Ataxic hemiparesis after corona radiata infarct: Diffusion tensor imaging correlation of corticoponto-cerebellar tract injury

Abstract

A 50-year-old female patient underwent conservative management for a right corona radiata infarct at the Department of Neurology in a university hospital ( Figure 1A). She had no history of diabetes, hypertension, or heart disease. The patient received a loading dose of clopidogrel (300 mg/day), followed by 75 mg/day plus 100 mg/day aspirin.She was transferred to the rehabilitation department of the same hospital 2 weeks after infarct onset. Prior to this presentation, the patient had no history of any neurological or psychological disorders. Physical examination revealed ataxia on her left upper and lower limbs. She scored 10 on the Scale for Assessment and Rating of Ataxia (range, 0-40 points with a higher score indicating a poorer state). In addition, she had mild weakness in the left upper and lower limbs (manual muscle test revealed a good grade on the upper and lower limbs). She was able to walk independently indoors with supervision and needed no physical assistance. There were no observations indicating spasticity, sensory deficits, visual disturbance, language impairment (such as dysarthria and aphasia), and dysphasia. Furthermore, she scored all 30 points on the mini-mental state examination. Her thyroid function test results were unremarkable. In addition, the white blood cell count (5,504 μl) and erythrocyte sedimentation rate (20 mm/H) were within normal range.Diffusion tensor imaging was performed 2 weeks after disease onset using a 6-channel head coil on a 1.5-T Philips Gyroscan Intera (Philips, Ltd, Best, The Netherlands) system with single-shot echo-planar imaging. Seventy contiguous slices were acquired parallel to the anterior commissure-posterior commissure line for each of the 32 non-collinear diffusion sensitizing gradients. The imaging parameters were: acquisition matrix = 96 × 96; reconstructed matrix = 192 × 192; field of view = 240 × 240 mm 2 ; repetition time = 10,398 ms; echo time = 72 ms; parallel imaging reduction factor = 2; echo-planar imaging factor = 59; b = 1000 s/mm 2 ; and slice thickness = 2.5 mm. Eddy current correction was applied to correct the head motion effect and image distortion before fiber tracking using the Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB) Diffusion Software.Fiber tracking was performed via probabilistic tractography using the default tractography option in the FMRIB Diffusion Software (streamline samples = 5000, step lengths = 0.5 mm, curvature thresholds = 0.2). To reconstruct the cortico-ponto-cerebellar tract (CPCT), a seed region of interest (ROI) was defined at the primary sensorimotor cortex on the axial image. Next, two target ROIs were placed at the anterior portion of pons on the axial image and the contralateral middle cerebellar peduncle on the coronal image [1]. We observed a thinned right CPCT (partial injury) and preserved left CPCT in our patient ( Figure 1B).The cerebellum plays a role in the coordination of voluntary movements and correction of errors in muscle contractions during active movements [2]. ...

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Relationship between recovery of motor function and neuropsychological functioning in cerebral infarction patients: the importance of social functioning in motor recovery

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