Posterior Limb Of Internal Capsule Research Articles

Gestational age-related changes in relaxation times of neonatal brain by quantitative synthetic magnetic resonance imaging.

This study aimed to explore the correlation between T1 and T2 relaxation times of synthetic MRI (SyMRI) and gestational age (GA) in each hemisphere of preterm and term newborns at the initial 28 days of birth. Seventy preterm and full-term infants were prospectively included in this study. All subjects completed 3.0 T routine MRI and SyMRI (MAGiC) one-stop scanning within 28 days of birth (aged 34-42 W at examination). The SyMRI postprocessing software (v8.0.4) was used to measure the T1 and T2 relaxation values of each brain region. The linear regression equations of quantitative relaxation values with GA were established to compare the variation speed in each brain region. A significant linear and negative correlation was found between relaxation times and GA in the neonate cerebral cortex and subcortical gray and white matter regions (All p<.05). The relaxation time of the left centrum semiovale decreased with maximum variance with increasing GA among all white matter regions (T1: b = -51.45, β = -0.65, p < .0001; T2: b = -8.77, β = -0.71, p < .0001), whereas the right posterior limb of internal capsule showed minimal variance (T1: b = -27.94, β = -0.60, p < .0001; T2: b = -3.25, β = -0.68, p < .0001). Among all gray matter regions, the right globus pallidus and thalamus indicated the most significant decreasing degree of T1 and T2 relaxation values with GA (right globus pallidus T1: b = -33.14, β = -0.64, p < .0001; right thalamus T2: b = -3.94, β = -0.81, p < .0001), and the right and left occipital lobes indicated the least significant decreasing degree of T1 and T2 relaxation values with GA, respectively (right occipital lobes T1: b = -11.18, β = -0.26, p = .028; left occipital lobes T2: b = -1.22, β = -0.27, p = .024). SyMRI could quantitatively evaluate the linear changes of T1 and T2 relaxation values with GA in brain gray and white matter of preterm and term neonates.

Stroke syndrome Z: Bilateral Symmetrical Corona Radiata strokes causing facial diplegia, anarthria, and quadriparesis mimicking an acute neuromuscular syndrome (P3-5.025)

<h3>Objective:</h3> We report a 63-year-old man with consecutive, bilateral, and symmetrical Corona Radiata infarcts within 4 weeks duration, who presented with quadriparesis in addition to acute onset anarthria, and facio-labio-glosso-pharyngo-laryngeal paralysis. To our knowledge, there are no reported cases of recurrent lacunar stroke affecting the same area in the contralateral hemisphere as seen in our case. <h3>Background:</h3> Stroke is a leading cause of death and disability in the United states and particularly in our region; western New york. Around ¼ of annual strokes are recurrent strokes. It is important to identify clinical stroke syndromes to prevent any delays in care and possible clinical deterioration associated with that delay. <h3>Design/Methods:</h3> Case report <h3>Results:</h3> A 63 year-old-male with a recent history of left corona radiata stroke with residual right-sided weakness was evaluated by the neurology team for acute onset anarthria, tongue hypotonia, difficulty with chewing, swallowing and mastication along with quadriplegia. Patient was unable to open mouth on command but was able to yawn. Brain MRI revealed an acute right corona radiata infarct, a mirror image of the recent left corona radiata infarct. Gradually, upper motor neuron signs start to appear on day 2. <h3>Conclusions:</h3> Our patient suffered an acute left corona radiation infarct, almost perfectly symmetrical to a subacute right corona radiata infarct that occurred a month prior. Due to involvement of bilateral posterior limb of internal capsule, initial presentation was acute flaccid paralysis with quadriparesis and cranial neuropathy. Initial working diagnosis was acute neuromuscular disorder rather than stroke due to clincal presentation. Loss of bilateral symmetrical neural impulse can lead to atypical presentation in acute state. <b>Disclosure:</b> Dr. Shaikh has nothing to disclose. Dr. Ouf has nothing to disclose. Dr. Van Coevering has nothing to disclose. Dr. Kandel has nothing to disclose.

