Diagnosis of Complex Regional Pain Syndrome I Following Traumatic Axonal Injury of the Corticospinal Tract in a Patient with Mild Traumatic Brain Injury

Abstract

A 54-year-old male suffered from direct head trauma resulting from a fall while working. At approximately two months after the accident, he began to feel pain (burning sensation) and swelling of the dorsum of the right hand and wrist. He showed the following clinical features among the clinical signs and symptoms of revised diagnostic criteria for complex regional pain syndrome (CRPS): spontaneous pain, mechanical hyperalgesia, vasodilation, skin temperature asymmetries, skin color changes, swelling, motor weakness. No specific lesion was observed on brain MRI taken at ten weeks after onset. Plain X-ray, electromyography, and nerve conduction studies for the right upper extremity detected no abnormality. A three-phase bone scan showed hot uptake in the right wrist in the delayed image. On two-month diffusion tensor tractography, partial tearing of the corticospinal tract (CST) was observed at the subcortical white matter in both hemispheres (much more severe in the left CST). In addition, the fiber number of the right CST was significantly decreased than that of seven normal control subjects. CRPS I of the right hand in this patient appeared to be related to traumatic axonal injury of the left CST following mild traumatic brain injury.

The Usefulness of Diffusion Tensor Tractography in Diagnosing Neuropathic Pain: A Narrative Review

“…DTT was used to demonstrate STT injury in relation to central pain ( Jang et al, 2019a ; Jang and Lee, 2019 ) and to find out STT injury in patients who had atypical type of central pain including abdominal pain ( Jang et al, 2020 ). Interestingly, CST damage was revealed using DTT in patients with CRPS following mild TBI ( Jang and Seo, 2020 ). These studies showed that DTT was useful in detecting STT injuries in patients with central pain after TBI.…”

Delayed development of aphasia related to degeneration of the arcuate fasciculus in the dominant hemisphere nine years after the onset in a patient with intracerebral hemorrhage: a case report

“…The DTI was performed twice (at one month and nine years after ICH onset). On both occasions, a sensitivity-encoding head coil on a 1.5-T Philips Gyroscan Intera scanner (Hoffman-LaRoche Ltd., Best, Netherlands) with single-shot echo-planar imaging and navigator echo was used for the acquisition of DTI data.67 contiguous slices were obtained parallel to the anterior commissure–posterior commissure line for each of the 32 non-collinear diffusion-sensitizing gradients [ 13 ]. DTI parameters were as follows: acquisition matrix = 96 × 96; reconstructed matrix = 128 × 128; field of view = 221 mm × 221 mm; repetition time = 10,726 ms; echo time = 76 ms; parallel imaging reduction factor = 2; echo-planar imaging factor = 49; b = 1000 s/mm 2 ; number of excitations = 1; and slice thickness of 2.3 mm with no gap (acquired voxel size 1.25 mm × 1.25 mm × 2.5 mm) [ 13 ].…”

“…On both occasions, a sensitivity-encoding head coil on a 1.5-T Philips Gyroscan Intera scanner (Hoffman-LaRoche Ltd., Best, Netherlands) with single-shot echo-planar imaging and navigator echo was used for the acquisition of DTI data.67 contiguous slices were obtained parallel to the anterior commissure–posterior commissure line for each of the 32 non-collinear diffusion-sensitizing gradients [ 13 ]. DTI parameters were as follows: acquisition matrix = 96 × 96; reconstructed matrix = 128 × 128; field of view = 221 mm × 221 mm; repetition time = 10,726 ms; echo time = 76 ms; parallel imaging reduction factor = 2; echo-planar imaging factor = 49; b = 1000 s/mm 2 ; number of excitations = 1; and slice thickness of 2.3 mm with no gap (acquired voxel size 1.25 mm × 1.25 mm × 2.5 mm) [ 13 ]. By using the fiber assignment continuous tracking algorithm, fiber tracking was performed within the diffusion tensor imaging task card software (Philips Extended MR Work Space 2.6.3, Philips, Amsterdam, Netherlands), and the DTI parameters (fractional anisotropy [FA], mean diffusivity [MD], and fiber number [FN, total voxel number of a neural tract]) were automatically calculated using PRIDE software (Philips Medical Systems, Best, Netherlands) [ 13 ].…”

“…DTI parameters were as follows: acquisition matrix = 96 × 96; reconstructed matrix = 128 × 128; field of view = 221 mm × 221 mm; repetition time = 10,726 ms; echo time = 76 ms; parallel imaging reduction factor = 2; echo-planar imaging factor = 49; b = 1000 s/mm 2 ; number of excitations = 1; and slice thickness of 2.3 mm with no gap (acquired voxel size 1.25 mm × 1.25 mm × 2.5 mm) [ 13 ]. By using the fiber assignment continuous tracking algorithm, fiber tracking was performed within the diffusion tensor imaging task card software (Philips Extended MR Work Space 2.6.3, Philips, Amsterdam, Netherlands), and the DTI parameters (fractional anisotropy [FA], mean diffusivity [MD], and fiber number [FN, total voxel number of a neural tract]) were automatically calculated using PRIDE software (Philips Medical Systems, Best, Netherlands) [ 13 ]. Image distortions and head motion effects was corrected by using a diffusion registration package (Philips Medical Systems) [ 13 ].…”

“…By using the fiber assignment continuous tracking algorithm, fiber tracking was performed within the diffusion tensor imaging task card software (Philips Extended MR Work Space 2.6.3, Philips, Amsterdam, Netherlands), and the DTI parameters (fractional anisotropy [FA], mean diffusivity [MD], and fiber number [FN, total voxel number of a neural tract]) were automatically calculated using PRIDE software (Philips Medical Systems, Best, Netherlands) [ 13 ]. Image distortions and head motion effects was corrected by using a diffusion registration package (Philips Medical Systems) [ 13 ]. For analysis of the AF, the seed ROI was assigned manually in the deep white matter located in the posterior parietal portion of the superior longitudinal fascicle, while the target ROI was placed on the posterior temporal lobe using the method of Nucifora et al [ 14 ].…”