Diffusion Tensor Tractography for Detection of Concomitant Traumatic Brain Injury in Patients With Traumatic Spinal Cord Injury.

OBJECTIVES: We investigated concomitant traumatic brain injury in patients with traumatic spinal cord injury (TSCI) who had head trauma history, using diffusion tensor tractography (DTT). DESIGN: Retrospective survey. PARTICIPANTS: We recruited 14 consecutive patients with TSCI and coexisting head trauma history at the time of TSCI and 30 control subjects. METHODS: The corticospinal tract (CST), corticoreticulospinal tract (CRT), cingulum, and fornix were reconstructed using DTT, and DTT parameters (fractional anisotropy and fiber volume) and configuration were estimated. RESULTS: The values of fractional anisotropy and fiber volume in the CST, CRT, cingulum, and fornix of the patient group were significantly lower than those of the control group (P < .05). On configurational analysis of DTT for each tract, the neural tracts for motor function (the CST and CRT) had more injury than the neural tracts for cognitive function (the cingulum and fornix). No association between the severity of TSCI and traumatic brain injury was observed in terms of DTT parameters. CONCLUSIONS: Using DTT, we found injury of the neural tracts in patients with head trauma history at the time of TSCI. Our results suggest that brain evaluation using DTT can be recommended for the patients with head trauma history at the time of TSCI irrespective of the results of conventional brain MRI.

Recovery of aphasia and change of injured arcuate fasciculus in the dominant hemisphere in stroke patients.

OBJECTIVES: We investigated the relation between recovery of aphasia and change of injured fasciculus (AF) in the dominant hemisphere using diffusion tensor tractography (DTT) in stroke patients with aphasia. METHODS: Sixteen consecutive right-handed stroke patients with aphasia with injury of the left AF were recruited for this study. The Western Aphasia Battery for assessment of aphasia and DTTs of the AF were used within 30 days of stroke onset and again three months after. DTTs of both AFs were reconstructed, and fractional anisotropy (FA) and voxel number of the AF were measured. RESULTS: A moderate positive correlation was observed between aphasia quotient (AQ) and voxel number of the left AF (r = 0.626, p < 0.01). However, no correlation was observed between AQ and FA of the left AF, and voxel number and FA of the right AF. In addition, the language quotient (LQ) of WAB was not correlated with FA and voxel number of the both AFs. CONCLUSIONS: We found a relation between recovery of aphasia from early to chronic stage of stroke and recovery of the injured AF in the dominant hemisphere irrespective of change of the AF in the non-dominant hemisphere. Our results suggest that facilitation of the injured AF in the dominant hemisphere could be an important strategy in neuro-rehabilitation for stroke patients with aphasia.

Comparison of Intraarticular Pulsed Radiofrequency and Intraarticular Corticosteroid Injection for Management of Cervical Facet Joint Pain.

BACKGROUND: Disorders of the facet joints are some of the most common sources of chronic spinal pain. Facet joint pain is responsible for approximately 50% of patients with chronic neck pain. Pulsed radiofrequency (PRF) stimulation, after placing needle electrodes into the joint space, has been recently reported for the management of joint pain. OBJECTIVE: The aim of this study was to evaluate the effect of intraarticular (IA) PRF for the management of cervical facet joint (CFJ) pain. In addition, we compared the effect of IA PRF to IA corticosteroid injection. STUDY DESIGN: Prospective observational study. SETTING: University hospital. METHODS: Forty patients with CFJ pain were included in the study and randomly assigned to one of 2 groups: the IA PRF group and the IA corticosteroid (ICI) group. There were 20 patients in each group. Pain intensity was evaluated using a numeric rating scale (NRS) at pre-treatment, and one, 3, and 6 months after treatment. RESULTS: When compared to the pretreatment NRS scores, patients in both groups showed a significant decrease in NRS scores at one, 3, and 6 months after treatment (P = 0.000). Changes in the NRS scores over time were not significantly different between the groups (P = 0.227). Six months after treatment, 10 patients (50.0%) in the PRF group and 12 patients (60.0%) in the ICI group reported successful pain relief (pain relief of = 50%). LIMITATIONS: A small number of participants. CONCLUSION: IA PRF stimulation is as effective as IA corticosteroid injection in attenuating CFJ pain. The use of PRF could decrease CFJ pain, while avoiding the adverse effects of steroids.Key words: Cervical facet joint pain, pulsed radiofrequency, intraarticular stimulation, chronic pain, corticosteroid injection, numeric rating scale.