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Clinical utility of diffusion tensor imaging and fibre tractography for evaluating diffuse axonal injury with hemiparesis.

Sugiyama K, Kondo T, Suzukamo Y, Oouchida Y, Sato M, Watanabe H, Izumi S - Case Rep Med (2013)

Bottom Line: DTI fractional anisotropy revealed changes in the right cerebral peduncle, the right posterior limb of the internal capsule, and the right corona radiata when compared with the corresponding structures observed on the patient's left side and in healthy controls.On FT evaluation, the right corticospinal tract (CST) was poorly visualised as compared with the left CST as well as the CST in healthy controls.Thus, DTI and FT represent useful techniques for the evaluation of patients with DAI and motor disorders.

View Article: PubMed Central - PubMed

Affiliation: Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan.

ABSTRACT
Although diffuse axonal injury (DAI) frequently manifests as cognitive and/or motor disorders, abnormal brain findings are generally undetected by conventional imaging techniques. Here we report the case of a patient with DAI and hemiparesis. Although conventional MRI revealed no abnormalities, diffusion tensor imaging (DTI) and fibre tractography (FT) revealed the lesion speculated to be responsible for hemiparesis. A 37-year-old woman fell down the stairs, sustaining a traumatic injury to the head. Subsequently, she presented with mild cognitive disorders and left hemiparesis. DTI fractional anisotropy revealed changes in the right cerebral peduncle, the right posterior limb of the internal capsule, and the right corona radiata when compared with the corresponding structures observed on the patient's left side and in healthy controls. On FT evaluation, the right corticospinal tract (CST) was poorly visualised as compared with the left CST as well as the CST in healthy controls. These findings were considered as evidence that the patient's left hemiparesis stemmed from DAI-induced axonal damage in the right CST. Thus, DTI and FT represent useful techniques for the evaluation of patients with DAI and motor disorders.

No MeSH data available.


Related in: MedlinePlus

The upper sections are T1-weighted MR images, and the lower sections are T2-weighted MR images. A lesion was detected in the left occipital lobe (arrow), but no lesion speculated to be the cause of the left hemiparesis could be identified in the right cerebral hemisphere or the brainstem.
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fig1: The upper sections are T1-weighted MR images, and the lower sections are T2-weighted MR images. A lesion was detected in the left occipital lobe (arrow), but no lesion speculated to be the cause of the left hemiparesis could be identified in the right cerebral hemisphere or the brainstem.

Mentions: Our patient was a 37-year-old woman, who worked as an English teacher at a local high school. She fell down the stairs of the height of three meters and sustained a head injury. She exhibited a partial loss of consciousness scored 12 at (E3V4 M5) on Glasgow Coma Scale after the injury and was therefore transported to the emergency hospital. CT revealed a left acute subdural hematoma, which was treated using the craniotomy hematoma exclusion method. The patient's consciousness status improved after surgery, and she was transferred to our hospital for rehabilitation. On admission, the patient presented with a right homonymous hemianopsia, mild memory and attention disorders, and left hemiparesis. Although conventional MRI revealed a lesion in the left occipital lobe, no apparent cause of the left hemiparesis could be identified. The patient subsequently participated in a rehabilitation program which sufficiently improved her cognitive disorders to allow for a return to work 1 year later. Unfortunately, the left hemiparesis remained. The patient's left hemiparesis was scored as follows, according to the Brunnstrom staging: upper extremity IV, finger V, and lower extremity IV. Thus, she required a short leg brace and a cane for walking. Despite the stable cognitive status which allowed for a return to work, the patient never regained control of her left upper extremity and fingers and never regained a normal degree of locomotion. Two years after the injury, we performed additional MRI which revealed the same occipital lesion noted earlier, but no evidence could be determined regarding right cerebral hemisphere or brainstem abnormalities, which were speculated to be responsible for the left hemiparesis (Figure 1). Therefore, DTI and FT were used to identify the cause of the patient's left hemiparesis.


