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In patients with intracerebral hemorrhage (ICH), the relationship between consciousness and the thalamocortical tract (TCT), which links the thalamic intralaminar nuclei (ILN) and the cerebral cortex, was investigated. Forty-one patients with ICH were assigned to 1 of 2 groups according to their preservation of consciousness as determined by their Glasgow coma scale (GCS) score. Patient group A had impaired consciousness (GCS < 15, 21 patients), and patient group B had intact consciousness (GCS = 15, 20 patients). The control group included 20 age- and sex-matched healthy subjects. For all groups, the TCTs from the thalamic ILN of both sides were reconstructed using a probabilistic tractography method based on a multifiber model. In addition, tract volume (TV) values were determined. The TV values for the ipsilateral TCT from the thalamic ILN of the all-patient groups and those for contralateral TCT of the patient group B showed no significant differences between ICH and contra-ICH sides (P > .05). The TV results for the ipsilateral and contralateral TCTs from the thalamic ILN of the ICH and contra-ICH sides were significantly different among the 3 groups (P < .05). Among the patients, there were moderate positive correlations between GCS scores and TV values of the ipsilateral TCT on the ICH and contra-ICH sides (R = 0.477, P < .05; R = 0.426, P < .05). The TV of the ipsilateral TCT from the thalamic ILN on the ICH and contra-ICH sides was significantly correlated with the consciousness level in patients with ICH. Our results could be helpful when developing therapeutic strategies for ICH patients with disorders of consciousness., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background and Purpose: We investigated the relation between the ipsilesional corticospinal tract (CST) state and activity of daily living independence in patients with chronic intracerebral hemorrhage., Methods: Fifty-six consecutive patients with unilateral intracerebral hemorrhage and 38 healthy control subjects were recruited for this study. The Motricity index and the modified Barthel index were used to evaluate motor function of the affected extremities and activity of daily living independence, respectively. The diffusion tensor imaging parameter values for fractional anisotropy (FA) and voxel number (VN) of the CST were determined. Ratios of the ipsilesional to the contralesional CST measures were calculated and are presented as the CST-ratio (FA value and VN)., Results: The FA value and VN of the ipsilesional CST and the CST-ratio in the patient group were lower than those of the control group ( P <0.05). There was a strong positive correlation between the Motricity index score of the affected extremities and the modified Barthel index score ( P <0.05), while the FA value and VN of the ipsilesional CST and the CST-ratio showed moderate and strong positive correlations with the Motricity index and modified Barthel index scores, respectively ( P <0.05). In addition, the VN of the ipsilesional CST showed excellent utility as a classifier, whereas the FA value of the ipsilesional CST and the FA value and VN of the CST-ratio showed good classifier utility ( P <0.05)., Conclusions: We demonstrated that impairment of activity of daily living independency was closely related to the injury severity of the ipsilesional CST in patients with chronic intracerebral hemorrhage. In addition, the injury severity of the ipsilesional CST can be used to classify the degree of activity of daily living independency. Registration: URL: http://www.e-irb.com/index.jsp; Unique identifier: 2021-03-014.

Background: We report on a patient with an intracerebral hemorrhage (ICH), who showed delayed development of aphasia, which was demonstrated via follow up diffusion tensor tractography (DTT) to be related to neural degeneration of the arcuate fasciculus (AF)., Case Presentation: A 51-year-old, right-handed male presented with right hemiparesis, which occurred at the onset of a spontaneous ICH in the left corona radiata and basal ganglia. Brain magnetic resonance images showed a hematoma in the left subcortical area at one month after onset and hemosiderin deposits in the left subcortical area at nine years after onset. At four weeks after onset, he exhibited severe aphasia, and Western Aphasia Battery (WAB) testing revealed an aphasia quotient in the 39.6 percentile (%ile). However, his aphasia improved to nearly a normal state, and at three months after onset, his aphasia quotient was in the 90.5 %ile. At approximately eight years after onset, he began to show aphasia, and his aphasia increased slowly with time resulting in a WAB aphasia quotient in the 12.5 %ile at nine years after onset. The integrity of the left AF over the hematoma was preserved on 1-month post-onset DTT. However, the middle portion of the left AF in the middle of the hemosiderin deposits showed discontinuation on 9-year post-onset DTT. The fractional anisotropy value of the left AF was higher on the 9-year post-onset DTT (0.48) than that on the 1-month post-onset DTT (0.35), whereas the mean diffusivity value was lower on the 9-year post-onset DTT (0.10) than that on the 1-month post-onset DTT (0.32). The fiber number of the left AF was decreased to 175 on the 9-year post-onset DTT from 239 on the 1-month post-onset DTT., Conclusions: We report on a patient with ICH who showed delayed development of aphasia, which appeared to be related to degeneration of the AF in the dominant hemisphere. Our results suggest that DTT would be useful in ruling out neural degeneration of the AF.