Acute, Transient, Brain Lesions on Magnetic Resonance Imaging in X-linked Charcot-Marie-Tooth type 1 (P13-4.002)

<h3>Objective:</h3> NA <h3>Background:</h3> CMTX1 is an X-linked dominant form of hereditary sensorimotor polyneuropathy. It is caused by mutations in the gap junction protein beta 1(GJB1) gene on chromosome Xq13.1, which encodes connexin 32 protein. CNS can be affected and lead to transient or persistent CNS symptoms including dysarthria, dysphagia, hemiparesis or quadriparesis, ataxia, aphasia, and encephalopathy. <h3>Design/Methods:</h3> <h3>Case Report:</h3> A 22-year-old man presented with acute onset left facial droop, dysarthria and left upper extremity weakness. Two weeks prior he experienced a one-day episode of gastroenteritis. Neurological examination showed weakness in the left lower face, distal muscle weakness in toe extension, ankle dorsiflexion and hand intrinsic muscles, absent lower extremity reflexes, diminished vibration and temperature senses in length-dependent pattern, high-arched feet and hammertoes. Family history of early onset polyneuropathy, never genetically tested. Brain MRI showed marked and symmetric restricted diffusion lesions involving bilateral fronto-parietal white matter, corpus callosum and posterior limb of internal capsule without contrast enhancement. CSF analysis was unremarkable. The patient was given pulse steroid therapy for possible demyelinating disease, his symptoms completely resolved within 48 hours. Two prior similar symptoms, one was diagnosed as acute disseminated encephalomyelitis (ADEM) and treated with steroids. Brain MRI of these two episodes showed similar restricted diffusion abnormalities. Repeat brain MRI seven months after the second episode showed complete resolution of restricted diffusion lesions. Leukodystrophy genetic panel was negative. Genetic testing showed hemizygous pathogenic mutation c.491G&gt;A in GJB1 gene, associated with X-linked Charcot-Marie-Tooth disease - CMTX1. <h3>Results:</h3> NA <h3>Conclusions:</h3> Young patients with history of polyneuropathy presenting with acute CNS symptoms with bilateral white matter and corpus callosum lesions, CMTX1 should be included in the differential diagnosis. Upon confirmation of CMTX1 diagnosis, patient reassurance is important as well as education regarding potential provoking factors that lead to CNS involvement. <b>Disclosure:</b> Dr. Altarazi has nothing to disclose. Dr. Chen has nothing to disclose. Dr. Sankaraneni has nothing to disclose.

Primary motor area-related injury of anterior central gyrus in Parkinson's disease with dyskinesia: A study based on MRS and Q-space

IntroductionBy using magnetic resonance spectroscopy (MRS) and Q-Space imaging technology, this research analyzes the imaging characteristics of white matter fibers in the primary motor cortex and posterior limbs of the subcortical internal capsule in parkinsonian patients with motor disorders. The correlation among the changes in axonal function and structure in the cerebral cortex and subcortical cortex and motor disorder is further revealed. MethodsFirst, motor function and clinical condition of 20 patients with Parkinson's disease is assessed the third section of the Unified Parkinson's Scale and H&Y Parkinson's Clinical Staging Scale. Magnetic resonance (MR) scanning is performed with 1H-MRS. Secondly, the range maps of N-acetylaspartic acid (NAA), Choline (Cho), and Creatine (Cr) in the region of interest (the primary motor area of anterior central cortex gyrus, i.e. M1 region) are obtained, and the ratios of NAA/Cr and Cho are calculated. Third, Q-Space MR diffusion imaging technique is used to collect Q-Space images, and a Dsi-studio workstation is used to post-process the images. The fraction anisotropic (FA), generalized fraction anisotropic (GFA), and apparent diffusion coefficient (ADC) parameters of Q-Space in the primary motor cortex and the region of interest in the posterior limb of the internal capsule are obtained. Finally, the parameters of MRS and Q-Space in the experimental group and the control group are further analyzed by SPSS statistical software. ResultsAfter assessing with Parkinson's score scale, there is obvious motor dysfunction in the experimental group. The average clinical stage of H&Y is 3.0 ± 0.31. In the analysis of MRS data, the ratio of NAA/Cr in the primary motor area of the anterior central gyrus in the experimental group is significantly lower than that in the control group (P < 0.05). In the ADC map obtained by Q-Space imaging technique, the ADC value in the primary motor area of the anterior central gyrus in the experimental group is higher than that in the control group (P < 0.05), and the difference is statistically significant (P < 0.05). There is no significant difference between the experimental group and the control group (P > 0.05) in FA and GFA values of the posterior limb of capsule to characterize the characteristics of white matter fibers. ConclusionsIn parkinsonian patients with motor dysfunction, there are apparent functional and structural changes in the primary motor area neurons and peripheral white matter of the anterior central gyrus, and no obvious damage to the axonal structure of the descending fibers in the cortex.

