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Neural injury of the Papez circuit following hypoxic–ischemic brain injury : A case report
Jang, Sung Ho,Kwon, Hyeok Gyu Williams & Wilkins Co 2016 Medicine Vol.95 No.44
<P><B>Abstract</B></P><P><B>Introduction:</B></P><P>Hypoxic–ischemic brain injury (HI-BI), a result of oxygen deprivation of the brain, is accompanied by memory impairment. In this study, we report on a patient with neural injury of the Papez circuit following HI-BI, demonstrated by diffusion tensor tractography (DTT).</P><P><B>Clinical Findings/Patient Concerns:</B></P><P>A 48-year-old male patient suffered spontaneous cardiopulmonary arrest and underwent cardiopulmonary resuscitation for approximately 20 minutes with the concomitant oxygen deprivation leading to HI-BI. The patient showed severe memory impairment at 10 weeks after onset: a Mini-Mental State Examination score of 11 (full score: 30, cut-off score < 24), and examination using the memory function test was not possible due to severe cognitive deficit.</P><P><B>Outcomes:</B></P><P>On 10-week DTT, discontinuation of the fornical column was observed in both hemispheres and thinning of the thalamocingulate tract was observed in the right hemisphere and nonreconstruction in the left hemisphere.</P><P><B>Conclusion:</B></P><P>Using DTT, neural injury of the Papez circuit was demonstrated in a patient with memory impairment following HI-BI. These results suggest that analysis of the Papez circuit using DTT could provide beneficial information by detecting injury of the Papez circuit that cannot be detected on conventional brain MRI in patients with HI-BI.</P>
Jang, Sung Ho,Park, So Min,Kwon, Hyeok Gyu Williams & Wilkins Co 2016 Medicine Vol.95 No.26
<P><B>Abstract</B></P><P>The periaqueductal gray (PAG) plays a pivotal role in pain modulation. We attempted to examine the relation between injury of the PAG and central pain in patients with mild traumatic brain injury (TBI).</P><P>Sixty-one patients with mild TBI with central pain and 31 healthy control subjects were recruited for this study. Visual analog scale (VAS) was used for evaluation of central pain. The region of interest was defined for the PAG and the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were measured.</P><P>The FA value was significantly lower in the patient group than in the control group (<I>P</I> < 0.05). However, no significant difference in the ADC value was observed between the patient and control groups (<I>P</I> > 0.05). VAS score of the patient group showed significant moderate negative correlation with the FA (<I>r</I> = −0.38), while no significant correlation was observed between VAS score and the ADC value (<I>P</I> < 0.05).</P><P>We demonstrated injury of the PAG in patients with central pain following mild TBI and the degree of injury of the PAG was closely related to the degree of central pain.</P>
Jang, Sung Ho,Yi, Ji Hyun,Kwon, Hyeok Gyu Williams & Wilkins Co 2016 Medicine Vol.95 No.39
<P><B>Abstract</B></P><P><B>Background:</B></P><P>Depression, a prevalent psychiatric disorder, is associated with abnormality in the prefrontal cortex, particularly the left dorsolateral prefrontal cortex. In this study, we report on a patient with severe depression who showed injury of the dorsolateral prefronto-thalamic tract following mild traumatic brain injury, which was demonstrated by diffusion tensor tractography (DTT).</P><P><B>Methods and results:</B></P><P>A 63-year-old female patient suffered an in-car accident. The patient lost consciousness for approximately 10 minutes and experienced posttraumatic amnesia approximately 30 minutes from the time of the accident. Her Glasgow Coma Scale score was 15. No specific lesion was observed on the conventional brain magnetic resonance imaging. Since the onset of head trauma, she had shown continuous depression and on 32 month evaluation, she exhibited severe depression (Beck Depression Inventory-II: 42 [full score: 63 score] and Patient Health Questionnaire-9: 24 [full score: 27 score]).</P><P><B>Results:</B></P><P>On 32-month DTT, partical tearing of the dorsolateral prefronto-thalamic tract was observed in the right hemisphere and thinning in the left hemisphere.</P><P><B>Conclusion:</B></P><P>Injury of the dorsolateral prefronto-thalamic tract was demonstrated in a patient with depression following mild traumatic brain injury, using DTT. We believe that injury of the dorsolateral prefronto-thalamic tract might be a pathogenetic mechanism of depression in patients with brain injury.</P>
Jang, Sung Ho,Kwon, Hyeok Gyu Williams & Wilkins Co 2017 Medicine Vol.96 No.49
<P><B>Abstract</B></P><P><B>Rationale:</B></P><P>We report on a patient with injury of the cortico-ponto-cerebellar tract (CPCT) following mild traumatic brain injury (TBI), diagnosed by diffusion tensor tractography (DTT).</P><P><B>Patient concerns:</B></P><P>A 53-year-old female patient was injured in a car crash. While under treatment at a local medical center for headache, mild motor weakness, and cognitive impairment that developed following the car crash, she fell, hitting her head on the ground, about six weeks after the car crash.</P><P><B>Diagnoses:</B></P><P>Approximately three months after the car crash, she began to show tremor on both hands and mild truncal ataxia. Twenty months after the car crash, when she underwent neurological evaluation at the rehabilitation department of a university hospital, she presented with mild resting and intentional tremor on both hands, and mild truncal ataxia.</P><P><B>Interventions:</B></P><P>N/A.</P><P><B>Outcomes:</B></P><P>On 20-month DTT, the left CPCT showed tearing at the level of the subcortical white matter and pons, and discontinuation at the cerebellar portion. However, the integrity of the DRTT was well-preserved in both hemispheres.</P><P><B>Lessons:</B></P><P>Using DTT, injury of the CPCT was demonstrated in a patient with ataxia and tremor following mild TBI.</P>