Rationale: Neurogenic fever is a non-infectious source of fever in a patient with brain injury, especially hypothalamic injury. We report on a stroke patient with neurogenic fever due to injury of hypothalamus, demonstrated by using diffusion tensor imaging (DTI)., Patient Concerns: A 28-year-old male patient was admitted to the rehabilitation department of university hospital at 30 months after onset. Brain MRI showed leukomalactic lesions in hypothalamus, bilateral medial temporal lobe, and bilateral basal ganglia. He showed intermittent high body temperature (maximum:39.5°C, range:38.5-39.2°C), but did not show any infection signs upon physical examination or after assessing his white blood cell count and inflammatory enzyme levels such as erythrocyte sedimentation rate and C-reactive protein. In addition, 8 age-matched normal (control) subjects (4 male, mean age: 26.6 years, range: 21-29years) were enrolled in the study., Diagnosis: Intraventricular hemorrhage and intracerebral hemorrhage in the left basal ganglia., Interventions: He underwent extraventricular drainage and ventriculoperitoneal shunting for hydrocephalus., Outcomes: DTI was performed at 30 months after onset, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were obtained for hypothalamus. The FA and ADC values of patient were lower and higher, respectively, by more than two standard deviations from control values. Injury of hypothalamus was demonstrated in a stroke patient with neurogenic fever., Lessions: Our results suggest that evaluation of hypothalamus using DTI would be helpful in patients show unexplained fever following brain injury., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background and Purpose- We investigated the relationship between impaired consciousness and ascending reticular activating system (ARAS) characteristics on diffusion tensor tractography during the early stage of spontaneous intracerebral hemorrhage confined to a unilateral supratentorial area. Methods- A total of 29 consecutive patients with impaired consciousness (the patient group A), 31 age- and sex-matched patients without impaired consciousness (the patient group B), and 20 age- and sex-matched healthy control subjects were recruited. The Glasgow Coma Scale was used to evaluate patients' conscious state in the early stage of intracerebral hemorrhage (within 30 days after onset). Three parts of the ARAS (lower dorsal, lower ventral, and upper) were reconstructed, and fractional anisotropy and tract volume values were determined. Results- The tract volume value of the lower dorsal ARAS in the patient group A was significantly lower than those of the patient group B and control group in the affected hemisphere (P<0.05). Among the diffusion tensor tractography parameters, only the tract volume of the lower dorsal ARAS in the affected hemispheres of the patient group A had a moderate positive correlation with Glasgow Coma Scale score (r=0.456; P<0.05). Conclusions- Impaired consciousness during the early stage of intracerebral hemorrhage was closely related to injury of the lower dorsal ARAS in the affected hemisphere. Clinical Trial Registration- URL: http://www.e-irb.com/index.jsp. Unique identifier: 2015-07-064.

Rationale: Recent studies have used diffusion tensor tractography (DTT) to demonstrate that central poststroke pain (CPSP) was related to spinothalamic tract (STT) injury in patients with stroke. However, few studies have been reported about delayed-onset CPSP due to degeneration of the STT following a stroke., Patient's Concerns: A 57-year-old female patient presented with right hemiparesis after stroke. Two weeks after onset, she did not report any pain. At approximately 6 months after onset, she reported pain in the right arm and leg, and the pain slowly intensified with the passage of time. At 14 months after onset, the characteristics and severity of her pain were assessed to be continuous pain without allodynia or hyperalgesia; tingling and cold-sensational pain in her right whole arm and leg (visual analog scale score: 5)., Diagnoses: The patient was diagnosed as the right hemiparesis due to spontaneous thalamic hemorrhage., Interventions: Clinical assessment and diffusion tensor imaging (DTI) were performed 2 weeks and 14 months after onset., Outcomes: She suffered continuous pain in her right whole arm and leg (visual analog scale score: 5). On DTT of the 2-week postonset DTI scans, the configuration of the STT was well-preserved in both hemispheres. However, in contrast to those 2-week postonset results, the 14-month postonset DTT results showed partial tearing and thinning in the left STT. Regardless, both the 2-week and 14-month postonset DTT showed that the left STT passed through the vicinity of the thalamic lesion., Lessons: Diagnostic importance of performing a DTT-based evaluation of the STT in patients exhibiting delayed-onset CPSP following intracerebral hemorrhage.

Rationale: Egocentric neglect is characterized by responses missing on the contralateral side with respect to the viewer, while allocentric neglect is characterized in responses missing on the contralateral side with respect to the object . However, little has been reported about the neural tracts associated with egocentric and allocentric neglect. We investigated which neural tracts were involved in two types of neglect (egocentric and allocentric) in a stroke patient who showed allocentric neglect by using the Apple Cancellation test, a specialized test to distinguish between egocentric and allocentric neglect., Patient Concerns: He showed good cognitive function but presented with severe neglect on the left side (A 42-year-old, right-handed male patient). He was unable to undergo even the pencil and paper test for evaluation of the severity of neglect., Diagnoses: He was diagnosed as spontaneous intracerebral hemorrhage at the right basal ganglia and underwent conservative management at the neurosurgery department of a university hospital., Interventions: Two weeks after onset, he began rehabilitation at the rehabilitation department of the same university hospital. During a seven month rehabilitation, the patient showed significant improvement of his severe left neglect., Outcomes: We used the Apple Cancellation test to distinguish between egocentric and allocentric neglect; the results failed to reveal egocentric neglect, however, they did reveal severe allocentric neglect. In addition, on diffusion tensor tractography (DTT) at 2 weeks after onset, the right superior longitudinal fasciculus (SLF) showed partial injury and narrowing in the parietal lobe compared to that of the left SLF. In addition, the right inferior fronto-occipital fasciculus (IFOF) was not reconstructed. By contrast, on 7-month post-onset DTT, the right SLF revealed elongation and thickening in the parietal lobe that approached similarity to that for the left SLF. However, the right IFOF was still not reconstructed., Lessons: The associations of egocentric neglect with the dorsal pathway (SLF) and the association of allocentric neglect with the ventral pathway (IFOF) in the right hemisphere were demonstrated in a stroke patient. It appears that DTT can be helpful in demonstrating both the affected pathway and the neglect type in patients with neglect.

