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Kiani P, Hassanzadeh G, Jameie SB, Batouli SAH. Exploration of the white matter bundles connected to the pineal gland: A DTI study. Surg Radiol Anat 2024; 46:1571-1584. [PMID: 39102045 DOI: 10.1007/s00276-024-03445-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 07/23/2024] [Indexed: 08/06/2024]
Abstract
PURPOSE Pineal gland (PG) is a structure located in the midline of the brain, and is considered as a main part of the epithalamus. There are reports on the role of this area for brain function by hormone secretion, as well as few reports on its role in brain cognition. However, little knowledge is available on the PG, and in particular on the structural connectivity of this region with the other brain structures. METHODS Using diffusion-weighted images collected by a 3T MRI scanner, and using a sample of 61 (29 F) mentally and physically healthy young individuals in the age range of 20-30 years old, we tried to extract the white matter bundles connected to the PG. Based on prior knowledge, seven target bundles were suggested to be between the PG body and the PG roots, Pons, Periventricular region, thalamus, caudate, lentiform, suprachiasmatic nuclei, and the supercervical ganglia. RESULTS Nearly all the target bundles were successfully extracted, with the exception of the lentiform. Rate of identification of the tracts was different, with the bundle between the PG body and roots having the highest identification rate (97%); then it was with the Pons (70%), Periventricular region (57%), SCN (55%), left thalamus (52%), right thalamus (47%), left caudate (27%) and right caudate (22%). CONCLUSION This study is an attempt to expand our knowledge on the neuroanatomy of the PG, which might help for identifying further roles for it in brain functionality, and also be a help for the treatment of some disorders in the future.
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Affiliation(s)
- Pejman Kiani
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, No.88, Italia Street, Keshavarz Boulevard, Tehran, Iran
| | - Gholamreza Hassanzadeh
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, No.88, Italia Street, Keshavarz Boulevard, Tehran, Iran
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Department of Digital Health, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Seyed Amir Hossein Batouli
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, No.88, Italia Street, Keshavarz Boulevard, Tehran, Iran.
- BrainEE Research Group, Tehran University of Medical Sciences, Tehran, Iran.
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He J, Zhang F, Pan Y, Feng Y, Rushmore J, Torio E, Rathi Y, Makris N, Kikinis R, Golby AJ, O'Donnell LJ. Reconstructing the somatotopic organization of the corticospinal tract remains a challenge for modern tractography methods. Hum Brain Mapp 2023; 44:6055-6073. [PMID: 37792280 PMCID: PMC10619402 DOI: 10.1002/hbm.26497] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/09/2023] [Accepted: 09/13/2023] [Indexed: 10/05/2023] Open
Abstract
The corticospinal tract (CST) is a critically important white matter fiber tract in the human brain that enables control of voluntary movements of the body. The CST exhibits a somatotopic organization, which means that the motor neurons that control specific body parts are arranged in order within the CST. Diffusion magnetic resonance imaging (MRI) tractography is increasingly used to study the anatomy of the CST. However, despite many advances in tractography algorithms over the past decade, modern, state-of-the-art methods still face challenges. In this study, we compare the performance of six widely used tractography methods for reconstructing the CST and its somatotopic organization. These methods include constrained spherical deconvolution (CSD) based probabilistic (iFOD1) and deterministic (SD-Stream) methods, unscented Kalman filter (UKF) tractography methods including multi-fiber (UKF2T) and single-fiber (UKF1T) models, the generalized q-sampling imaging (GQI) based deterministic tractography method, and the TractSeg method. We investigate CST somatotopy by dividing the CST into four subdivisions per hemisphere that originate in the leg, trunk, hand, and face areas of the primary motor cortex. A quantitative and visual comparison is performed using diffusion MRI data (N = 100 subjects) from the Human Connectome Project. Quantitative evaluations include the reconstruction rate of the eight anatomical subdivisions, the percentage of streamlines in each subdivision, and the coverage of the white matter-gray matter (WM-GM) interface. CST somatotopy is further evaluated by comparing the percentage of streamlines in each subdivision to the cortical volumes for the leg, trunk, hand, and face areas. Overall, UKF2T has the highest reconstruction rate and cortical coverage. It is the only method with a significant positive correlation between the percentage of streamlines in each subdivision and the volume of the corresponding motor cortex. However, our experimental results show that all compared tractography methods are biased toward generating many trunk streamlines (ranging from 35.10% to 71.66% of total streamlines across methods). Furthermore, the coverage of the WM-GM interface in the largest motor area (face) is generally low (under 40%) for all compared tractography methods. Different tractography methods give conflicting results regarding the percentage of streamlines in each subdivision and the volume of the corresponding motor cortex, indicating that there is generally no clear relationship, and that reconstruction of CST somatotopy is still a large challenge. Overall, we conclude that while current tractography methods have made progress toward the well-known challenge of improving the reconstruction of the lateral projections of the CST, the overall problem of performing a comprehensive CST reconstruction, including clinically important projections in the lateral (hand and face areas) and medial portions (leg area), remains an important challenge for diffusion MRI tractography.
