Ann Rehabil Med.  2017 Feb;41(1):153-157. 10.5535/arm.2017.41.1.153.

Diagnostic Challenge of Diffusion Tensor Imaging in a Patient With Hemiplegia After Traumatic Brain Injury

• Shin HE
• Suh HC
• Kang SH
• Seo KM
• Kim DK
• Shin HW

• KMID: 2383690
• DOI: http://doi.org/10.5535/arm.2017.41.1.153

Abstract

A 51-year-old man showed hemiplegia on his right side after a traumatic brain injury (TBI). On initial brain computed tomography (CT) scan, an acute subdural hemorrhage in the right cerebral convexity and severe degrees of midline shifting and subfalcine herniation to the left side were evident. On follow-up brain magnetic resonance imaging (MRI), there were multiple microhemorrhages in the left parietal and occipital subcortical regions. To explain the occurrence of right hemiplegia after brain damage which dominantly on the right side of brain, we used diffusion tensor imaging (DTI) to reconstruct the corticospinal tract (CST), which showed nearly complete injury on the left CST. We also performed motor-evoked potentials, and stimulation of left motor cortex evoked no response on both sides of upper extremity. We report a case of patient with hemiplegia after TBI and elucidation of the case by DTI rather than CT and MRI.

Keyword

Diffusion tensor imaging; Traumatic brain injuries; Corticospinal tract

MeSH Terms

Brain
Brain Injuries*
Diffusion Tensor Imaging*
Diffusion*
Follow-Up Studies
Hematoma, Subdural
Hemiplegia*
Humans
Magnetic Resonance Imaging
Middle Aged
Motor Cortex
Pyramidal Tracts
Rabeprazole
Upper Extremity

Figure

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  Fig. 1 Brain computed tomography at the onset of injury shows an acute subdural hemorrhage in right cerebral convexity and a small subarachnoid hemorrhage in frontoparietal sulci and sylvian cistern (yellow arrow), with severe degrees of midline shifting and subfalcine herniation towards the left side (blue arrow).

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  Fig. 2 Brain magnetic resonance imaging at 1 week after injury. (A) T2 FLAIR image (TR/TE=9000/120 ms) shows cytotoxic edema with diffusion restriction in right inferior frontal and right temporal lobe. In addition, hemorrhagic cortical contusions in right inferior frontal, temporal, and left parietal lobe can be seen; otherwise, no definite abnormalities such as cerebral infarction were found in the left hemisphere. (B) Susceptibility-weighted image (TR/TE=22.8/31.9 ms) shows multiple microhemorrhages in left parietal and occipital subcortical regions (blue arrow).

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  Fig. 3 Diffusion tensor image at 3 months after injury shows that the right corticospinal tract (CST) was injured in the subcortical white matter and that the left CST was nearly completely injured.

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