Rationale: A 67-year-old, right-handed male patient underwent craniotomy and drainage for hematoma removal related to an intracerebral hemorrhage (ICH) in the right thalamus and basal ganglia at the neurosurgery department of a university hospital., Patient Concerns: He presented with severe motor weakness of left extremities, impairment of proprioception, and severe pusher syndrome at the start of rehabilitation., Diagnoses: He was diagnosed as ICH in the right thalamus and basal ganglia., Interventions: The patient received comprehensive rehabilitative therapy, movement therapy, and somatosensory stimulation., Outcomes: Four months after onset, left leg motor function (Motricity Index [MI] = 51) did not show significant recovery from that at two months after onset (MI = 41); however, in the same period, Nottingham Sensory Assessment and scale for contraversive pushing significantly improved. At four months, the patient was able to stand independently but required manual contact of one person during independent walking on an even floor. At seven months after onset, he was able to walk independently on an even floor., Lessons: Recovery of a severely injured medial lemniscus with concurrent recovery of impaired proprioception and pusher syndrome.

Rationale: We report on a patient who developed allocentric neglect due to injury of the inferior fronto-occipital fasciculus (IFOF) following intracranial hemorrhage, diagnosed using diffusion tensor tractography (DTT)., Patient Concerns: Her cognition seemed normal (A 17-year-old, right-handed female patient). However, in spite of a normal visual field, her perception was missing on the left side, and she had no awareness of her deficit. She was unable to perceive the left side in each of 2 objects, regardless of position of the 2 objects, and failed at detail exploration of the left side of 1 object. In addition, the line bisection test, the most representative neglect test, did not reveal any abnormality., Diagnoses: She was diagnosed with an intracerebral hemorrhage (right thalamus), intraventricular hemorrhage, and subarachnoid hemorrhage due to arteriovenous malformation in the right thalamus., Interventions: Seven weeks after onset, she began rehabilitation. Consequently, the apple cancellation test to discriminate between allocentric and egocentric neglect was performed, with the result of severe allocentric neglect., Outcomes: The right superior longitudinal fasciculus and inferior longitudinal fasciculus were well-reconstructed without definite injury compared with those of the left side. However, the right IFOF was discontinued in the anterior portion around the frontal lobe., Lessons: Allocentric neglect due to injury of IFOF was demonstrated in a stroke patient using DTT. It appears that DTT would be helpful in demonstrating the neglect type and pathway in patients with neglect., (Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Rationale: We examined injuries of the dentato-rubro-thalamic tract (DRTT), cortico-ponto-cerebellar tract (CPCT), dorsal spinocerebellar tract (SCT), and inferior cerebellar peduncle (ICP) in a patient with severe ataxia following bilateral tegmental pontine hemorrhage (PH), using diffusion tensor tractography (DTT)., Patient Concerns: A 75-year-old female patient underwent conservative management for bilateral tegmental PH. She presented with moderate motor weakness, severe resting and intentional tremor on both hands, and severe truncal ataxia (Scale for Assessment and Rating of Ataxia [25 points/0-40 points: a higher score indicates a worse state]), and she was not able to sit independently., Diagnoses and Outcomes: On DTT taken at 2 weeks after initial presentation, both DRTTs and the left dorsal SCT were not reconstructed, whereas the CPCTs showed thinning of the entire pathways between the primary sensorimotor cortex and cerebellum in both hemispheres. The right ICP was discontinued at the transverse cerebellar branch of the ICP and thinning of the left ICP was observed in the vertical and transverse cerebellar branch of the ICP., Lessons: Using DTT, concurrent injuries of the DRTT, CPCT, dorsal SCT, and ICP were demonstrated in a patient with severe ataxia following PH. Our result suggests the necessity of evaluation of these neural tracts in patients who develop ataxia after brain injury., Competing Interests: The authors have no conflicts of interest to disclose.

Objective: The difference in the widest distance between corticospinal tracts (CST) on diffusion tensor tractography (DTT) in stroke patients with hydrocephalus was investigated retrospectively., Methods: Distances were measured on an axial slice of the corona radiata, which provided the widest distance between CSTs. Two distances were measured, the absolute distance - the distance between the most medial point of the CSTs and the relative distance - calculated as a percentage of the absolute distance., Results: The absolute distances of CSTs were 55.34 mm for the patient group and 46.75 mm for the control group. The relative distances of the CSTs were 44.12% and 35.96% for the patient group and the control group. Significant differences in the absolute and relative distances of CSTs were observed between the patient and the control group., Conclusion: These results suggest that the absolute and relative distances between CSTs might be used to diagnose hydrocephalus in stroke patients., (© The Author(s) 2015.)

The red nucleus (RN) is involved in motor control and it is known to have potential to compensate for injury of the corticospinal tract (CST). We investigated the change of connectivity of the RN (RNc) and its relation to motor function in patients with striatocapsular hemorrhage. Thirty-five chronic patients with striatocapsular hemorrhage were recruited. Motricity Index (MI), Modified Brunnstrom Classification (MBC), and Functional Ambulation Category (FAC) were measured for motor function. The probabilistic tractography method was used for evaluation of the RNc. Fractional anisotropy (FA), mean diffusivity (MD), and tract volume (TV) of the RNc were measured. FA and TV ratios of the RNc in patients with discontinuation of the affected CST were significantly higher than those of patients with preserved integrity of the CST in the affected hemisphere (p < 0.05). TV ratio of the RNc showed significant negative correlation with upper MI (weak correlation, r = -0.35), total MI (weak correlation, r = -0.34), and MBC (moderate correlation, r = -0.43), respectively (p < 0.05). We found that the neural structure of the RNc was relatively increased in the unaffected hemisphere compared with the affected hemisphere in patients with more severe injury of the CST.

