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Correlation between ambulatory function and clinical factors in hemiplegic patients with intact single lateral corticospinal tract: A pilot study.

Hong JS, Kim JM, Kim HS - Medicine (Baltimore) (2016)

Bottom Line: Participants underwent DTI tractography, which showed that 1 lateral CST had been clearly destroyed.Functional ambulation classification (FAC) scores at admission, discharge, and 6 months after discharge were used to evaluate the patients' ability to walk.The type of stroke (infarction or hemorrhage), site of the lesion, spasticity of lower extremities, cranioplasty, and the time taken from onset to MRI were not statistically significantly correlated with the ability to walk.However, statistically significant correlations were found in relation to age, K-MBI scores, and initial NIHSS scores.Despite the complete damage to the lesion site and the preservation of 1 unilateral CST, as shown by DTI, good outcomes can be predicted on the basis of younger age, low NIHSS scores, and high MBI scores at onset.

View Article: PubMed Central - PubMed

Affiliation: Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea.

ABSTRACT
To define the relationship between the complete destruction of 1 lateral corticospinal tract (CST), as demonstrated by diffusion tensor imaging (DTI) tractography, and ambulatory function 6 months following stroke.Twenty-six adults (17 male, 9 female) with poststroke hemiplegia who were transferred to the physical medicine and rehabilitation department. Participants underwent DTI tractography, which showed that 1 lateral CST had been clearly destroyed.Functional ambulation classification (FAC) scores at admission, discharge, and 6 months after discharge were used to evaluate the patients' ability to walk. The National Institutes of Health Stroke Scale (NIHSS) and the Korean version of the modified Barthel index (K-MBI) at admission, discharge, and 6 months after discharge were used to evaluate the degree of functional recovery.Of the 26 patients, 18 were nonambulatory (FAC level 1-3), and 8 were able to walk without support (FAC level 4-6). The type of stroke (infarction or hemorrhage), site of the lesion, spasticity of lower extremities, cranioplasty, and the time taken from onset to MRI were not statistically significantly correlated with the ability to walk. However, statistically significant correlations were found in relation to age, K-MBI scores, and initial NIHSS scores.Despite the complete damage to the lesion site and the preservation of 1 unilateral CST, as shown by DTI, good outcomes can be predicted on the basis of younger age, low NIHSS scores, and high MBI scores at onset.

No MeSH data available.


Related in: MedlinePlus

Example of a single lateral corticospinal tract. (A) Coronal view. (B) Sagittal view. (C) Axial view. (D) Three-dimensional imaging.
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Figure 2: Example of a single lateral corticospinal tract. (A) Coronal view. (B) Sagittal view. (C) Axial view. (D) Three-dimensional imaging.

Mentions: Diffusion registration was implemented as a preprocessing step. This process can be used to correct for the patient movement that can occur during a dynamic scan. Thus, diffusion registration improves image quality in calculated diffusion images. The DTI datasets and anatomic MRI scans were analyzed with FiberTrak software for diffusion tensor analysis and fiber tracking from the MRI Workspace (Philips Healthcare)1. The parameters for the tractography were as follows: a minimum fractional anisotropy (FA) level of 0.15, a maximum angle change of 27°, and a minimum fiber length of 10 mm. The principle directions of diffusion, which represent the vector of the fiber axis, are color-coded in blue for the rostral-caudal axis, red for the left-right axis, and green for the ventral-dorsal axis. Two regions of interest (ROI) were selected to reconstruct the CST. One ROI was placed on the CST portion of the anterior lower pons, and the other was placed on the CST portion of the posterior limbs in the internal capsule.[27,28] Fiber tracts passing through both ROIs were designated as the final tracts of interest (Fig. 2). All data processing and CST reconstruction tasks were performed by a single physician (JSH) who was unaware of the patients’ clinical data.


Correlation between ambulatory function and clinical factors in hemiplegic patients with intact single lateral corticospinal tract: A pilot study.

Hong JS, Kim JM, Kim HS - Medicine (Baltimore) (2016)

Example of a single lateral corticospinal tract. (A) Coronal view. (B) Sagittal view. (C) Axial view. (D) Three-dimensional imaging.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4979795&req=5

Figure 2: Example of a single lateral corticospinal tract. (A) Coronal view. (B) Sagittal view. (C) Axial view. (D) Three-dimensional imaging.
Mentions: Diffusion registration was implemented as a preprocessing step. This process can be used to correct for the patient movement that can occur during a dynamic scan. Thus, diffusion registration improves image quality in calculated diffusion images. The DTI datasets and anatomic MRI scans were analyzed with FiberTrak software for diffusion tensor analysis and fiber tracking from the MRI Workspace (Philips Healthcare)1. The parameters for the tractography were as follows: a minimum fractional anisotropy (FA) level of 0.15, a maximum angle change of 27°, and a minimum fiber length of 10 mm. The principle directions of diffusion, which represent the vector of the fiber axis, are color-coded in blue for the rostral-caudal axis, red for the left-right axis, and green for the ventral-dorsal axis. Two regions of interest (ROI) were selected to reconstruct the CST. One ROI was placed on the CST portion of the anterior lower pons, and the other was placed on the CST portion of the posterior limbs in the internal capsule.[27,28] Fiber tracts passing through both ROIs were designated as the final tracts of interest (Fig. 2). All data processing and CST reconstruction tasks were performed by a single physician (JSH) who was unaware of the patients’ clinical data.

Bottom Line: Participants underwent DTI tractography, which showed that 1 lateral CST had been clearly destroyed.Functional ambulation classification (FAC) scores at admission, discharge, and 6 months after discharge were used to evaluate the patients' ability to walk.The type of stroke (infarction or hemorrhage), site of the lesion, spasticity of lower extremities, cranioplasty, and the time taken from onset to MRI were not statistically significantly correlated with the ability to walk.However, statistically significant correlations were found in relation to age, K-MBI scores, and initial NIHSS scores.Despite the complete damage to the lesion site and the preservation of 1 unilateral CST, as shown by DTI, good outcomes can be predicted on the basis of younger age, low NIHSS scores, and high MBI scores at onset.

View Article: PubMed Central - PubMed

Affiliation: Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea.

ABSTRACT
To define the relationship between the complete destruction of 1 lateral corticospinal tract (CST), as demonstrated by diffusion tensor imaging (DTI) tractography, and ambulatory function 6 months following stroke.Twenty-six adults (17 male, 9 female) with poststroke hemiplegia who were transferred to the physical medicine and rehabilitation department. Participants underwent DTI tractography, which showed that 1 lateral CST had been clearly destroyed.Functional ambulation classification (FAC) scores at admission, discharge, and 6 months after discharge were used to evaluate the patients' ability to walk. The National Institutes of Health Stroke Scale (NIHSS) and the Korean version of the modified Barthel index (K-MBI) at admission, discharge, and 6 months after discharge were used to evaluate the degree of functional recovery.Of the 26 patients, 18 were nonambulatory (FAC level 1-3), and 8 were able to walk without support (FAC level 4-6). The type of stroke (infarction or hemorrhage), site of the lesion, spasticity of lower extremities, cranioplasty, and the time taken from onset to MRI were not statistically significantly correlated with the ability to walk. However, statistically significant correlations were found in relation to age, K-MBI scores, and initial NIHSS scores.Despite the complete damage to the lesion site and the preservation of 1 unilateral CST, as shown by DTI, good outcomes can be predicted on the basis of younger age, low NIHSS scores, and high MBI scores at onset.

No MeSH data available.


Related in: MedlinePlus