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Affiliation(s)
- Jianzhong He
- Institution of Information Processing and AutomationZhejiang University of TechnologyHangzhouChina
| | - Fan Zhang
- Department of Radiology, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
- University of Electronic Science and Technology of ChinaChengduSichuanChina
| | - Yiang Pan
- Institution of Information Processing and AutomationZhejiang University of TechnologyHangzhouChina
| | - Yuanjing Feng
- Institution of Information Processing and AutomationZhejiang University of TechnologyHangzhouChina
| | - Jarrett Rushmore
- Departments of Psychiatry, Neurology and RadiologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Department of Anatomy and NeurobiologyBoston University School of MedicineBostonMassachusettsUSA
| | - Erickson Torio
- Department of NeurosurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Yogesh Rathi
- Department of Radiology, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Department of PsychiatryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Nikos Makris
- Departments of Psychiatry, Neurology and RadiologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Department of PsychiatryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Ron Kikinis
- Department of Radiology, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Alexandra J. Golby
- Department of Radiology, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Department of NeurosurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Lauren J. O'Donnell
- Department of Radiology, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
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Miyawaki Y, Yoneta M, Okawada M, Kawakami M, Liu M, Kaneko F. Neural bases characterizing chronic and severe upper-limb motor deficits after brain lesion. J Neural Transm (Vienna) 2023; 130:663-677. [PMID: 36943506 DOI: 10.1007/s00702-023-02622-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/14/2023] [Indexed: 03/23/2023]
Abstract
Chronic and severe upper-limb motor deficits can result from damage to the corticospinal tract. However, it remains unclear what their characteristics are and whether only corticospinal tract damage determines their characteristics. This study aimed to investigate the clinical characteristics and neural bases of chronic and severe upper-limb motor deficits. Motor deficits, including spasticity, of 45 patients with brain lesions were assessed using clinical scales. Regarding their scores, we conducted a principal component analysis that statistically extracted the clinical characteristics as two principal components. Using these principal components, we investigated the neural bases underlying their characteristics through lesion analyses of lesion volume, lesion sites, corticospinal tract, or other regional white-matter integrity. Principal component analysis showed that the clinical characteristics of chronic and severe upper-limb motor deficits could be described as a comprehensive severity and a trade-off relationship between proximal motor functions and wrist/finger spasticity. Lesion analyses revealed that the comprehensive severity was correlated with corticospinal tract integrity, and the trade-off relationship was associated with the integrity of other regional white matter located anterior to the posterior internal capsule, such as the anterior internal capsule. This study indicates that the severity of chronic and severe upper-limb motor deficits can be determined according to the corticospinal tract integrity, and such motor deficits may be further characterized by the integrity of other white matter, where the corticoreticular pathway can pass through, by forming a trade-off relationship where patients have higher proximal motor functions but more severe wrist/finger spasticity, and vice versa.
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Affiliation(s)
- Yu Miyawaki
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashi-Oku, Arakawa-ku, Tokyo, 116-8551, Japan
- Human Augmentation Research Center, National Institute of Advanced Industrial Science and Technology, Chiba, Japan
| | - Masaki Yoneta
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Megumi Okawada
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashi-Oku, Arakawa-ku, Tokyo, 116-8551, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Fuminari Kaneko
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
- Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashi-Oku, Arakawa-ku, Tokyo, 116-8551, Japan.