This study reports on a patient with an intracerebral hemorrhage who showed recovery of an injured arcuate fasciculus (AF) in the dominant hemisphere, using follow-up diffusion tensor tractography. A 43-year-old right-handed man presented with severe aphasia and hemiparesis resulting from a spontaneous intracerebral hemorrhage in the left parietotemporal lobes. The patient showed severe aphasia at 1 month after onset, with an aphasia quotient of 5% on the Korean-Western Aphasia Battery. He underwent comprehensive rehabilitative therapy until 22 months after onset and his aphasia showed improvement, with an aphasia quotient of 58% on the Korean-Western Aphasia Battery. On 1-month diffusion tensor tractography, only the thin ascending part of the left AF from the Wernicke area remained. In contrast, on 16-month diffusion tensor tractography, the injured left AF was thickened and elongated to around the left Broca area; however, discontinuation of the left AF was observed around the left Broca area, and this continuation was elongated to the left Broca area on 22-month diffusion tensor tractography. This study reports on a patient who showed recovery from injury of the left AF along with improvement of aphasia. Recovery of the injured AF in the dominant hemisphere appears to be one of the mechanisms for recovery from aphasia.

Little is known about the motor recovery mechanisms via transcallosal or tranpontine fibers in stroke patients. In the current study, an attempt was made to demonstrate motor recovery via transcallosal and transpontine fibers in a patient with intracerebral hemorrhage using diffusion tensor tractography and transcranial magnetic stimulation. A 39-yr-old male patient presented with complete weakness of the right extremities at the onset of a left midbrain hemorrhage. His motor weakness had shown slow recovery for 4 mos to the point that he was able to grasp and release using the right hand. Diffusion tensor tractography and transcranial magnetic stimulation were performed at 2 wks and 4 mos after onset. Discontinuation of the left corticospinal tract below the left midbrain was observed on the 2-wk diffusion tensor tractography and no motor evoked potential was elicited in the right hand on the 2-wk transcranial magnetic stimulation study. Four-month diffusion tensor tractography showed that the discontinuation of the left corticospinal tract had not been restored; however, a new neural pathway was observed, which originated from the left primary motor cortex and descended to the left corticospinal tract at the pons through the transcallosal and transpontine fibers. In the 4-mo transcranial magnetic stimulation study, the latency of motor evoked potential obtained at the right hand by stimulation of the left motor cortex was delayed by 9 msecs, compared with the opposite motor evoked potential, which seems to be compatible with transcallosal and transpontine conduction time. The results suggest that the motor function of the affected extremities in this patient was recovered through the transcallosal and transpontine fibers from the left motor cortex.

Background: Several studies have reported on injury of the corticoreticular pathway (CRP), however, little is known about the mechanism for recovery of an injured CRP. We report on a patient with intracerebral hemorrhage (ICH) who showed recovery of an injured CRP via transcallosal fibers, which was demonstrated by diffusion tensor tractography (DTT)., Case Presentation: A 67-year-old man presented with complete paralysis (Medical Research Council: 0/5) of the left extremities at the onset of a right putaminal hemorrhage. At six weeks after onset, he presented with more severe weakness of proximal joint muscles than distal joint muscles (right shoulder abductor; 2-, finger extensor; 3+, hip flexor; 2+, ankle dorsiflexor; 3). Although his right hemiplegia had recovered well, he consistently showed more severe proximal weakness (right shoulder abductor; 3, finger extensor; 4, hip flexor; 3+, ankle dorsiflexor; 4) until 16 weeks after onset. On both six- and 16-week DTTs, in the left (affected) hemisphere, the CRP showed severe narrowing with discontinuation of the anterior fibers at the corona radiata on six-week DTT, however, the discontinued anterior fibers of the CRP were connected to the right cerebral cortex via transcallosal fibers on 16-week DTT., Conclusion: We demonstrated recovery of an injured CRP via transcallosal fibers in a patient with ICH. We believe that this might be a mechanism for recovery of an injured CRP.

Objective: 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., Case Report: 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., Results: 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)., Conclusion: 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.

Objectives: Many diffusion tensor imaging (DTI) studies have described the effects of hydrocephalus on periventricular white matter in patients with normal pressure hydrocephalus. However, little is known about hydrocephalus following stroke. We investigated the effect of hydrocephalus on periventricular white matter in patients with hydrocephalus after an intracerebral hemorrhage (ICH) using DTI., Methods: Fourteen patients with ICH and hydrocephalus, and 17 age- and sex-matched normal control subjects were recruited. DTI parameters were estimated in six regions of interest (ROIs) in periventricular white matter: the anterior corona radiata, the posterior corona radiata, the genu of the corpus callosum, the splenium of corpus callosum, the anterior limb of the internal capsule, and the posterior limb of the internal capsule., Results: Mean fractional anisotropy of the anterior corona radiata in patients was significantly higher than in controls (p < 0.05), but apparent diffusion coefficient (ADC) was not different in the two groups (p > 0.05). No significant differences between fractional anisotropies and ADCs were observed in the other five ROIs (p > 0.05)., Conclusions: The anterior corona radiata was found to be more compressed by hydrocephalus than the other five regions of periventricular white matter examined in patients with hydrocephalus following ICH. It is believed that the results of the present study will be useful for the diagnosis and management of hydrocephalus following stroke.

