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Neural Tract Injuries by Brain Herniations After Head Trauma

Hong, Ji Heon MS; Kim, Seong Ho MD, PhD; Kim, Oh Lyong MD, PhD; Byun, Woo Mok MD; Jang, Sung Ho MD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

Journal of Head Trauma Rehabilitation:
doi: 10.1097/HTR.0b013e31820fc480
Focus on Clinical Research and Practice, Part 1
Abstract

Objectives: Little is known about the usefulness and findings of brain herniation on diffusion tensor tractography (DTT). Using DTT, we demonstrated neural tract injuries in 2 patients who showed subfalcine and trasntentorial herniations after subdural hematoma resulting from motor vehicle accident.

Design: Two patients and 6 age- and sex-matched, healthy volunteers were recruited for this study.

Setting: An inpatient rehabilitation unit.

Main Outcome Measures: Diffusion tensor tractography for the patients was performed 5 weeks after onset.

Results: Diffusion tensor tractography of patient 1 showed complete injury of both cingulums at or around the rostrum of the corpus callosum, the fornix at the anterior and posterior body, and both corticospinal tracts at the pons. In addition, partial injury of both somatosensory tracts at the midbrain was also observed. Patient 2 showed complete injury of both cingulums above the body of the corpus callosum, the fornix at the anterior and posterior body, and right corticospinal tracts at the pons level and partial injury of the right somatosensory tract. We found that the fractional anisotropy values of all neural tracts, except fornix, in both patients and left somatosensory tract in patient 2 and voxel number for left somatosensory tract in patient 2 were decreased 2 SDs below that of normal controls.

Conclusions: We determined that DTT would be a good technique for use in the detection of underlying lesions in patients with brain herniation.

Author Information

Author Affiliations: Department of Physical Therapy, Yeungnam College of Science & Technology, Daegu, Republic of Korea (Dr Hong), Department of Physical Medicine and Rehabilitation (Dr Jang), Department of Neurosurgery (Drs S. H. Kim and O. L. Kim), and Department of Diganostic radiology (Dr Byun), College of Medicine, Yeungnam University, Namku, Taegu, Republic of Korea.

Corresponding Author: Sung Ho Jang, MD, Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Taegu, 705-717, Republic of Korea (strokerehab@hanmail.net, belado@med.yu.ac.kr).

This work was supported by National Research Foundation of Korea grant funded by the Korean Government (KRF-2008-314-E00173).

The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.