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Chang MC, Seo Y, Kwak S. Deterioration of the Corticobulbar Tract in Older Dysphagic Patients Without Neurologic Diseases. Am J Phys Med Rehabil 2022; 101:353-357. [PMID: 35302528 DOI: 10.1097/phm.0000000000001826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Less is known how dysphagia affects older patients without neurologic diseases and whether the symptoms of dysphagia have any association with impaired central control of swallowing. This study investigated the state of the corticobulbar tract, the surrogate marker for the central control of swallowing, in older dysphagic patients without any neurologic diseases, using diffusion tensor tractography. DESIGN This retrospective observational study was conducted at a tertiary university hospital including 10 patients 60 yrs or older with oropharyngeal dysphagia without neurological disease and 11 age- and sex-matched control participants. The corticobulbar tract was reconstructed, and the fractional anisotropy and tract volume were measured using diffusion tensor tractography. RESULTS The corticobulbar tracts of the dysphagia group were narrowed and not reconstructed by their configurations and had lower fractional anisotropy and tract volume values when compared with those of control group. Significant asymmetry between the left and the right corticobulbar tract hemispheres was found in the dysphagia group, whereas no asymmetry was found in the control group. CONCLUSIONS A deteriorated corticobulbar tract could be associated with the development of dysphagia in older adults without neurological diseases. Our findings might help establish more appropriate treatment strategies, such as targeted neuromodulation therapies in the future.
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Affiliation(s)
- Min Cheol Chang
- From the Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Kim Y, Han YJ, Park HY, Park GY, Jung M, Lee S, Im S. Neural correlates in the development of and recovery from dysphagia after supratentorial stroke: A prospective tractography study. NEUROIMAGE: CLINICAL 2022; 35:103103. [PMID: 35779464 PMCID: PMC9251599 DOI: 10.1016/j.nicl.2022.103103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 11/18/2022] Open
Abstract
Stroke may lead to unilateral or bilateral CBT changes regardless of dysphagia. Poor fractional anisotropy of the unaffected sides relates to limited recovery. Swallowing recovery may depend on the integrity of the unaffected CBT. Bi-hemispheric reorganization of the CBT is associated with swallowing recovery.
Background Methods Results Conclusions
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Affiliation(s)
- Youngkook Kim
- Department of Rehabilitation Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeon-Jae Han
- Department of Rehabilitation Medicine, Hankook-hyo Convalescent Hospital, Republic of Korea
| | - Hae-Yeon Park
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Geun-Young Park
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Moa Jung
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soohwan Lee
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Im
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Dysphagia prognosis prediction via corticobulbar tract assessment in lateral medullary infarction: a diffusion tensor tractography study. Dysphagia 2020; 36:680-688. [PMID: 32865624 DOI: 10.1007/s00455-020-10182-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/24/2020] [Indexed: 12/19/2022]
Abstract
We investigated the capacity for dysphagia prognosis prediction using diffusion tensor tractography (DTT) to assess the state of the corticobulbar tract (CBT) during the initial period following lateral medullary infarction (LMI). Twenty patients with LMI and 20 control subjects were recruited for this study. The patients were classified into two subgroups: subgroup A (16 patients with nasogastric tube required for six months or less after LMI onset) and subgroup B (4 patients with nasogastric tube required for more than six months after onset). DTT was used to reconstruct the CBTs of each patient and control subject, and the fractional anisotropy (FA) and tract volume (TV) measurements were obtained. In the affected hemisphere, the FA value of the CBT was significantly lower in subgroup B than in subgroup A and the control group (p < 0.05), with no significant difference between subgroup A and the control group. In the affected and unaffected hemispheres, the TV values of CBT in subgroups A and B were lower than those of the control group (p < 0.05), with no significant difference between subgroups A and B. In addition, among the four patients of subgroup B, reconstruction of the CBT was not possible in three patients, and the remaining patients exhibited on old lesion in the corona radiate involving descending pathway of the CBT in the affected hemisphere. We found that the injury severity of the CBT in the affected hemisphere appeared to be related to a poor dysphagia prognosis following LMI. Our results suggest that evaluation of the CBT state during the early post-LMI could be useful for dysphagia prognosis prediction.
