Abstract
Accurate diagnosis of the presence and severity of neural injury in patients with subarachnoid hemorrhage (SAH) is important in neurorehabilitation because it is essential for establishing appropriate therapeutic strategies and developing a prognosis. Diffusion tensor imaging has a unique advantage in the identification of microstructural white matter abnormalities which are not usually detectable on conventional brain magnetic resonance imaging. In this mini-review article, 12 diffusion tensor imaging studies on SAH-related brain injury were reviewed. These studies have demonstrated SAH-related brain injuries in various neural tracts or structures including the cingulum, fornix, hippocampus, dorsolateral prefrontal region, corticospinal tract, mamillothalamic tract, corticoreticular pathway, ascending reticular activating system, Papez circuit, optic radiation, and subcortical white matter. We believe that these reviewed studies provide information that would be helpful in science-based neurorehabilitation of patients with SAH. Furthermore, the results of these reviewed studies would also be useful for clarification of the pathophysiological mechanisms associated with SAH-related brain injury. However, considering the large number of neural tracts or neural structures in the brain, more research on SAH-related brain injury in other neural tracts or structures should be encouraged.
Highlights
Spontaneous subarachnoid hemorrhage (SAH), which involves the extravasation of blood into the subarachnoid space between the arachnoid membrane and the pia mater covering the brain, mainly occurs following rupture of an aneurysm, and comprises 5% of all cases of stroke [1, 2]
Diffusion tensor tractography (DTT), which is a derivative of diffusion tensor imaging (DTI), enables the three-dimensional visualization and estimation of neural tracts [122,831]
The authors concluded that the anterior cingulum and fornix can be vulnerable to injury by SAH following the rupture of an anterior communicating artery (ACoA) aneurysm; on that basis, they recommended using DTT to evaluate the cingulum and fornix in patients with an ACoA aneurysm rupture [3]
Summary
Spontaneous subarachnoid hemorrhage (SAH), which involves the extravasation of blood into the subarachnoid space between the arachnoid membrane and the pia mater covering the brain, mainly occurs following rupture of an aneurysm, and comprises 5% of all cases of stroke [1, 2]. Several mechanisms have been suggested: global vasogenic edema in both white and deep gray matter, vasospasm and cerebral ischemia, mechanical injury (via increased intracranial pressure or direct mass effect by SAH), and chemical injury (a blood clot can cause neural injury by release of potentially damaging substances, such as free iron, which may result in the generation of free radicals or inflammatory cytokines) [3, 5, 32,33,34,35,36,37] In this mini-review, DTI studies on spontaneous SAHrelated brain injury are reviewed. The authors concluded that the anterior cingulum and fornix can be vulnerable to injury by SAH following the rupture of an ACoA aneurysm; on that basis, they recommended using DTT to evaluate the cingulum and fornix in patients with an ACoA aneurysm rupture [3] Their patients were not evaluated using detailed neuropsychological tests and the study included a relatively small number of subjects, limiting the application of the results.
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