the patient had no history of any neurological or psychological disorders.Physical examination revealed ataxia on her left upper and lower limbs.She scored 10 on the Scale for Assessment and Rating of Ataxia (range, 0-40 points with a higher score indicating a poorer state).In addition, she had mild weakness in the left upper and lower limbs (manual muscle test revealed a good grade on the upper and lower limbs).She was able to walk independently indoors with supervision and needed no physical assistance.There were no observations indicating spasticity, sensory deficits, visual disturbance, language impairment (such as dysarthria and aphasia),
Rationale: To report a patient with primary progressive freezing gait (PPFG) whose degeneration of corticofugal tract (CFT) from the supplementary motor area (SMA) was demonstrated using diffusion tensor tractography (DTT). Patient concerns: A 66-year-old woman presented with a solitary symptom of a sudden transient break on walking (i.e., freezing gait), which slowly progressed for 4 years. Diagnoses: Imaging evidence using magnetic resonance imaging and 18F-florinated-N-3-fluoropropyl-2-β-carboxymethoxy-3-β-(4-lodophenyl) nortropane positron emission tomography scanning was unremarkable, and our patient's symptom was not affected by dopamine agonist medication. Based on the clinical symptoms and imaging findings, we diagnosed our patient as having PPFG. Interventions: From the patient and 20 age- and sex- matched normal controls, diffusion tensor imaging data were acquired using a 1.5 T magnetic resonance scanner. Outcomes: In DTT findings, the CFT from the left SMA was partially torn and thinned. Moreover, the fractional anisotropy value and tract volume of CFT from the left SMA were more than two standard deviations lower than those of normal controls. Lessons: In our opinion, the lesion in the CFT from the left SMA in our patient was attributed to the occurrence of PPFG. We believe that the results of this study suggest one of the pathological mechanisms for the occurrence of gait difficulty in PPFG.
Objectives: To advance development of rehabilitation robots, the conditions to induce appropriate brain activation during rehabilitation performed by robots should be optimized, based on the concept of brain plasticity. In this study, we examined differences in cortical activation according to the speed of passive wrist movements performed by a rehabilitation robot. Methods: Twenty three normal subjects participated in this study. Passive movements of the right wrist were performed by the wrist rehabilitation robot at three different speeds: 0.25 Hz; slow, 0.5Hz; moderate and 0.75 Hz; fast. We used functional near-infrared spectroscopy to measure the brain activity accompanying the passive movements performed by a robot. The relative changes in oxy-hemoglobin (HbO) were measured in two regions of interest: the primary sensory-motor cortex (SM1) and premotor area (PMA). Results: In the left SM1 the HBO value was significantly higher at 0.5Hz, compared with movements performed at 0.25Hz and 0.75Hz (p0.05). In the group analysis, the left SM1 was activated during passive movements at three speeds (uncorrected p<0.05) and the greatest activation in the SM1 was observed at 0.5 Hz. Conclusions: In conclusion, the contralateral SM1 showed the greatest activation by a moderate speed (0.5 Hz) rather than slow (0.25 Hz) and fast (0.75 Hz) speed. Our results suggest an ideal speed for execution of the wrist rehabilitation robot. Therefore, our results might provide useful data for more effective and empirically-based robot rehabilitation therapy.
Objectives: We reported on a patient with mild traumatic brain injury (TBI) who showed recovery of an injured cingulum concurrent with improvement of short-term memory, which was demonstrated on follow-up diffusion tensor tractography (DTT).Methods: A 55-year-old male patient suffered head trauma resulting from falling from approximately 2 m while working at a construction site. The patient showed mild memory impairment (especially short-term memory impairment) at 3 months after onset: Memory Assessment Scale (global memory: 95 (37%ile), short-term memory: 75 (5%ile), verbal memory: 80 (9%ile) and visual memory: 112 (79%ile)). By contrast, at 2 years after onset, his mild memory impairment had improved to a normal state: Memory Assessment Scale (global memory: 104 (61%ile), short-term memory: 95 (37%ile), verbal memory: 101 (53%ile) and visual memory: 106 (66%ile)).Results: On 3-month DTT, discontinuation of the right anterior cingulum was observed over the genu of the corpus callosum, while on 2-year DTT, the discontinued right anterior cingulum was elongated to the right basal forebrain.Conclusion: In conclusion, recovery of an injured cingulum concurrent with improvement of short-term memory was demonstrated in a patient with mild TBI.
Diffusion tensor imaging (DTI) provides valuable information on the subcortical white matter that is unavailable with conventional CT and MRI.Therefore, the development of DTI in the 1990s led to a new era for examination of the subcortical white matter in live human brains (1).In addition, diffusion tensor tractography (DTT), which is reconstructed from DTI data, is used to visualize and estimate the neural tracts in the subcortical white matter of the brain (2, 3).As a result, DTI has contributed to the revolutionary development of neuroscience.For example, it allows the detection of brain lesions, which are undetectable by conventional MRI in various brain pathologies, including axonal injury in a concussion, stroke, hypoxic-ischemic brain injury, and cerebral palsy (4-7).
We describe here a patient with intracerebral haemorrhage who showed recovery of an injured medial lemniscus and its related thalamocortical pathway on follow- up diffusion tensor tractography.A 48-year-old man presented with right hemiplegia following a spontaneous intracerebral haemorrhage in the left corona radiata and basal ganglia. He underwent conservative management for intracerebral haemorrhage and comprehensive rehabilitative therapy.The kinesthetic sensation score (maximum score 24 points) of the Nottingham Sensory Assessment improved from 6 points (at 2 weeks after injury) to 10 points (at 6 weeks) and to 18 points (at 12 weeks). For the left thalamocortical pathway, a discontinuation at the left midbrain below the haematoma was observed on the 2-week diffusion tensor tractography. The 6-week diffusion tensor tractography showed that the integrity of the left thalamocortical pathway had been restored to the left primary motor cortex, and the 12-week diffusion tensor tractography showed restoration to the left primary somatosensory cortex. The fibre number of the left thalamocortical pathway showed an increase (470 at 2 weeks after injury, 1,080 at 6 weeks, and 1,626 at 12 weeks).This patient underwent recovery of an injured thalamocortical pathway over a period of 10 weeks after the second week following intracerebral haemorrhage, in terms of restoration of discontinued integrity and increased fibre number in the thalamocortical pathway.
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