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Im S, Han YJ, Kim SH, Yoon MJ, Oh J, Kim Y. Role of bilateral corticobulbar tracts in dysphagia after middle cerebral artery stroke. Eur J Neurol 2020; 27:2158-2167. [PMID: 32524719 DOI: 10.1111/ene.14387] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE The corticobulbar tract is a potential neural pathway involved in swallowing. The frontal operculum, insular cortex, corona radiata and internal capsule, which are frequently involved in middle cerebral artery (MCA) strokes, are locations in which lesions cause dysphagia. However, it is unclear whether the locations are linked to the corticobulbar tract or whether corticobulbar tract integrity is associated with dysphagia severity. This study aimed to assess the association between corticobulbar tract integrity and dysphagia severity after MCA stroke. METHODS Thirty dysphagic patients after MCA stroke and 27 healthy controls were examined. Diffusion tensor imaging (DTI)-derived parameters of the corticobulbar tract were compared between patient and control groups. Next, patients were divided into mild and moderate-to-severe dysphagia groups, and DTI-derived parameters of the corticobulbar tract were compared between the subgroups. Logistic regression analysis was used to determine the association between corticobulbar tract integrity and dysphagia severity. RESULTS The tract volume (TV) of the affected corticobulbar tract was lower in dysphagic patients than in healthy controls (P < 0.001). According to dysphagia severity, TV of the unaffected corticobulbar tract was higher in the mild dysphagia group than in the moderate-to-severe dysphagia group (P = 0.012). TV of the unaffected corticobulbar tract was independently associated with dysphagia severity according to the logistic regression model (adjusted odds ratio 0.817, 95% confidence interval 0.683-0.976). CONCLUSIONS The corticobulbar tract was affected after MCA stroke and may be associated with dysphagia. A higher corticobulbar TV in the unaffected hemisphere was indicative of better swallowing function in dysphagic patients after MCA stroke.
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Affiliation(s)
- S Im
- Department of Rehabilitation Medicine, College of Medicine, Bucheon St. Mary's Hospital, Catholic University of Korea, Bucheon, Korea
| | - Y J Han
- Department of Rehabilitation Medicine, College of Medicine, Bucheon St. Mary's Hospital, Catholic University of Korea, Bucheon, Korea
| | - S-H Kim
- Department of Family Medicine, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - M-J Yoon
- Department of Rehabilitation Medicine, College of Medicine, Yeouido St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - J Oh
- Rehabilitation Medicine, Independent Scholar, Seoul, Korea
| | - Y Kim
- Department of Rehabilitation Medicine, College of Medicine, Yeouido St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
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Jang SH, Kwak SY, Chang CH, Jung YJ, Kim J, Kim SH, Kim JY. Prognostic Prediction of Dysphagia by Analyzing the Corticobulbar Tract in the Early Stage of Intracerebral Hemorrhage. Dysphagia 2020; 35:985-992. [PMID: 32040613 DOI: 10.1007/s00455-020-10093-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/01/2020] [Indexed: 10/25/2022]
Abstract
We investigated the predictive value of the corticobulbar tract (CBT) for dysphagia using diffusion tensor tractography in the early stage of intracerebral hemorrhage (ICH) for dysphagia. Forty-two patients with spontaneous ICH ± intraventricular hemorrhage (IVH) and 22 control subjects were recruited. The patients were classified into three groups: group A-could remove nasogastric tube (NGT) in the acute stage of ICH, group B-could remove NGT within 6 months after onset, and group C-could not remove NGT until 6 months after onset. The CBT were reconstructed, and fractional anisotropy (FA) and tract volume (TV) values were determined. The FA of the CBT in the affected hemisphere in group A was lower than in the control group (p < 0.05). The FA and TV of the CBT in the affected hemisphere in group B were lower than those in the control group (p < 0.05). In group C, the FA and TV in the affected hemisphere and unaffected hemispheres were lower than in the control group (p < 0.05). The TV of the CBT in the affected hemisphere in group B showed a moderate negative correlation with the length of time until NGT removal (r = 0.430, p < 0.05). We found that patients with CBT injuries in both hemispheres were not able to remove the NGT until 6 months after onset, whereas patients who were injured only in the affected hemisphere were able to remove NGT within 6 months of onset. The severity of injury to the CBT in the affected hemisphere appeared to be related to the length of time until NGT removal.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Taegu, 705-717, Republic of Korea
| | - So Young Kwak
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Taegu, 705-717, Republic of Korea
| | - Chul Hoon Chang
- Department of Neurosurgery, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Taegu, 705-717, Republic of Korea
| | - Young Jin Jung
- Department of Neurosurgery, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Taegu, 705-717, Republic of Korea
| | - JongHoon Kim
- Department of Neurosurgery, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Taegu, 705-717, Republic of Korea
| | - Seong Ho Kim
- Department of Neurosurgery, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Taegu, 705-717, Republic of Korea
| | - Jun Young Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Taegu, 705-717, Republic of Korea.
