No abstract

We found injuries of the cingulum and fornix in patients with an ACoA aneurysm rupture. It is our belief that sustained memory impairment of patients with an ACoA aneurysm rupture might be related to injury of the cingulum and fornix. Therefore, we recommend evaluation of the cingulum and fornix with diffusion tensor tractography for patients with an ACoA aneurysm rupture.

ObjectiveThe increased use of bypass surgery in the treatment of ischemic cerebrovascular diseases requires a better understanding of the superficial temporal artery (STA) anatomy. This study is to describe the gross anatomy of STA in adult Korean population with respect to cranial surgery and to provide basic anatomic data for bypass surgery.MethodsThe study evaluated retrospectively 35 patients who visited the neurosurgery department at a single institution. For each patient, both the left and right STA (70 vessels) were evaluated by a 3-dimensional computed tomographic angiogramfor diameter and anatomic relationships to external landmarks.ResultsOf 70 STAs, 69 had a bifurcation. Among these, 57 (82.6%) were above the superior margin of the zygomatic arch. The STA bifurcation was 53.2 ± 5.9 mm posterior to the keyhole, 9.5 ± 5.3 mm anterior to the posterior margin of condylar process of the mandible, and 21.7 ± 15.8 mm superior to the superior margin of the zygomatic arch. The inner diameter of the STA was 1.8 ± 0.5 mm at the superior margin of the zygomatic arch, and 1.4 ± 0.4 mm and 1.4 ± 0.5 mm for frontal and parietal branches, respectively. The 75.7% of frontal and 66.7% of parietal branches were suitable for microvascular anastomosis.ConclusionThis present study demonstrated the STA in Korean adults, which may benefit the clinician in dealing with the surgical procedures related to this STA.

BackgroundNo study on the characteristics of injury of the corticospinal tract (CST) or corticoreticular pathway (CRP) in patients with putaminal hemorrhage has been reported. In this study, using diffusion tensor tractography, we attempted to investigate the characteristics of injury of the CST and CRP in hemiparetic patients with putaminal hemorrhage.MethodFifty seven consecutive patients with putaminal hemorrhage and 57 healthy control subjects were recruited for this study. Diffusion tensor imaging was performed during the early period (8 ~ 30 days) after onset. We defined injury of the CST or CRP in terms of the configuration (discontinuation of a neural tract) or abnormal DTT parameters (the fractional anisotrophy value or fiber number was more than two standard deviations lower than that of normal control subjects). The Motricity Index, the modified Brunnstrom Classification, and the Functional Ambulation Categories were used for evaluation of motor function.ResultsAmong 57 patients, injury of the CST was found in 41 patients (71.9%) and injury of the CRP was found in 50 patients (87.8%), respectively, and 37 patients (64.9%) had injury of both the CST and CRP. All three motor functions of patients with injury of both the CST and CRP were significantly lower than those of patients with injury of either the CST or CRP (p < 0.05).ConclusionOur results indicate that the putaminal hemorrhage frequently accompanies injury of both the CST and CRP, and the CRP appears to be more vulnerable to putaminal hemorrhage than the CST. These findings suggest the necessity for evaluation of both the CRP and the CST in patients with putaminal hemorrhage.

Rationale:We report on a stroke patient who showed change of the ascending reticular activating system (ARAS) concurrent with recovery from a vegetative state (VS) to a minimally conscious state (MCS), which was demonstrated on diffusion tensor tractography (DTT).Patient concerns:A 59-year-old male patient underwent CT-guided stereotactic drainage 3 times for management of intracerebral hemorrhage and intraventricular hemorrhage.Diagnosis:After 4 months from onset, when starting rehabilitation, the patient showed impaired consciousness, with a Glasgow Coma Scale (GCS) score of 6 and a Coma Recovery Scale-Revised score of 2. At 10 months after onset, his GCS score had recovered to 11 with a GRS-R score of 20, and he was able to perform rock–scissors–paper using his right hand according to verbal command.Interventions:On 10-month DTT, marked increased neural connectivity of the thalamic intralaminar nucleus (ILN) to the cerebral cortex was observed in both prefrontal cortexes and the right thalamus compared with 4-month DTT. However, no significant change was observed in the lower dorsal ARAS between the pontine reticular formation (PRF) and the thalamic ILN. In addition, the reconstructed lower ventral ARAS between the PRF and hypothalamus had disappeared in both hemispheres on 10-month DTT.Outcomes:Change of the ARAS was demonstrated in a stroke patient who showed recovery from a VS to an MCS.Lessons:It appeared that the prefrontal cortex and thalamus, which showed increased neural connectivity, contributed to recovery from a VS to an MCS in this patient.