Predictors of Functional Recovery of Upper Limb Following acute Ischemic Stroke

Background: Although age-standardised rates of stroke mortality have decreased worldwide, overall stroke burden has significantly increased over the last two and half decades especially in developing countries.Objectives: To predict the functional recovery of upper limb potential after acute ischemic stroke.Methods: 51 people were recruited and studied. SAFE, NIHS Score, Median nerve SSEP, Conventional MRI brain imaging are done for all 51 patients. 40 patients were cooperative for further DTI neuroimaging &amp; FA value analysis done within 1wk of stroke onset. Standard care &amp; rehabilitation given. Followed up for upper limb recovery with ARAT scores at 1st, 2nd &amp; 3rd months. Clinical, electrophysiological and neuroimaging recovery variables of upper limb were analyzed between two groups.Results: FA asymmetry index of posterior limb of internal capsule (PLIC) suggest more structural asymmetry of PLIC and poor recovery. There is a significant negative correlation between fractional anisotropy asymmetry index and ARAT III score. Correlation coefficient (r) is -0.319.Conclusion: With initial simple clinical assessment scales most of the recovery can be predicted and thereby patient expectations can be managed and use effective targeted rehabilitation strategies, time &amp; resources to bring the best outcome

Characterisation of brain microstructural alterations in children with obstructive sleep apnea syndrome using diffusion kurtosis imaging.

Obstructive sleep apnea (OSA) is a common chronic sleep-related breathing disorder in children. Previous studies showed widespread alterations in white matter (WM) in children with OSA mainly by using diffusion tensor imaging (DTI), while diffusional kurtosis imaging (DKI) extended DTI and exhibited improved sensitivity in detecting developmental and pathological changes in neural tissues. Therefore, we conducted whole-brain DTI and DKI analyses and compared the differences in kurtosis and diffusion parameters within the skeleton between 41 children with OSA and 32 healthy children. Between-group differences were evaluated by tract-based spatial statistics (TBSS) analysis (p < 0.05, TFCE corrected), and partial correlations between DKI metrics and sleep parameters were assessed considering age and gender as covariates. Compared with the controls, children with OSA showed significantly decreased kurtosis fractional anisotropy (KFA) mainly in white matter regions with a complex fibre arrangement including the posterior corona radiate (PCR), superior longitudinal fasciculus (SLF), and inferior fronto-occipital fasciculus (IFOF), while decreased FA in white matter regions with a coherent fibre arrangement including the posterior limb of internal capsule (PLIC), anterior thalamic radiation (ATR), and corpus callosum (CC). Notably, the receiver operating characteristic (ROC) curve analysis demonstrated the KFA value in complex tissue regions significantly (p < 0.001) differentiated children with OSA from the controls. In addition, the KFA value in the left PCR, SLF, and IFOF showed significant partial correlations to the sleep parameters for children with OSA. Combining DKI derived kurtosis and diffusion parameters can provide complementary neuroimaging biomarkers for assessing white matter alterations, and reveal pathological changes and monitor disease progression in paediatric OSA.

Disruption of specificwhite matter tracts is associated with neurogenic lower urinary tract dysfunction in women with multiple sclerosis.

