Ann Rehabil Med.  2018 Jun;42(3):396-405. 10.5535/arm.2018.42.3.396.

Changes in Diffusion Metrics of the Red Nucleus in Chronic Stroke Patients With Severe Corticospinal Tract Injury: A Preliminary Study

• Kim H
• Lee H
• Jung KI
• Ohn SH
• Yoo WK

• KMID: 2417831
• DOI: http://doi.org/10.5535/arm.2018.42.3.396

Abstract

OBJECTIVE
To explore plastic changes in the red nucleus (RN) of stroke patients with severe corticospinal tract (CST) injury as a compensatory mechanism for recovery of hand function.
METHODS
The moderate group (MG) comprised 5 patients with synergistic hand grasp movement combined with limited extension, and the severe group (SG) included 5 patients with synergistic hand grasp movement alone. The control group (CG) included 5 healthy subjects. Motor assessment was measured by Motricity Index (MI). Diffusion tensor imaging was analyzed using fractional anisotropy (FA) and radial diffusivity (RD) in the individual regions of interest (ROIs)"”bilateral internal capsule and anterior pons for CST injury and bilateral RN for rubrospinal tract (RST) injury.
RESULTS
The SG showed a significantly lower MI score than the MG mainly due to differences in hand subscores. Significantly reduced FA was observed in both MG and SG compared with CG, while SG showed increased MD and RD in the affected ROIs of CST, and increased FA on the unaffected side compared with CG. However, in the RN ROI, a significantly increased FA and decreased RD on the unaffected side similar to the affected side were found only in the SG. The relative index of FA was lower and RD in SG was higher than in CG in RST.
CONCLUSION
The diffusion metrics of RST showed changes in patients with severe CST injury, suggesting that RST may play a role in the recovery of hand function in patients with severe CST injury.

Keyword

Extrapyramidal tract; Neuronal plasticity; Recovery of function; Upper extremity; Paraplegia

MeSH Terms

Anisotropy
Diffusion Tensor Imaging
Diffusion*
Extrapyramidal Tracts
Hand
Hand Strength
Healthy Volunteers
Humans
Internal Capsule
Neuronal Plasticity
Paraplegia
Plastics
Pons
Pyramidal Tracts*
Recovery of Function
Red Nucleus*
Stroke*
Upper Extremity
Plastics

Figure

• 

  Fig. 1. Region of interest (ROI) selection. (A) Internal capsule ROI of the corticospinal tract. The posterior limb of the internal capsule within the projection fibers (dark and light blue color) was selected without including the retrosplenial fibers of internal capsule in the color-coded image. (B) Pons ROI of the corticospinal tract. The descending corticospinal tract at the pons level was drawn by selecting the anterior corticospinal tract (blue color) in the color-coded image. (C) The red nucleus. The dark area in the mid-brain was drawn on the T2 image.

• 

  Fig. 2. Corticospinal metrics in the internal capsule (A) and pons (B) of the three groups. FA, fractional anisotropy; MD, mean diffusivity; AD, axial diffusivity; RD, radial diffusivity. *p<0.05.

• 

  Fig. 3. Metrics of rubrospinal tract in the three groups. FA, fractional anisotropy; MD, mean diffusivity; AD, axial diffusivity; RD, radial diffusivity . *p<0.05.

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