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Ko EJ, Choi KH, Kwon SU. The Relationship Between Leukoaraiosis Involving Contralateral Corticobulbar Tract and Dysphagia in Patients with Acute Unilateral Corona Radiata Infarction with Corticobulbar Tract Involvement. Dysphagia 2018; 34:654-664. [PMID: 30465078 DOI: 10.1007/s00455-018-9963-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 11/14/2018] [Indexed: 02/04/2023]
Abstract
This study investigated the impact of leukoaraiosis (LA) involving the contralateral corticobulbar tract (CBT) on dysphagia in patients with unilateral corona radiata (CR) infarction with CBT involvement. Patients admitted to the Department of Neurology (September 2011-August 2014) were evaluated; those with a first episode of acute unilateral CR infarction involving the CBT and with LA were included. The 'Case' group comprised patients with LA involving the contralateral CBT; the 'Control' group comprised patients with LA not involving the contralateral CBT. The primary outcome was the feeding method at discharge; secondary outcomes were the feeding method at admission and results of the bedside swallowing test, videofluoroscopic swallowing study (VFSS), videofluoroscopic dysphagia scale, penetration-aspiration scale, American Speech-Language-Hearing Association National Outcome Measurement System Swallowing Scale (ASHA NOMS), oral transit time, and pharyngeal transit time. Infarct size was measured using brain magnetic resonance imaging; LA severity was rated using the Fazekas scale. Eighty-one patients were included (mean age 64.6 ± 11.5 years; 64% male; Case group: 20, 5 underwent VFSS; Control group: 67, 11 underwent VFSS). The Case group was older and had higher total Fazekas scale score than the Control group. The feeding method at discharge and ASHA NOMS score were significantly worse in the Case group than in the Control group. Multivariate analysis revealed that LA involving the contralateral CBT independently predicted the feeding method at discharge and ASHA NOMS score. In conclusion, LA involving the contralateral CBT is associated with dysphagia in patients with unilateral CR infarction involving the CBT.
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Affiliation(s)
- Eun Jae Ko
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Sun U Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Abstract
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.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Department of Physical Medicine and Rehabilitation
| | - Seong Ho Kim
- Department of Neurosurgery, College of Medicine Yeungnam University, Department of Neurosurgery
| | - Young Hyeon Kwon
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University 317–1, Daemyungdong, Namku, Daegu, Republic of Korea
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Moon HI, Kim GS, Lee E. Is the Location of White Matter Lesions Important in the Swallowing Function of Older Patients with Mild Stroke? Dysphagia 2018; 34:407-414. [PMID: 30382381 DOI: 10.1007/s00455-018-9955-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/20/2018] [Indexed: 10/28/2022]
Abstract
Older patients with stroke have poor functional prognosis compared to younger patients. Patients with stroke who have severe white matter (WM) lesions have been reported to have swallowing problems. The aim of this study was to determine whether the location of WM lesions affects swallowing function in older patients with mild stroke. We conducted a retrospective analysis of 88 patients aged > 65 years who had a National Institutes of Health Stroke Scale score of ≤ 5 and who underwent videofluoroscopic swallowing examination after their first stroke. Participants were divided into three groups according to the involvement of corticobulbar tract (CBT) as follows: group I, no involvement of CBT; group II, involvement of CBT in one hemisphere; and group III, involvement of CBT in both hemispheres. Linear regression analysis showed that pharyngeal transit time tended to increase according to the involvement of CBT in WM lesion (p = 0.043). In addition, inadequate laryngeal elevation was related to the involvement of CBT (p = 0.016). Early spillage, inadequate laryngeal elevation, and penetration could also be predicted by Fazekas grade. Accordingly, the location of WM lesions can be regarded as a potential predictive factor for dysphagia. Moreover, in patients with WM lesions involving CBT, detailed evaluation of dysphagia is required.