Objectives: The correlation between somatosensory function and cortical activation induced by touch stimulation in patients with intracerebral hemorrhage (ICH) was investigated by functional magnetic resonance imaging (fMRI)., Methods: Thirty-two chronic ICH patients with somatosensory deficits in tactile sensation were enrolled. For fMRI, touch stimulation was applied on the dorsum of the affected hand (contralateral to the ICH), using a rubber brush at a frequency of 1 Hz. Regions of interests (ROIs) were set at the primary sensory-motor cortex [SM1: Brodmann's area (BA) 1, 2, 3, 4], the posterior parietal cortex (PPC: BA 5, 7) and the secondary somatosensory cortex (S2: BA 43) in both hemispheres. The tactile sensation subscale of the Nottingham Sensory Assessment (NSA) was used to determine somatosensory function., Results: Significant correlations were found between NSA scores and voxel counts in the contralateral (ipsilesional) SM1 (r = 0.642; p < 0.05), the contralateral PPC (r = 0.507; p < 0.05) and the ipsilateral (contralesional) SM1 (r = 0.466; p < 0.05). However, no correlation was found between NSA scores and the contralateral S2 (r = 0.323; p > 0.05), the ipsilateral PPC (r = 0.252; p > 0.05) or the ipsilateral S2 (r = 0.280; p > 0.05)., Conclusions: It was found that somatosensory functions were positively correlated with degrees of blood oxygenation level dependent signal change of the following ROIs: the contralateral SM1, the contralateral PPC and the ipsilateral SM1. Opposingly, the S2 showed no correlation on either side of the brain.

The main function of the corticospinal tract (CST) is control of the distal musculature used for fine movements, in contrast, the corticoreticular pathway (CRP) innervates the proximal and axial musculature. We report on a patient with an intracerebral hemorrhage (ICH) who showed recovery of an injured CST and an injured CRP by diffusion tensor tractography (DTT). The patient, a 38-year-old man, presented with severe paralysis of the right upper and lower extremities due to a spontaneous ICH in the left corona radiata and basal ganglia. When he started rehabilitation at 3 weeks after onset, he showed more severe weakness in the proximal joints (shoulder and hip joints) than distal joints (hand and ankle joints). This proximal weakness improved rapidly in parallel with distal weakness over 3 weeks of rehabilitation. DTT performed at 3 and 6 weeks post-ICH revealed that a thin left CST observed at 3 weeks thickened at 6 weeks, and that a discontinuation of the left CRP at the midbrain level at 3 weeks was restored at 6 weeks. In addition, the track volumes of the left CST and CRP increased from 221 and 244 at 3 weeks to 725 and 625 at 6 weeks. In conclusion, we demonstrated the recovery of an injured CST and an injured CRP in a patient with ICH.

Most of the motor recovery in stroke occurs within 3 months after stroke onset and this period has been regarded as critical for motor recovery. Little is known about the motor recovery process during the critical period of stroke. We report on a patient with intracerebral hemorrhage (ICH) who showed recovery of an injured corticospinal tract (CST) during the critical period for motor recovery. A 43-year-old woman underwent conservative management for a spontaneous ICH in the right corona radiata and basal ganglia. She presented with complete left hemiplegia at the onset of ICH. She showed continuous and slow recovery, and consequently, she was able to flex her left fingers without gravity at 6 weeks after onset and extend the left fingers without gravity at 12 weeks. The 3- and 6-week DTTs showed that the right CST was discontinued around the hematoma. However, the 12-week DTT revealed that the right CST was originated from the right primary motor cortex and descended along the CST pathway. No motor evoked potential (MEP) was evoked from the right hemisphere on the 3- and 6-week TMS study. However, on the 12-week TMS study, an MEP which had the characteristics of the CST was evoked from the right hemisphere to the left abductor pollicis brevis muscle. Our results indicate that the injured right CST had been recovered between 6 weeks and 12 weeks after ICH onset. Consequently, we believe that this case demonstrated the recovery process of a severely injured CST during the critical period for motor recovery after ICH.

Objective: We report here on a patient with intracerebral haemorrhage (ICH), who showed unusually delayed motor recovery of the leg, which started at 6 months after ICH onset., Case Report: A 53-year-old man underwent craniotomy and drainage for a right putaminal ICH. The patient presented with complete paralysis of the left extremities at ICH onset. Despite having undergone rehabilitation starting at 7 weeks after onset, the patient did not show significant motor recovery of the left extremities until 6 months after onset, when the affected left leg began to show motor recovery to the point that he was able to extend his hip and knee without gravity 7 months after onset. As a result, he was able to walk independently on an even floor 9 months after onset., Results: On 6-month diffusion tensor tractography, the right corticospinal tract showed disruption with Wallerian degeneration to the pontomedullary junction., Conclusion: This case study highlights the extensive potential for the human brain to aid in the recovery of walking after injury. In conclusion, clinicians should attempt to determine the causes of difficulty walking when examining patients with ICH and then perform intensive rehabilitation for the recovery of walking.

Objective: The majority of motor recovery following stroke is known to occur within 3-6 months after onset; this period is therefore regarded as critical for motor recovery in stroke patients. We report here a case of a patient with intracerebral haemorrhage who showed changes in the affected motor function and in the damaged corticospinal tract (CST) at the primary motor cortex (M1) during rehabilitative management., Case Description: A 51-year-old woman underwent decompressive craniectomy and removal of haematoma due to a rupture of an arteriovenous malformation. Brain magnetic resonance imaging revealed a leukomalactic lesion at the fronto-parietal cortex centred on the precentral knob. Diffusion tensor imaging data were acquired 4 times (5, 8, 11 and 18 weeks after onset) and she started rehabilitation for right hemiplegia at 5 weeks after onset., Results: We found close relationships between changes in the CST branch from M1 on diffusion tensor tractography, the state of motor weakness, and the rehabilitative management: the CST branch from M1 was observed concurrently with motor recovery and the process of rehabilitation., Conclusion: This case report indicates the importance of active and comprehensive rehabilitative management during the critical period for motor recovery in stroke patients.