To identify specific white matter tracts (WMTs) whose disruption is associated with the severity of neurogenic lower urinary tract dysfunction (NLUTD) in two independent cohorts of women with multiple sclerosis(MS) and NLUTD. Cohort 1 consisted of twenty-eight women with MS and NLUTD. The validation cohort consisted of 10women with MS and NLUTD. Eleven healthy women served as controls. Participants of both MS cohorts had the same inclusion and exclusion criteria. Both MS cohorts and the healthy controls underwent the same clinical assessment and functional MRI(fMRI) protocol, except that the validation MS cohort underwent 7-Tesla fMRI scan. Fifteen WMTs (six coursing to relevant brainstem areas) involved in bladder control were a priori regions of interest (ROI). Spearman's correlation test was performed between each the Fractional Anisotropy (FA) and mean diffusivity (MD) of each WMT and the clinical parameters. Overall, we found a very high degree of overlap (100% of a priori ROI) in the tracts identified by our correlation analysis as having the greatest contribution to NLUTD symptoms in MS women. The right inferior cerebellar peduncle, left posterior limb of internal capsule, and left superior cerebellar peduncle displayed significant associations to the greatest number of clinical parameters. Our correlation analysis supports the role of specific WMT disruptions in the contribution of symptoms in women with MS and NLUTD, as confirmed in two independent MS cohorts.

The value of MR diffusion tensor imaging in assessing white matter changes in short-term methamphetamine withdrawal

Objective: To explore the value of MRI diffusion tensor imaging (DTI) in the white matter changes of short-term methamphetamine (MA) abstinence. Methods: The data of DTI, demographics features, general information of addiction and impulsivity scale eleven (BIS-11) of 55 short-term MA addicts who were from Changsha, Zhuzhou and Yueyang compulsory detoxification centers in Hunan province, including 40 males and 15 females, aged 14-45 (37.24±7.31) years old, and 52 healthy controls, including 40 males and 12 females aged 18-59 (40.3±9.1) years were collected prospectively from August 2017 to December 2018. The differences of DTI indicators between the two groups were compared by tract-based spatial statistics (TBSS), and then the correlation between the different indicators and the age of first MA use, time of MA use, daily dose used, BIS-11 score were performed. Results: There were significant differences in BIS total score(P<0.001), BIS motivational impulsivity(P<0.001) and BIS attentional impulsivity(P=0.003) between MA group and healthy control group in short-term withdrawal. And compared with the healthy control group, the fractional anisotropy (FA) (0.58±0.02 vs 0.56±0.02,0.77±0.02 vs 0.75±0.04,0.79±0.04 vs 0.76±0.06; all P<0.05), axial diffusivity (AD) (0.57±0.01 vs 0.56±0.02,P=0.001) and mean diffusivity (MD) (0.66±0.02 vs 0.65±0.02,0.52±0.07 vs 0.51±0.06; both P<0.05)values in the MA group were all increased (P<0.05), but there was no significant difference in the radial diffusivity (RD) value (P>0.05). The white matter areas with increased FA value were located in the knee and body of corpus callosum, bilateral anterior corona radiata and left superior corona radiata; the areas with increased AD value were located in the knee, body and pressure of corpus callosum, bilateral anterior limb of internal capsule, posterior limb of internal capsule, anterior, superior and posterior corona radiata, external capsule and superior longitudinal fasciculus; and the areas with increased MD value were mainly located in the right superior longitudinal fasciculus, anterior and posterior limb of internal capsule. The corpus callosum, where there was a difference in FA between the two groups, was positively correlated with the daily dose of MA (r=0.301, P=0.026). Conclusion: MA addicted individuals with short-term withdrawal have white matter edema and damage, and the degree of corpus callosum damage is positively correlated with the daily dose of MA,which is helpful to understand the pathophysiological process of white matter damage in the nervous system and the potential mechanism of neuropsychiatric symptoms in short-term withdrawal MA addicted individuals.

