Ann Rehabil Med.  2014 Dec;38(6):871-875. 10.5535/arm.2014.38.6.871.

Intracranial Hemorrhage in the Corpus Callosum Presenting as Callosal Disconnection Syndrome: FDG-PET and Tractography: A Case Report

• Kim IH
• Lee S
• Lee CY
• Lee DG

• KMID: 2267102
• DOI: http://doi.org/10.5535/arm.2014.38.6.871

Abstract

We report the findings of 18F-fluorodeoxyglocese positron emission tomography (FDG-PET) and diffusion tensor tractography (DTT) in a right-handed patient presenting with callosal disconnection syndrome, including alien hand syndrome, after an anterior communicating artery aneurysmal rupture. The 49-year-old patient had right hemiparesis and unintended movement of the right hand during action of the left hand. A brain magnetic resonance imaging revealed lesions in the upper part of the genu and body in the corpus callosum as well as hemorrhage in the inter-hemispheric fissure. We observed extensive disruption of corpus callosum fibers in the upper genu and trunk by DTT for the evaluation of inter-hemispheric connection. FDG-PET revealed severe hypometabolism in the left cerebral hemisphere, including basal ganglia and thalamus, and hypermetabolism in the right cerebral hemisphere. Based on findings of FDG-PET and DTT, the callosal disconnection syndrome presented in the patient could be the result of loss of transcallosal inhibition in the contralateral hemisphere.

Keyword

Corpus callosum; Positron emission tomography; Diffusion tensor imaging

MeSH Terms

Alien Hand Syndrome
Basal Ganglia
Brain
Cerebrum
Corpus Callosum*
Diffusion
Diffusion Tensor Imaging
Hand
Hemorrhage
Humans
Intracranial Aneurysm
Intracranial Hemorrhages*
Magnetic Resonance Imaging
Middle Aged
Paresis
Positron-Emission Tomography
Rupture
Thalamus

Figure

• 

  Fig. 1 Sagittal T2-weighted brain magnetic resonance imaging (A) and axial images (B) showed hyperintensity in the corpus callosum genu and body as the result of anterior communicating artery aneurysm rupture. (C) Diffusion tensor tractography of the corpus callosum fibers shows extensive disruption.

• 

  Fig. 2 Three-dimensional rendering, showing the spatial distribution of significant metabolic changes by Statistical Parametric Mapping (SPM) (p<0.001). (A) 18F-fluorodeoxyglocese positron emission tomography (FDG-PET) scans reveal diffuse hypometabolism in the left hemisphere with the exception of the occipital lobe. (B) Metabolism of the right hemisphere is generally increased.

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