Objectives: As the mesencephalic locomotor center, the pedunculopontine nucleus (PPN) is known to be involved in control of locomotor function. We investigated neural connectivity of the PPN in relation to walking ability in chronic patients with spontaneous intracerebral hemorrhage., Methods: Forty-three consecutive chronic patients with subcortical hemorrhage and 20 healthy control subjects were recruited. A seed region of interest was manually drawn on the PPN and connectivity of the PPN was measured., Results: In the affected hemisphere, connectivity with the ipsilesional cerebellar locomotor center and connectivity with the contralesional pontine locomotor center were decreased in patients who could not walk, compared with patients who could walk and normal controls (p < 0.05)., Conclusions: Connectivity between the PPN and ipsi-lesional cerebellum locomotor center and contralesional pontine locomotor center in the affected hemisphere appears to be related to walking ability., (Copyright © 2012 S. Karger AG, Basel.)

Little is known about prognostic factors associated with motor outcome when the corticospinal tract (CST) was compressed by hematoma. Using diffusion tensor tractography (DTT), we attempted to investigate prognostic factors for motor outcome in patients whose affected CST was compressed by hematoma. The study included 51 consecutive severe hemiparetic patients with a hematoma involving the corona radiata and basal ganglia. Integrities of the affected CSTs were preserved to the cerebral cortex and were found to be compressed by a hematoma on DTT. Patients were classified into four groups according to the region which the CST was originated from the precentral gyrus (type A), postcentral gyrus (type B), posterior parietal cortex (type C), and premotor cortex (type D). We measured the ratios of DTT parameters between affected/unaffected hemispheres.The motor function of the affected extremities at 6-month after onset was better with the following order: DTT type A, type B, type C, and type D patients. The 6-month motor function for DTT type A patients was higher than that of DTT type D patients (p=0.008). The fractional anisotropy ratio between the affected and unaffected CST was positively correlated with the 6-month motor function of the affected extremities (Pearson's correlation coefficient, p=0.025, r=0.313). We found that motor outcome differed according to the originated area of the affected CST and the degree of injury of the affected CST in patients whose affected CST was compressed by hematoma.

Objectives: Intraventricular hemorrhage (IVH) in adult stroke patients is known to be an independent risk factor for poor functional outcome. Using diffusion tensor imaging (DTI), we attempted to investigate the effect of IVH on the white matter., Methods: We recruited 10 consecutive patients with IVH and 18 age- and sex-matched control subjects. Using a 1.5-T Philips Gyroscan Intera system, DTI data was acquired at an average of 84 days (range: 38-149) after IVH onset. We measured fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values at the fornix, corpus callosum (CC), corona radiata (CR), and posterior limb of the internal capsule (PL). In addition, integrity and fiber number were measured for the fornix., Results: DTI revealed disruption of the fornix in all patients. FA values showed a decrease in the fornix, CC, and CR; in contrast, the ADC value showed an increase in the CC, without changes in the fornix or CR. Fiber number of the fornix also decreased. However, no change was observed in the PL., Conclusions: We found periventricular white matter (fornix, CC, and CR) injury following IVH. We think that this result would be helpful in the establishment of management strategies for patients with IVH., (Copyright © 2011 S. Karger AG, Basel.)

Background: TMS (transcranial magnetic stimulation) and DTT (diffusion tensor tractography) have different advantages in evaluating stroke patients. TMS has good clinical accessibility and economical benefit. On the contrary, DTT has a unique advantage to visualize neural tracts three-dimensionally although it requires an expensive and large MRI machine. Many studies have demonstrated that TMS and DTT have predictive values for motor outcome in stroke patients. However, there has been no study on the comparison of these two evaluation tools. In the current study, we compared the abilities of TMS and DTT to predict upper motor outcome in patients with ICH (intracerebral hemorrhage)., Methods: Fifty-three consecutive patients with severe motor weakness were evaluated by TMS and DTT at the early stage (7-28 days) of ICH. Modified Brunnstrom classification (MBC) and the motricity index of upper extremity (UMI) were evaluated at onset and 6 months after onset., Results: Patients with the presence of a motor evoked potential (MEP) in TMS or a preserved corticospinal tract (CST) in DTT showed better motor outcomes than those without (p=0.000). TMS showed higher positive predictive value than DTT. In contrast, DTT showed higher negative predictive value than TMS., Conclusions: TMS and DTT had different advantages in predicting motor outcome, and this result could be a reference to predict final neurological deficit at the early stage of ICH.

Objectives: A connection of fibers between corticospinal tracts (CSTs) at the pons, originating from the CST of the affected hemisphere, has been observed in hemiparetic patients with stroke. The authors investigated the incidence and the clinical significance of transpontine connection of fibers (TCFs) in hemiparetic patients with intracerebral hemorrhage (ICH), using diffusion tensor tractography (DTT)., Subjects and Methods: Forty-two patients with ICH with weakness of the affected extremities at the time of DTI scanning and 41 age-matched control subjects were recruited. TCFs were classified into three types according to severity: type A - no TCF extending to the opposite hemisphere, type B - a TCF crossing to the opposite hemisphere and ending at the subcortical level, and type C - a TCF crossing the pons and ascending to the cortex of the opposite hemisphere., Results: TCFs originating from the CST in affected and unaffected hemispheres were significantly more prevalent among patients than controls (both p < 0.05). In addition, TCF severity was found to be closely related to motor function reduction in affected extremities (p < 0.05) and to extent of CST injury in affected hemispheres (p < 0.05)., Conclusions: TCF appears to represent a compensatory mechanism associated with motor weakness or CST injury in patients with ICH., (Copyright 2010 S. Karger AG, Basel.)