Clinical utility of diffusion tensor imaging and fibre tractography for evaluating diffuse axonal injury with hemiparesis.

Sugiyama K, Kondo T, Suzukamo Y, Oouchida Y, Sato M, Watanabe H, Izumi S - Case Rep Med (2013)

The upper sections are T1-weighted MR images, and the lower sections are T2-weighted MR images. A lesion was detected in the left occipital lobe (arrow), but no lesion speculated to be the cause of the left hemiparesis could be identified in the right cerebral hemisphere or the brainstem.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3860099&req=5

fig1: The upper sections are T1-weighted MR images, and the lower sections are T2-weighted MR images. A lesion was detected in the left occipital lobe (arrow), but no lesion speculated to be the cause of the left hemiparesis could be identified in the right cerebral hemisphere or the brainstem.
Mentions: Our patient was a 37-year-old woman, who worked as an English teacher at a local high school. She fell down the stairs of the height of three meters and sustained a head injury. She exhibited a partial loss of consciousness scored 12 at (E3V4 M5) on Glasgow Coma Scale after the injury and was therefore transported to the emergency hospital. CT revealed a left acute subdural hematoma, which was treated using the craniotomy hematoma exclusion method. The patient's consciousness status improved after surgery, and she was transferred to our hospital for rehabilitation. On admission, the patient presented with a right homonymous hemianopsia, mild memory and attention disorders, and left hemiparesis. Although conventional MRI revealed a lesion in the left occipital lobe, no apparent cause of the left hemiparesis could be identified. The patient subsequently participated in a rehabilitation program which sufficiently improved her cognitive disorders to allow for a return to work 1 year later. Unfortunately, the left hemiparesis remained. The patient's left hemiparesis was scored as follows, according to the Brunnstrom staging: upper extremity IV, finger V, and lower extremity IV. Thus, she required a short leg brace and a cane for walking. Despite the stable cognitive status which allowed for a return to work, the patient never regained control of her left upper extremity and fingers and never regained a normal degree of locomotion. Two years after the injury, we performed additional MRI which revealed the same occipital lesion noted earlier, but no evidence could be determined regarding right cerebral hemisphere or brainstem abnormalities, which were speculated to be responsible for the left hemiparesis (Figure 1). Therefore, DTI and FT were used to identify the cause of the patient's left hemiparesis.

Bottom Line: DTI fractional anisotropy revealed changes in the right cerebral peduncle, the right posterior limb of the internal capsule, and the right corona radiata when compared with the corresponding structures observed on the patient's left side and in healthy controls.On FT evaluation, the right corticospinal tract (CST) was poorly visualised as compared with the left CST as well as the CST in healthy controls.Thus, DTI and FT represent useful techniques for the evaluation of patients with DAI and motor disorders.

View Article: PubMed Central - PubMed

Affiliation: Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan.

ABSTRACT
Although diffuse axonal injury (DAI) frequently manifests as cognitive and/or motor disorders, abnormal brain findings are generally undetected by conventional imaging techniques. Here we report the case of a patient with DAI and hemiparesis. Although conventional MRI revealed no abnormalities, diffusion tensor imaging (DTI) and fibre tractography (FT) revealed the lesion speculated to be responsible for hemiparesis. A 37-year-old woman fell down the stairs, sustaining a traumatic injury to the head. Subsequently, she presented with mild cognitive disorders and left hemiparesis. DTI fractional anisotropy revealed changes in the right cerebral peduncle, the right posterior limb of the internal capsule, and the right corona radiata when compared with the corresponding structures observed on the patient's left side and in healthy controls. On FT evaluation, the right corticospinal tract (CST) was poorly visualised as compared with the left CST as well as the CST in healthy controls. These findings were considered as evidence that the patient's left hemiparesis stemmed from DAI-induced axonal damage in the right CST. Thus, DTI and FT represent useful techniques for the evaluation of patients with DAI and motor disorders.

No MeSH data available.


Related in: MedlinePlus