Rehabilitation of a 17-Year-Old Patient with X-Linked Adrenoleukodystrophy

X-linked adrenoleukodystrophy is an X-linked recessive disease affecting the white matter of the central nervous system along with occasional involvement of the adrenal gland due to mutation of the ABCD1 gene, which leads to accumulation of very-long-chain fatty acid (VLCFA) in the white matter of the brain and adrenal cortex. Diminished vision, speech disturbance, motor weakness, bladder–bowel involvement and adrenal insufficiency can be seen in affected individuals according to phenotype and involved area. In this case, the patient was a 17-year-old male with progressive weakness of all limbs along with the difficulty of speech and vision. Magnetic resonance imaging showed T2 hyperintensity in white matters of temporo-parieto-occipital region, splenium and body of corpus callosum, peritrigonal area, posterior limb of internal capsule and corticospinal tract location of pons and midbrain. His plasma VLCFA was elevated. Along with medical treatment, our rehabilitation team comprising a physiatrist and other supporting members provided rehabilitation management. Although different methods such as dietary modification, bone marrow transplantation and gene therapy have been tried for these types of cases globally, rehabilitation remains the backbone of the management protocol for advanced cases.

A deep learning pipeline for the automated segmentation of posterior limb of internal capsule in preterm neonates

Segmentation of specific brain tissue from MRI volumes is of great significance for brain disease diagnosis, progression assessment, and monitoring of neurological conditions. Manual segmentation is time-consuming, laborious, and subjective, which significantly amplifies the need for automated processes. Over the last decades, the active development in the field of deep learning, especially convolutional neural networks (CNNs), and the associated performance improvements have increased the demand for the application of CNN-based methods to provide consistent measurements and quantitative analyses. In this paper, we present an efficient deep learning approach for the segmentation of brain tissue. More specifically, we address the problem of segmentation of the posterior limb of the internal capsule (PLIC) in preterm neonates. To this end, we propose a CNN-based pipeline comprised of slice-selection modules and a multi-view segmentation model, which exploits the 3D information contained in the MRI volumes to improve segmentation performance. One special feature of the proposed method is its ability to identify one desired slice out of the whole image volume, which is relevant for pediatricians in terms of prognosis. To increase computational efficiency, we apply a strategy that automatically reduces the information contained in the MRI volumes to its relevant parts. Finally, we conduct an expert rating alongside standard evaluation metrics, such as dice score, to evaluate the performance of the proposed framework. We demonstrate the benefit of the multi-view technique by comparing it with its single-view counterparts, which reveals that the proposed method strikes a good balance between exploiting the available image information and reducing the required computing power compared to 3D segmentation networks. Standard evaluation metrics as, well as expert-based assessment, confirm the good performance of the proposed framework, with the latter being more relevant in terms of clinical applicability. We demonstrate that the proposed deep learning pipeline can compete with the experts in terms of accuracy. To prove the generalisability of the proposed method, we additionally assess our deep learning pipeline to data from the Developing Human Connectome Project (dHCP).

Combined fractional anisotropy and subcortical volumetric deficits in patients with mild-to-moderate depression: Evidence from the treatment of antidepressant traditional Chinese medicine

Numerous neuroimaging studies have demonstrated that diverse brain structural plasticity could occur in a human brain during a depressive episode. However, there is a lack of knowledge regarding the underlying mechanisms of mild-to-moderate depression (MMD), especially the changes of brain structural characteristics after treatment with the Shuganjieyu capsule (SG), a kind of traditional Chinese medicine that has been recommended for the specialized treatment of MMD. In this study, we investigated the structural brain plasticity in MMD that have been undergoing 8 weeks of SG treatment compared with age- and sex-matched healthy controls (HCs) and assessed the relationship between these brain structural alternations and clinical symptoms in MMD. At the baseline, we found that: (1) fractional anisotropy (FA) values in patients with MMD were found to be significantly increased in the regions of anterior limb of internal capsule (ALIC) [MNI coordinates: Peak (x/y/z) = 102, 126, 77; MMD FApeak (Mean ± SD) = 0.621 ± 0.043; HCs FApeak (Mean ± SD) = 0.524 ± 0.052; MMD > HCs, t = 9.625, p < 0.001] and posterior limb of internal capsule (PLIC) [MNI coordinates: Peak (x/y/z) = 109, 117, 87; MMD FApeak (Mean ± SD) = 0.694 ± 0.042; HCs FApeak (Mean ± SD) = 0.581 ± 0.041; MMD > HCs, t = 12.90, p < 0.001], and FA values were significantly positively correlated with HAMD scores in patients with MMD. (2) Patients with MMD showed smaller gray matter volume (GMV) of the dorsolateral prefrontal cortex (DLPFC), frontal cortex, occipital cortex, and precuneus, and the GMV of DLPFC was negatively correlated with HAMD scores. After SG treatment, we found that (1) the HAMD scores decreased; (2) FA values were significantly decreased in the regions of the ALIC and PLIC compared to those at baseline and TBSS revealed no significant differences in FA values between patients with MMD and HCs. (3) The structural characteristics of DLPFC in patients with MMD obtained at the 8th week were improved, e.g., no significant differences in GMV of DLPFC between the two groups. Taken together, our results provided neuroimaging evidence suggesting that SG is an effective treatment for patients with MMD. Moreover, alterations of GMV after 8 weeks of SG treatment indicated a potential modulation mechanism in brain structural plasticity within the DLPFC in patients with MMD.