Objectives: Contribution by the unaffected hemisphere is one of the motor recovery mechanisms following stroke. We attempted to investigate changes in the corticospinal tract (CST) in the unaffected hemisphere at the early stage in patients with intracerebral hemorrhage (ICH), using diffusion tensor tractography (DTT)., Subjects and Methods: Fifty-three consecutive hemiparetic patients and 40 age- and sex-matched control subjects were enrolled. DTT was performed using a 1.5-tesla system at the early stage of ICH (7-28 days after onset). We measured the fiber number, fractional anisotropy and apparent diffusion coefficient of CST tractography in the unaffected hemisphere, and assessed the motor function of the affected extremities., Results: The fiber number of the CST in the unaffected hemisphere of the patient group was higher than that of the control group (p = 0.000). In contrast, the fractional anisotropy value was lower than that of the control group (p = 0.018). However, there were no significant differences in the apparent diffusion coefficient values between the 2 groups (p = 0.654)., Conclusions: We demonstrated that the CST in the unaffected hemisphere was changed at the early stage in patients with ICH, using DTT., (Copyright 2010 S. Karger AG, Basel.)

We demonstrated the recovery of a severely damaged corticospinal tract (CST) in a 45-year-old female patient with intracerebral hemorrhage using diffusion tensor tractography and transcranial magnetic stimulation. Two longitudinal evaluations were conducted. There was no evidence of a CST in the affected hemisphere on the first evaluation. However, we observed evidence of a CST on the second evaluation. It seems that the affected motor function was recovered through the recovery of the damaged CST.

The diffusion tensor tractography (DTT) allows the corticospinal tract(CST) to be visualized at the subcortical level and functional MRI (fMRI) is capable of precisely identifying activation sites at the cortex. Therefore, it seems that combined DTT/fMRI would allow more accurate evaluation of the state of the CST. We have attempted to demonstrate cortical reorganization in a patient with cortical hemorrhage using DTT analyzed by fMRI activations. Six normal subjects and a 12-year-old female patient with a hemorrhage in the left fronto-parietal cortex were recruited. fMRI was performed at 1.5-T with timed hand grasp-release movements, and DTT was performed using 1.5-T with a Synergy-L Sensitivity Encoding head coil. Three-dimensional reconstructions of the fiber tracts were obtained using the fMRI activation as the seed region of interest and the CST area of the anterior pons as the target region of interest. The tract of the affected hemisphere originated from the lateral area of the injured precentral knob and descended along the known corticospinal tract pathway. It seems that the motor function of the affected hand was reorganized into the lateral area of the injured precentral knob. Therefore, these combined modalities would be helpful in elucidating the state of the CST.

We tried to demonstrate the restoration of corticospinal tract in a patient with intracerebral hemorrhage, using diffusion tensor tractography and functional magnetic resonance imaging, and transcranial magnetic stimulation. Transcranial magnetic stimulation demonstrated the corticospinal tract had been spared since subacute stage. Diffusion tensor tractography and functional magnetic resonance imaging showed that the corticospinal tract that was displaced by a hematoma had been restored. These combined modalities would be helpful in elucidating the state and change of corticospinal tract.

We tried to investigate the motor outcome according to diffusion tensor tractography (DTT) findings for the corticospinal tract (CST) in the early stage for hemiparetic patients with intracerebral hemorrhage (ICH). Forty patients with severe paralysis of the affected side were enrolled. DTT was obtained in the early stage of the stroke (7-30 days) and was classified into four groups: type A, the CST originating from primary motor cortex was preserved around the hematoma; type B, the CST was similar to type A except the fiber originated from the adjacent areas to the primary motor cortex; type C, the CST was interrupted at or around the hematoma; and type D, the CST did not reach the hematoma due to degeneration (Fig. 1). Six months after onset, motor function was measured and the statistical influence of the DTT type was tested. Initially, none of the motor function scales of the affected side differed among the four DTT types. Six months after the onset of ICH, motor functions of the same side were significantly different according to DTT type (p<0.05). All motor scales were highest in the DTT type A group, and were lowest in the DTT type D group (p<0.0003). The early DTT findings for CST may be used to predict the motor outcome of the affected extremities in hemiparetic patients with ICH.

Objectives: Little is known about the mechanism of motor recovery for patients with intracerebral hemorrhage (ICH). We attempted to demonstrate the motor recovery mechanism in a hemiparetic patient with ICH using diffusion tensor tractography (DTT), transcranial magnetic stimulation (TMS), and functional MRI (fMRI)., Subjects: A 37-year-old female patient and twelve age-matched control subjects were evaluated. The patient presented with complete paralysis of the left extremities, which occurred at the onset of a spontaneous ICH in the left corona radiata and basal ganglia. Over the 16 month period following onset, motor function of the affected extremities slowly recovered to a nearly normal state. Three longitudinal evaluations (at 1 month, 4 months, and 16 months from onset) were conducted for the patient., Results: DTT showed that the origin of the corticospinal tract (CST) had changed from the posterior parietal cortex, primary sensory cortex, and primary motor cortex. Additionally, TMS and fMRI demonstrated the recovery process of the damaged lateral CST., Conclusions: It seems that, in this patient, the affected motor function was recovered through the normalization process of the damaged lateral CST of the affected hemisphere. We conclude that this may be one of various motor recovery mechanisms for patients with ICH. Process of the damaged lateral CST.

The purpose of this study was to demonstrate corticospinal tract compression that was due to a hematoma by using diffusion tensor tractography (DTT) and functional MRI (fMRI) in a patient with an intracerebral hemorrhage (ICH). A 23-year-old right-handed woman presented with severe paralysis of her right extremities at the onset of a spontaneous ICH. Over the first three days from onset, the motor function of the affected upper and lower extremities rapidly recovered to the extent that she was able to overcome applied resistance to the affected limbs, and her limbs regained normal function 3 weeks after onset. The tract of the right hemisphere originated from the primary sensori-motor cortex (SM1) and it passed through the known corticospinal tract pathway. However, the tract of the left hemisphere was similar to that of the right hemisphere except that it was displaced to the antero-medial side by the hematoma at the cerebral peduncle. Only the contralateral SM1 area centered on the precentral knob was activated during affected (right) or unaffected (left) hand movements, respectively. In conclusion, fMRI and DTT demonstrated a corticospinal tract compression due to hematoma in this patient. We conclude that the combined use of these two modalities appears to improve the accuracy of investigating the state of the corticospinal tract.