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Affiliation(s)
- Hyun Im Moon
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, 20, Seohyeon-ro 180 beon-gil, Bundang-gu, Seoungnam-si, Gyeonggi-do, 13590, Republic of Korea.
| | - Gyu Seong Kim
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, 20, Seohyeon-ro 180 beon-gil, Bundang-gu, Seoungnam-si, Gyeonggi-do, 13590, Republic of Korea
| | - Eunchae Lee
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, 20, Seohyeon-ro 180 beon-gil, Bundang-gu, Seoungnam-si, Gyeonggi-do, 13590, Republic of Korea
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Jang SH, Lee HD. Weak phonation due to unknown injury of the corticobulbar tract in a patient with mild traumatic brain injury: a diffusion tensor tractography study. Neural Regen Res 2018; 13:936. [PMID: 29863026 PMCID: PMC5998621 DOI: 10.4103/1673-5374.232491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Daegu, Republic of Korea
| | - Han Do Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Daegu, Republic of Korea
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Jang SH, Kim SH, Seo JP. Image of the month: Dysphagia due to injury of the corticobulbar tract following traumatic brain injury. Clin Med (Lond) 2017; 17:584-585. [PMID: 29196365 PMCID: PMC6297680 DOI: 10.7861/clinmedicine.17-6-584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University
| | - Seong Ho Kim
- Department of Neurosurgery, College of Medicine Yeungnam University
| | - Jeong Pyo Seo
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University
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Abstract
RATIONALE The corticobulbar tract (CBT) is known to be involved in the motor function of the non-oculomotor cranial nuclei and controls the muscles of the face, head, and neck. Several studies have reported injury of the CBT in patients with brain injury, however, little is known about recovery of the injured CBT. PATIENT CONCERNS A 59-year-old right-handed male underwent decompressive craniectomy for management of brain swelling and intracerebral hemorrhage following an infarction in the left middle cerebral artery territory. Initially, the patient had showed severe dysphagia and had to be fed using a Levin tube. Five weeks after the onset of stroke, the patient was transferred to the rehabilitation department and underwent comprehensive rehabilitative therapy. Cranioplasty was performed eight weeks after the onset. The patient was completely recovered from dysphagia and the Levine tube was removed nine weeks after the onset. INTERVENTIONS Diffusion tensor imaging was performed twice; at five weeks and nine weeks from the onset. OUTCOME On five-week diffusion tensor tractography (DTT), the right CBT was discontinued at the subcortical white matter and showed severe narrowing and the left CBT was not reconstructed. By contrast, on nine-week DTT, the right CBT was extended to the cerebral cortex and thickened while the left CBT remained not reconstructed in DTT. LESSONS This case demonstrates the association of the recovery of injured CBT with the recovery of dysphagia using DTT.
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Affiliation(s)
- Sungho Jang
- Department of Physical Medicine & Rehabilitation
| | - Jonghoon Kim
- Department of Neurosurgery, College of Medicine, Yeungnam University, Nam-gu, Daegu, Republic of Korea
| | - Yousung Seo
- Department of Physical Medicine & Rehabilitation
| | - Soyoung Kwak
- Department of Physical Medicine & Rehabilitation
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Oropharyngeal dysphagia in secondary normal pressure hydrocephalus due to corticobulbar tract compression: cases series and review of literature. Acta Neurochir (Wien) 2017; 159:1005-1011. [PMID: 28421284 DOI: 10.1007/s00701-017-3157-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
Abstract
The association and mechanism involved in swallowing disturbance and normal pressure hydrocephalus (NPH) needs to be established. We report a case report where a patient who showed progressive swallowing dysfunction was diagnosed with secondary NPH. Tractography analysis showed corticobulbar tract compression by ventricular dilation. Drainage operation led to the recovery of tract volume with an improvement of swallowing function. We also report ten case series in which secondary NPH was associated with a swallowing disturbance. In these cases, dysphagia also showed improvement after shunt operation. We review the literature regarding the corticobulbar tract and its association with swallowing disturbance and the possible underlying pathophysiological mechanism in secondary NPH. This report highlights that swallowing disturbance may manifest in those with secondary NPH due to corticobulbar tract involvement. Our findings suggest that involvement of the corticobulbar tract may be a possible cause of dysphagia in secondary NPH that may be reversible after shunt operation.