The Construction of a Predictive Composite Index for Decision-Making of CSF Diversion Surgery in Pediatric Patients following Prenatal Myelomeningocele Repair.

There is a wide range of clinical and radiographic factors affecting individual surgeons' ultimate decision for CSF diversion for pediatric patients following prenatal myelomeningocele repair. Our aim was to construct a composite index (CSF diversion surgery index) that integrates conventional clinical measures and neuroimaging biomarkers to predict CSF diversion surgery in these pediatric patients. This was a secondary retrospective analysis of data from 33 patients with prenatal myelomeningocele repair (including 14 who ultimately required CSF diversion surgery). Potential independent variables, including the Management of Myelomeningocele Study Index (a dichotomized variable based on the shunt-placement criteria from the Management of Myelomeningocele Study), postnatal DTI measures (fractional anisotropy and mean diffusivity in the genu of the corpus callosum and the posterior limb of internal capsule), fronto-occipital horn ratio at the time of DTI, gestational ages, and sex, were evaluated using stepwise logistic regression analysis to identify the most important predictors. The CSF diversion surgery index model showed that the Management of Myelomeningocele Study Index and fractional anisotropy in the genu of the corpus callosum were significant predictors (P < .05) of CSF diversion surgery. The predictive value of the CSF diversion surgery index was also affected by fractional anisotropy in the posterior limb of the internal capsule and sex with marginal effect (.05<P < .10), but not by the fronto-occipital horn ratio (P > .10). The overall CSF diversion surgery index model fit the data well with statistical significance (eg, likelihood ratio: P < .001), with the performance (sensitivity = 78.6%; specificity = 86.5%, overall accuracy = 84.8%) superior to all individual indices in sensitivity and overall accuracy, and most of the individual indices in specificity. The CSF diversion surgery index model outperformed all single predictor models and, with additional validation, may potentially be developed and incorporated into a sensitive and robust clinical tool to assist clinicians in hydrocephalus management.

An Updated Overview of MRI Injuries in Neonatal Encephalopathy: LyTONEPAL Cohort.

Background: Brain magnetic resonance imaging (MRI) is a key tool for the prognostication of encephalic newborns in the context of hypoxic−ischemic events. The purpose of this study was to finely characterize brain injuries in this context. Methods: We provided a complete, descriptive analysis of the brain MRIs of infants included in the French national, multicentric cohort LyTONEPAL. Results: Among 794 eligible infants, 520 (65.5%) with MRI before 12 days of life, grade II or III encephalopathy and gestational age ≥36 weeks were included. Half of the population had a brain injury (52.4%); MRIs were acquired before 6 days of life among 247 (47.5%) newborns. The basal ganglia (BGT), white matter (WM) and cortex were the three predominant sites of injuries, affecting 33.8% (n = 171), 33.5% (n = 166) and 25.6% (n = 128) of participants, respectively. The thalamus and the periventricular WM were the predominant sublocations. The BGT, posterior limb internal capsule, brainstem and cortical injuries appeared more frequently in the early MRI group than in the late MRI group. Conclusion: This study described an overview of brain injuries in hypoxic−ischemic neonatal encephalopathy. The basal ganglia with the thalamus and the WM with periventricular sublocation injuries were predominant. Comprehensive identification of brain injuries in the context of HIE may provide insight into the mechanism and time of occurrence.

