• We used transcranial magnetic stimulation (TMS) and diffusion tensor imaging (DTI) to explore the neural network of Lance-Adams syndrome (LAS). • Gamma-aminobutyric acid type B (GABA B)-mediated inhibition was decreased on TMS. • There were significant changes in some diffusion metrics on DTI.

BACKGROUND: Laryngeal penetration, which is a less serious form of aspiration, should be considered in patients with stroke to ensure early detection of risk of laryngeal aspiration and prevention of pneumonia. OBJECTIVE: As a follow-up to a previous study that demonstrated the association of pharyngeal width to laryngeal aspiration, the present study sought to determine whether the pharyngeal width was related to not only laryngeal aspiration but also laryngeal penetration in patients with deglutition disorder following stroke. METHODS: The pharyngeal width on the roentgenogram was measured and compared based on the severity of aspiration. Moreover, the optimal cut-off points were determined for predicting the penetration and aspiration so that the difference between the penetration and the aspiration could be elucidated. RESULTS: The pharyngeal width of the patients was wider than the controls. The increase of the pharyngeal width by aspiration severity was more evident in the patients with chronic and right cerebral stroke. The optimal cut-off point of the pharyngeal width was approximately 1 mm lesser for the prediction of penetration than for aspiration. CONCLUSIONS: The pharyngeal width could be an ancillary method for detecting penetration and aspiration in stroke patients.

The catechol-O-methyltransferase (COMT) gene has been noted to play an important role in individual variations in the aging process. We investigated whether COMT polymorphism could influence cognition related to white matter networks. More specifically, we examined whether methionine (Met) allele loading is associated with better individual cognitive performance. Thirtyfour healthy elderly participants were recruited; each participant's COMT genotype was determined, and Korean version of Montreal Cognitive Assessment scores and a diffusion tensor image were obtained for all participants. The Met carrier group showed significantly lower mean diffusivity, axial diffusivity, and radial diffusivity values for the right hippocampus, thalamus, uncinate fasciculus, and left caudate nucleus than the valine homozygote group. The Met carrier group also scored higher for executive function and attention on the Korean version of Montreal Cognitive Assessment. Based on these results, we can assume that the COMT Met allele has a protective effect on cognitive decline contributing to individual differences in cognitive function in late life period. Abbreviations: AD = axial diffusivity, CN = caudate nucleus, COMT = catechol-O-methyltransferase, DA = dopamine, DLPFC = dorsolateral prefrontal cortex, DNA = Deoxyribonucleic Acid, DTI = diffusion tensor image, FA = fractional anisotropy, FSL = FMRIB Software Library, HC = hippocampus, IFOF = inferior fronto-occipital fasciculus, MCI = mild cognitive impairment, MD = mean diffusivity, Met = methionine, MMSE = mini-mental status examination, MoCA-K = Korean version of Montreal Cognitive Assessment, MRI = magnetic resonance imaging, PFC = prefrontal cortex, RD = radial diffusivity, ROIs = region of interests, TE = echo time, TM = thalamus, TR = repetition time, UF = uncinate fasciculus, Val = valine, VLPFC = ventrolateral prefrontal cortex.

Chronic post-hypoxic myoclonus (PHM) is a rare complication after successful cardiopulmonary resuscitation that causes severe gait disability due to action myoclonus.We report a case of a 69-year-old male patient with chronic PHM who showed significant improvement in myoclonus and gait. The diffusion tensor imaging (DTI) was taken at initial admission and long-term follow-up (3 years) to find the changes in the diffusion matrices of the related neural correlate region of interest (ROI). There was a change in pedunculopontine nucleus and several subcortical networks.