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Weiss Lucas C, Tursunova I, Neuschmelting V, Nettekoven C, Oros-Peusquens AM, Stoffels G, Faymonville AM, Jon SN, Langen KJ, Lockau H, Goldbrunner R, Grefkes C. Functional MRI vs. navigated TMS to optimize M1 seed volume delineation for DTI tractography. A prospective study in patients with brain tumours adjacent to the corticospinal tract. NEUROIMAGE-CLINICAL 2016; 13:297-309. [PMID: 28050345 PMCID: PMC5192048 DOI: 10.1016/j.nicl.2016.11.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/18/2016] [Accepted: 11/19/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND DTI-based tractography is an increasingly important tool for planning brain surgery in patients suffering from brain tumours. However, there is an ongoing debate which tracking approaches yield the most valid results. Especially the use of functional localizer data such as navigated transcranial magnetic stimulation (nTMS) or functional magnetic resonance imaging (fMRI) seem to improve fibre tracking data in conditions where anatomical landmarks are less informative due to tumour-induced distortions of the gyral anatomy. We here compared which of the two localizer techniques yields more plausible results with respect to mapping different functional portions of the corticospinal tract (CST) in brain tumour patients. METHODS The CSTs of 18 patients with intracranial tumours in the vicinity of the primary motor area (M1) were investigated by means of deterministic DTI. The core zone of the tumour-adjacent hand, foot and/or tongue M1 representation served as cortical regions of interest (ROIs). M1 core zones were defined by both the nTMS hot-spots and the fMRI local activation maxima. In addition, for all patients, a subcortical ROI at the level of the inferior anterior pons was implemented into the tracking algorithm in order to improve the anatomical specificity of CST reconstructions. As intra-individual control, we additionally tracked the CST of the hand motor region of the unaffected, i.e., non-lesional hemisphere, again comparing fMRI and nTMS M1 seeds. The plausibility of the fMRI-ROI- vs. nTMS-ROI-based fibre trajectories was assessed by a-priori defined anatomical criteria. Moreover, the anatomical relationship of different fibre courses was compared regarding their distribution in the anterior-posterior direction as well as their location within the posterior limb of the internal capsule (PLIC). RESULTS Overall, higher plausibility rates were observed for the use of nTMS- as compared to fMRI-defined cortical ROIs (p < 0.05) in tumour vicinity. On the non-lesional hemisphere, however, equally good plausibility rates (100%) were observed for both localizer techniques. fMRI-originated fibres generally followed a more posterior course relative to the nTMS-based tracts (p < 0.01) in both the lesional and non-lesional hemisphere. CONCLUSION NTMS achieved better tracking results than fMRI in conditions when the cortical tract origin (M1) was located in close vicinity to a brain tumour, probably influencing neurovascular coupling. Hence, especially in situations with altered BOLD signal physiology, nTMS seems to be the method of choice in order to identify seed regions for CST mapping in patients.
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Key Words
- APB, Abductor pollicis brevis muscle
- BOLD, Blood-oxygenation-level dependent
- CST
- CST, Corticospinal tract
- DCS, Direct cortical stimulation
- DTI, Diffusion tensor imaging
- Deterministic
- EF, Electric field
- EMG, Electromyography
- FA(T), Fractional anisotropy (threshold)
- FACT, Fibre assignment by continuous tracking
- FOV, Field-of-view
- FWE, Family-wise error
- KPS, Karnofsky performance scale
- LT, Lateral tongue muscle, anterior third
- M1, Primary motor cortex
- MEP, Motor-evoked potential
- MFL, Minimal fibre length
- MPRAGE, Magnetization prepared rapid acquisition gradient echo (T1 MR seq.)