Altered regional brain white matter in dry eye patients: a brain imaging study.

This study aimed to investigate the regional changes of brain white matter (WM) in DE patients using diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI). A total of 25 dry eye patients (PAT) and 25 healthy controls (HC) were recruited. All subjects underwent DTI and NODDI, fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), isotropic volume fraction (FISO), intra-cellular volume fraction (FICVF), and orientation dispersion index (ODI) were obtained respectively. Then complete Hospital Anxiety and Depression Scale (HADS), anxiety score (AS) or depression scores (DS) were obtained. Receiver operating characteristic (ROC) curve analysis was used to evaluate the reliability of DTI and NODDI in distinguishing the two groups. DTI revealed that PAT had lower FA in both the left superior longitudinal fasciculus (LSLF) and the corpus callosum (CC), and higher MD in the LSLF, the right posterior limb of the internal capsule and the right posterior thalamic radiation. PAT had significant AD changes in regions including the genu of the CC, the right posterior limb of internal capsule, and the right splenium of the CC. From NODDI, PAT showed increased ODI in the LSLF and increased FISO in the right splenium of the CC. FICVF showed a significant decrease in the LSLF while increased in the left anterior corona radiata and the CC. Furthermore, the average values of MD and FICVF were significantly correlated with DS and AS. Hence the results of this study suggest that there are regional changes in WM in DE patients which may contribute to further understanding of the pathological mechanism of DE.

Posterior Limb of Internal Capsule Infarct Predicts Functional Outcome in Acute Terminal Internal Carotid Artery Occlusion After Thrombectomy.

This study investigated the impact of posterior limb of internal capsule (PLIC) infarct on outcomes of acute internal carotid artery (ICA) occlusion after endovascular thrombectomy (EVT) and the diagnostic accuracy of pretreatment noncontrast computerized tomography (NCCT) and computerized tomography angiography (CTA) findings. Patients who underwent EVT for acute ICA occlusion between September 2014 and August 2020 were included in the study. The patients were dichotomized as PLIC infarct or spared. The risk factors for PLIC infarct were investigated, and the association between infarct patterns and clinical outcomes were assessed using logistic regression analysis. Pretreatment NCCT and CTA findings, including PLIC hypodensity, choroid plexus enhancement (CPE), and posterior cerebral artery (PCA) flow status, were calculated for diagnosis of PLIC infarct. Among 72 patients, the mean age was 70.9 years, and the mean stroke scale was 19.4. PLIC infarct was identified in 15 patients (20.8%). PLIC infarct was associated with worse 90-day functional outcome (P = 0.01, shift test). Lack of CPE is the only independent predictor of PLIC infarct (odds ratio: 127.48, P = 0.001). Lack of CPE and impaired PCA flow produce greater diagnostic accuracy for PLIC infarct than does NCCT hypodensity (area under the receiver operating characteristics curve: 0.85 and 0.76, P = 0.0005 and 0.02, respectively). In acute ICA occlusion, PLIC infarct is an independent risk factor for worse clinical outcome at 90 days. The lack of CPE was associated with PLIC infarct, and pretreatment CTA can be useful for early diagnosis.

Evaluation of White Matter Microstructural Alterations in Patients with Post-Stroke Cognitive Impairment at the Sub-Acute Stage.