Purpose: We hypothesized that diffusion tensor imaging (DTI) could be useful for exploring corticospinal tract (CST) regeneration if longitudinal changes of diffusion anisotropy can be detected. In this study, we explored the recovery of a CST partially damaged by intracerebral hematoma in a patient by DTI., Methods: A 61-year-old female patient and six age-matched control subjects were evaluated. The patient presented with complete paralysis of the left extremities, which occurred at the onset of a spontaneous intracerebral hemorrhage (ICH) in the right corona radiata and internal capsule. Over the five-month period following onset, motor function of the affected extremities slowly recovered to the normal range. Two longitudinal DTIs were acquired from the patient (at 3 weeks and 5 months from onset) and one DTI from the control subjects. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were measured using a region of interest (ROI) method., Results: On the 3-week DTI, FA values of ROIs in the ICH regions in the affected hemisphere were significantly lower, and ADC values of ROIs in the same areas were significantly higher than those of the control subjects (p<0.002). However, both mean FA and ADC values of the affected hemisphere in the 5-month DTI showed no significant differences versus those of the control.

We investigated the relationships of the arcuate fasciculus (AF) and the nigrostriatal tract (NST) with the language ability in patients with putaminal hemorrhage (PH) in the dominant hemisphere, using diffusion tensor tractography (DTT). Twenty-seven consecutive right-handed patients with PH and 27 age- and sex-matched normal control subjects were recruited. The aphasia quotient (AQ) score was used to evaluate the language ability at the early stage (within six weeks after onset). The fractional anisotropy (FA) value and tract volume (TV) of the ipsilesional AF and the ipsilesional NST were measured. The FA values and TVs of the ipsilesional AF and the ipsilesional NST of the patient group were lower than those of the control group (p < 0.05). The AQ score showed no significant correlation with the FA values of the ipsilesional AF and the ipsilesional NST (p > 0.05). By contrast, the AQ score showed a strong positive correlation with the TV of the ipsilesional AF (r = 0.868, p < 0.05). In addition, the AQ score revealed a moderate positive correlation with the TV of the ipsilesional NST (r = 0.577, p < 0.05). The states of the ipsilesional AF and the ipsilesional NST were closely related to the language ability at the early stages in patients with PH in the dominant hemisphere. Furthermore, the ipsilesional AF was more closely related to the language ability than the ipsilesional NST. [ABSTRACT FROM AUTHOR]

This paper presents a case in whom a differential diagnosis of akinetic mutism with a disorder of consciousness was made using diffusion tensor tractography (DTT). A 69-year-old female patient was diagnosed with subarachnoid hemorrhage, intraventricular hemorrhage, and intracerebral hemorrhage produced by the subarachnoid hemorrhage. She exhibited impaired consciousness with a Coma Recovery Scale-Revised score of 13 until 1 month after onset. Her impaired consciousness recovered slowly to a normal state according to the Coma Recovery Scale-Revised (23 points: full score) at 7 weeks after onset. On the other hand, she exhibited the typical clinical features of akinetic mutism (no spontaneous movement [akinesia] or speech [mutism]). On the DTT performed at 1-month, the upper, and lower dorsal ascending reticular activating systems, which are related to a disorder of consciousness, showed an almost normal state. In contrast, the prefronto-caudate and prefronto-thalamic tracts, which are related to akinetic mutism, showed severe injuries. These DTT results suggested that the patient's main clinical features were not a disorder of consciousness but akinetic mutism. Therefore, DTT for the ascending reticular activating system, and the prefronto-caudate and prefronto-thalamic tracts could provide additional evidence for a differential diagnosis of DOC and AM at the early stages of stroke. [ABSTRACT FROM AUTHOR]

Diffusion tensor tractography (DTT) allows for identification and evaluation of the spinothalamic tract and its thalamocortical pathway (STP). We attempted to investigate the relationship between tactile sensation and the STP in chronic stroke patients. We measured fractional anisotropy, mean diffusivity, and tract volume of the STP. The tactile sensation score of the affected side in patients with preserved STP integrity was higher compared with that of patients with an interrupted STP. The remaining volume and integrity of the STP in the affected hemisphere were important factors for tactile sensation of the affected side in chronic patients with intracerebral hemorrhage (ICH). [ABSTRACT FROM AUTHOR]

Objectives: Many diffusion tensor tractography (DTT) studies have reported on fornix injury in various diseases. However, there has been no DTT study on fornix injury by intracerebral hemorrhage (ICH). We attempted to investigate fornix body injury in patients with ICH, using DTT. Methods: We identified 58 consecutive stroke patients using the following criteria: (1) first-ever stroke, (2) age: 45-65 years, (3) hemorrhage confined within the corona radiata and basal ganglion level, (4) an available DTT scan performed during the early stage of ICH (1-5 weeks after onset). Among 58 consecutive patients, we identified six patients who showed disruption at the fornix body. Results: Following ICH, 10.7%% of patients revealed complete disruption of the fornix body on DTT. Results from DTT of the fornix showed disruption in anterior and posterior portions of the fornix body in three patients, in the anterior portion of the fornix body in two patient, and in the posterior portion of the fornix body in one patient. Conclusions: We report on six patients who showed complete disruption of the fornix body following ICH. It is our belief that the fornix of patients with ICH could be evaluated using DTT. [ABSTRACT FROM AUTHOR]