- OR, Odd's ratio
- PLIC, Posterior limb of the internal capsule
- PM, Plantar muscle
- Pyramidal tract
- RMT, Resting motor threshold
- ROI
- ROI, Region-of-interest
- SD, Standard deviation
- SE, Standard error
- Somatotopic
- X-sq, X-squared (Pearson's chi-square test)
- dMRI, Diffusion magnetic resonance imaging (i.e., diffusion-weighted imaging, DWI)
- fMRI
- fMRI, Functional magnetic resonance imaging
- nTMS
- nTMS, Neuronavigated transcranial magnetic stimulation
- pxsq, p-value according to Pearson's chi-square test
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Affiliation(s)
| | - Irada Tursunova
- University of Cologne, Center of Neurosurgery, 50924 Cologne, Germany
| | | | | | | | - Gabriele Stoffels
- Institute of Neuroscience and Medicine, Research Centre Jülich, 52425 Jülich, Germany
| | | | - Shah N Jon
- Institute of Neuroscience and Medicine, Research Centre Jülich, 52425 Jülich, Germany; RWTH Aachen University, University Clinic Aachen, Departments of Nuclear Medicine and Neurology, 52074 Aachen, Germany; Department of Electrical and Computer Systems Engineering, Monash University, Melbourne, Victoria, Australia; Monash Institute of Medical Engineering, Monash University, Melbourne, Victoria, Australia; Monash Biomedical Imaging, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Karl Josef Langen
- Institute of Neuroscience and Medicine, Research Centre Jülich, 52425 Jülich, Germany; RWTH Aachen University, University Clinic Aachen, Departments of Nuclear Medicine and Neurology, 52074 Aachen, Germany
| | - Hannah Lockau
- University of Cologne, Department of Radiology, 50937 Cologne, Germany
| | | | - Christian Grefkes
- Institute of Neuroscience and Medicine, Research Centre Jülich, 52425 Jülich, Germany; University of Cologne, Department of Neurology, 50924 Cologne, Germany
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Chankaew E, Srirabheebhat P, Manochiopinig S, Witthiwej T, Benjamin I. Bulbar dysfunction in normal pressure hydrocephalus: a prospective study. Neurosurg Focus 2016; 41:E15. [PMID: 27581311 DOI: 10.3171/2016.6.focus16183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Normal pressure hydrocephalus (NPH) is clinically characterized by gait disturbance, cognitive impairment, and urinary incontinence, as well as enlargement of the ventricles. To the best of the authors' knowledge, there have been no previous publications regarding the correlation between bulbar dysfunction and NPH. The primary objective of this study was to compare preoperative and postoperative prevalence of bulbar dysfunction in patients with NPH. Secondary objectives included assessing the results of surgery for swallowing, speech, gait, cognition, and urination, and evaluating the correlation between bulbar dysfunction and triad symptoms. METHODS Fifty-three patients with NPH who underwent shunt placement surgery at Siriraj Hospital were included in the study. Patients were evaluated for gait, cognition, urination, swallowing, and speech before and 6 months after shunt placement. Triad symptoms were assessed using standard methods. Bulbar dysfunctions were assessed using the Swallowing Problem Questionnaire, Thai Articulation Test, Resonation Screening Test (RST), and Thai Nasality Test. The Thai Speech Assessment Program and nasometer were used for objective speech measurement. RESULTS Preoperatively, 86% (43/50) of patients had swallowing problems and 75% (37/49) had speech problems, as measured by the RST. Postoperatively, there was significant improvement in swallowing (p < 0.001), speech problems by RST (p = 0.008), and voice volume (p = 0.009), but no significant change in the nasometer test. All triad symptoms were improved. There were significant correlations between swallowing impairment and gait disturbance (r = 0.358, p = 0.009), and RST and cognitive impairment (r = -0.502, p < 0.001). CONCLUSIONS This is the first study of bulbar dysfunction in patients with NPH. The results showed that the prevalence of bulbar dysfunction is very high. The correlation between bulbar dysfunction and the classic NPH triad has been documented and published. These bulbar symptoms also significantly improved after surgery. As such, bulbar dysfunction should be regarded as a core symptom that should be considered along with the classic triad in the clinical diagnosis and management of NPH.
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Affiliation(s)
| | | | - Sriwimon Manochiopinig
- Division of Speech-Language Therapy, Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Jang SH, Shin SM. The usefulness of diffusion tensor tractography for estimating the state of corticobulbar tract in stroke patients. Clin Neurophysiol 2016; 127:2708-9. [PMID: 27209061 DOI: 10.1016/j.clinph.2016.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 04/07/2016] [Accepted: 04/09/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Republic of Korea
| | - So Min Shin
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Republic of Korea.
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Reorganization of the Corticobublar Tract in a Patient with Bilateral Middle Cerebral Artery Territory Infarct. Am J Phys Med Rehabil 2016; 95:e58-9. [DOI: 10.1097/phm.0000000000000424] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jang SH, Lee J, Seo JP. Pseudobulbar palsy due to bilateral injuries of corticobulbar tracts in a stroke patient. Int J Stroke 2015. [PMID: 26202710 DOI: 10.1111/ijs.12523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Korea
| | - Jun Lee
- Department of Neurology, College of Medicine Yeungnam University, Daegu, Korea
| | - Jeong Pyo Seo
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Korea
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