Medial Lemniscus Lesion in Pediatric Hemiplegic Patients without Corticospinal Tract and Posterior Thalamic Radiation Lesion

Abstract

Objectives: Using diffusion tensor imaging (DTI), we investigated the state of medial lemniscus (ML), corticospinal tract (CST), and posterior thalamic radiation (PTR), which were expected as probable reasons for clinical hemiplegia in pediatric patients, especially those who showed impaired fine motor control and proprioception, but no definite motor weakness or spasticity. Methods: We recruited 13 hemiplegic patients and 8 age-matched healthy control subjects. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) for the bilateral ML, CST, and PTR were calculated and compared between the affected hemisphere of the patient (AP), the unaffected hemisphere of the patient (UP), and the mean value of the bilateral hemispheres in control subjects (MC). Results: FA and ADC values for the CST and PTR did not differ significantly between the AP, UP, and MC subgroups (p > 0.05). However, the FA value for the ML in AP showed a significant decrease, compared with that in UP (p = 0.012) and MC (p = 0.047). DTT for the CST and PTR showed preserved integrity and ML in the UP also had continuity to the cortex; however, ML in AP showed disruption. Conclusions: Using DTI, we demonstrated that the ML lesion might be related to clinical hemiplegia in pediatric patients.

Detection of hand and leg motor tract injury using novel diffusion tensor MRI tractography in children with central motor dysfunction

“…Previous studies have investigated diffusion metric changes within the CST in hemiplegic children [18-20]. Jung et al [18] reported that fractional anisotropy (FA) and apparent diffusion coefficient (ADC) are preserved in CST of both affected and unaffected hemisphere in hemiplegic patients having impaired fine motor control but no definite motor weakness.…”

“…Jung et al [18] reported that fractional anisotropy (FA) and apparent diffusion coefficient (ADC) are preserved in CST of both affected and unaffected hemisphere in hemiplegic patients having impaired fine motor control but no definite motor weakness. This report suggested the direct role of CST in definite motor weakness.…”

Successful Application of an Insole with a Metatarsal Inhibition Bar and Deep Heel Cup for Improving Gait Dysfunction in a Patient with Poor Coordination with Disrupted Corticoreticular Tracts: A Case Report

“…In addition, we applied the following parameters: streamline samples, 5000; length of step, 0.5 mm; thresholds of curvature, 0.2. The CST, CRT, and ML were depicted by the selection of fibers passing through the target and seed regions of interest (ROIs) [ 11 , 12 ]. To evaluate the CST state, we located a seed ROI of the CST on the portion of the level of the anterior mid-pons, in which the CST passed on a two-dimensional color map.…”

Motor, sensory and executive function brain networks in children with unilateral cerebral palsy

“…In particular, FA in the optic radiations was shown to correlate with ophthalmological function in children with PVL 179 . In children with CP who had normal appearance on structural MRI, no difference could be appreciated in FA or MD of the posterior thalamic radiations compared with controls 185 .…”

“…The corticopontocerebellar tracts were shown to have an increased asymmetry (based on streamline count) in children with unilateral spastic CP, and this was shown to correlate with Assisting Hand Assessment scores 113 . The medial lemniscus was also studied, and shown to have reduced FA in children with unilateral CP who had normal structural MRI; this cohort was also not found to have any significant FA or MD changes in either the corticospinal tract or the posterior thalamic radiations 185 . Both of these findings highlight that motor impairment is not simply explained by corticospinal tract damage; and further assessment of other motor pathways is needed.…”