Disrupted hypothalamic functional connectivity related to cognitive impairment after diffuse axonal injury.

ABSTRACT: This study aims to investigate whether there is imaging evidence of disrupted hypothalamic functional connectivity (FC) in patients with diffuse axonal injury (DAI) and relationships with cognitive impairment.Resting-state functional magnetic resonance imaging (fMRI) data were acquired from acute patients with diagnosed DAI (n = 30) and healthy controls (HC) (n = 30). We first assessed hypothalamic FC with seed-based analysis. Furthermore, the lateral and medial hypothalamic seed was selected to show distinct functional connectivity in DAI. In addition, partial correlation was used to measure the clinical associations with the altered hypothalamic FC in DAI patients.Compared with HC, DAI group showed significantly increased hypothalamic FC with superior temporal gyrus, and the regions around the operculum. Furthermore, there was a significant negative correlation between the connectivity coefficient of hypothalamus to right and left superior temporal gyrus and the disability rating scale scores in DAI group. When the seed regions were divided into lateral and medial hypothalamus, except for increased connectivity of medial hypothalamus (P < .01 with correction), we more observed that decreased left lateral hypothalamic connectivity was positively correlated with mini-mental state examination (MMSE) scores.Our results suggest that there are alterations of hypothalamic FC in DAI and offer further understanding of clinical symptoms including related cognitive impairment.

Extensive traumatic axonal injury of brain due to violence: A case report.

RATIONALE: Many studies using diffusion tensor imaging (DTI) have demonstrated traumatic axonal injury (TAI) in patients whose conventional brain magnetic resonance imaging (MRI) results are negative following head trauma. Injury mechanism for TAI in these patients has been mainly associated with motor vehicle accident, whereas very little is known about TAI by violence. PATIENT CONCERNS: A 42-year-old male patient presented after experiencing head trauma due to violence. His face was hit several times by 2 men, and 1 of the men kicked the right side of the patient's head, after which the patient's left parietal area hit the ground while falling. After the head trauma, he felt mild motor weakness of the left upper and lower extremities and had mild articulation difficulty, cognitive dysfunction including memory impairment, and excessive daytime sleepiness. DIAGNOSES: The patient was diagnosed as TAI. INTERVENTIONS: Clinical assessments and DTI were performed at 10 days after the head trauma. OUTCOMES: He showed mild left hemiparesis (5/4), mild dysarthria, mild cognitive abnormality (Clinical Dementia Rating: 0.5) and mild abnormality on the Epworth Sleepiness Scale (score: 12; cut-off score: 10, maximum score: 24). DTI showed the following configurational abnormalities: right corticospinal tract narrowing, left corticobulbar tract narrowing, discontinuations in the anterior portion of both cingula, discontinuation of the left fornical crus, non-reconstruction of the right dorsolateral prefronto-thalamic tract, and narrowing in both lower ventral ascending reticular activating systems. LESSONS: Extensive TAI of various neural tracts was demonstrated by performing DTI of a patient with head trauma due to violence. Analysis of the neural tracts via DTI can be useful in detection of TAI in patients who show various neurological features following head trauma due to violence.

Thalamocortical Sensorimotor Circuit Damage Associated with Disorders of Consciousness for Diffuse Axonal Injury Patients.

The relationship of structural and functional brain damage and disorders of consciousness (DOC) for diffuse axonal injury (DAI) is still not fully explored. We employed diffusion tensor imaging (DTI) and resting-state fMRI (RS-fMRI) to examine the changes of resting activations and white matter (WM) integrity for DAI with DOC. WM damages were observed in the body and genu of the corpus callosum, right external capsule (EC) and superior corona radiate (SCR), left superior cerebellar peduncle (SCP) and posterior thalamic radiation (PTR). The RS-fMRI revealed augmented amplitude of low-frequency fluctuation (ALFF) in the anterior cingulate cortex, hippocampus, insula, amygdala and putamen, and reduced ALFF in the precuneus, thalamus, pre-central and post-central gyri. Correlation analysis identified positive associations between the Glasgow Coma Scale (GCS) and activation of the precuneus and between GCS and DTI measurements in the left PTR and SCP, but a negative correlation was found between GCS and activation of the thalamus. Cross modality association analyses indicated that activations of the amygdala and postcentral gyrus were correlated with DTI measurements of the right EC and left PTR respectively. These results implicate that the WM damages in thalamocortical sensorimotor circuit and aberrant brain activity responding to self-awareness and sensation are critical factors to DOC, which expand the current understanding of the neural mechanisms underlying DAI.

Hypothalamic-amygdalar-brainstem volume reduction in a patient with narcolepsy secondary to diffuse axonal injury.

A 17-year-old male with diffuse axonal injury (DAI) was referred to our psychiatric clinic with a diagnosis of depression. However, further investigation indicated that he had narcolepsy without cataplexy secondary to DAI. We assessed regional volume alterations in the patient; MRI analysis showed a significant decrease in the volume of the hypothalamus, left amygdala, and brainstem. Our findings add to further understanding of the structural basis of secondary narcolepsy, and may provide basis for future neuroimaging studies on sleep disturbances in traumatic brain injury (TBI).

[Acupuncture treatment for a patient with diffuse axonal injury--report no. 2].

Acupuncture has been applied as a therapeutic technique in China, Japan and East Asia. Recently, its application is extended to treat neural injuries. We describe a 26-year-old man with consciousness disturbance and intense muscle spasticity of extremities due to severe diffuse axonal injury (DAI) in whom acupuncture treatment for 1 month was effective to alleviate these symptoms remarkably. We also investigated the cerebral blood flow two times by 123I-IMP SPECT in acupuncture period. Acupuncture treatment may be effective to improve consciousness disturbance and intense spasticity of DAI and to modulate cerebral blood flow.

[Acupuncture treatment for a patient with diffuse axonal injury].

Acupuncture has been used as a therapeutic technique in China, Japan and East Asia. Recently, it is used to treat neural injuries. We describe a 6-year-old boy with consciousness disturbance and heavy muscle spasticity of extremities due to severe diffuse axonal injury (DAI) in whom acupuncture treatment for 6 months alleviated these symptoms remarkably. Acupuncture treatment may be effective to improve consciousness disturbance and heavy spasticity of DAI.

Thalamic deep brain stimulation for posttraumatic action tremor.

We report a case of thalamic deep brain stimulation (DBS) for treatment of posttraumatic tremor. An 18-year-old right-handed man developed a disabling and medically refractory action tremor in the right upper extremity 9 months after sustaining diffuse axonal injury in a motor vehicle collision. DBS of the left ventral intermediate nucleus of the thalamus (Vim) suppressed the tremor without complication and should be considered as an option for the management of intractable posttraumatic tremor.

Successful treatment by spinal cord stimulation for gait disturbance in a patient with diffuse axonal injury.

The authors present a case of diffuse axonal injury (DAI) treated by cervical spinal cord stimulation (C-SCS) for gait disturbance. The patient had right hemiparesis of moderate degree, mild ataxia, ideational apraxia and gait disturbance, when admitted to our hospital for rehabilitation. He could not walk by himself, nevertheless neurorehabilitation was done for four months. Xenon-CT was examined by C-SCS loading and the changes of regional cerebral blood flow were significantly increased in both hemispheres, especially in the thalamus. C-SCS was performed continuously on condition of 25 Hz, 200 microsec and 0.5 V, daily for a month. Neurological deficits, especially gait disturbance due to ideational apraxia, were gradually improved after initiation of C-SCS, and the patient could walk by himself. We speculate that C-SCS played a role in triggering improvement of gait disturbance at the chronic stage in our case, and SCS may be helpful for neurorehabilitation of focal symptoms after DAI.