PurposeTo investigate white matter alterations in post-stroke cognitive impairment (PSCI) patients at the subacute stage employing diffusion kurtosis and tensor imaging.MethodsThirty PSCI patients at the subacute phase and 30 healthy controls (HC) underwent diffusion kurtosis imaging (DKI) scans and neuropsychological assessments. Based on the tract-based spatial statistics and atlas-based ROI analysis, fractional anisotropy (FA), mean diffusivity (MD), mean kurtosis (MK), kurtosis fractional anisotropy (KFA), axial kurtosis (AK), and radial kurtosis (RK) were compared in specific white matter fiber bundles between the groups (with family-wise error correction). Adjusting for age and gender, a partial correlation was conducted between neurocognitive assessments and DKI metrics in the PSCI group.ResultsIn comparison with the HC, PSCI patients significantly showed decreased MK, RK, and FA and increased MD values in the genu of corpus callosum, anterior limb internal capsule, and left superior corona radiata. In addition, DKI detected more white matter region changes in MK (31/48), KFA (40/48), and RK (25/48) than DTI with FA (28/48) and MD (21/48), which primarily consisted of the right cingulum, right superior longitudinal fasciculus, and left posterior limb of internal capsule. In the left anterior limb of internal capsule, MK and RK values were significantly negatively correlated with TMT-B (r = −0.435 and −0.414, P < 0.05), and KFA values (r = −0.385, P < 0.05) of corpus callosum negatively associated with TMT-B.ConclusionCombing DTI, DKI, and neuropsychological tests, we found extensive damaged white matter microstructure and poor execution performance in subacute PSCI patients. DKI could detect more subtle white matter changes than DTI metrics. Our findings provide added information for exploring the mechanisms of PSCI and conducting cognitive rehabilitation in the subacute stage.

Abnormal Regional Spontaneous Brain Activities in White Matter in Patients with Autism Spectrum Disorder

Previous studies have demonstrated patients with autism spectrum disorder (ASD) are accompanied by alterations of spontaneous brain activity in gray matter. However, whether the alterations of spontaneous brain activity exist in white matter remains largely unclear. In this study, 88 ASD patients and 87 typical controls (TCs) were included and regional homogeneity (ReHo) was calculated to characterize spontaneous brain activity in white matter. Voxel-wise two-sample t-tests were performed to investigate ReHo alterations, and cluster-level analyses were conducted to examine structural–functional coupling changes. Compared with TCs, the ASD group showed significantly decreased ReHo in the left superior corona radiata and left posterior limb of internal capsule, and decreased ReHo in the left anterior corona radiata with a trend level of significance. In addition, significantly weaker structural–functional coupling was observed in the left superior corona radiata and left posterior limb of internal capsule in ASD patients. Taken together, these findings highlighted abnormalities of white matter’s regional spontaneous brain activity in ASD, which may provide new insights into the pathophysiological mechanisms of this disorder.

Prognosis prediction of motor outcome in hemiparetic patients with anterior choroidal artery infarction: Radiologic and transcranial magnetic stimulation prognostic validation studies (STROBE).

To investigate prognosis prediction of motor outcome in anterior choroidal artery (AChA) infarction patients using radiologic and transcranial magnetic stimulation (TMS) studies.Twenty six patients with complete weakness of the affected hand were recruited. The Motricity Index (MI), Medical Research Council (MRC) scores for the affected finger extensors, Modified Brunnstrom classification (MBC) and Functional Ambulation Category (FAC) were evaluated twice: at onset and the chronic stage (3–4 months after onset). Patients were assigned according to the presence of infarction at the corona radiata (CR); the CR-positive group (infarct presence at the CR and posterior limb of internal capsule [PLIC], 11 patients) and CR-negative group (infarct presence at the PLIC, 15 patients), and the presence of motor evoked potentials at the affected hand muscle: the TMS-positive group (11 patients) and the TMS-negative group (15 patients).At the second evaluation, the MI scores were significantly different between the CR-positive (45.10 ± 7.06) and CR-negative groups (57.90 ± 11.56), and between the TMS-positive (60.37 ± 11.53) and TMS-negative groups (46.70 ± 7.99) (P < .05). The MRC scores for the finger extensors were also significantly different between the CR-positive (0.95 ± 1.01) and CR-negative (2.57 ± 1.33) groups and between the TMS-positive (3.05 ± 0.88) and TMS-negative (1.03 ± 1.14) groups (P < .05). Fourteen (53.85%) of the 26 patients recovered to have a functional hand score (MBC ≥5) and 19 (73.07%) of the 26 patients recovered to have an independent gait score (FAC ≥3) on their second evaluation.The results show that CR involvement in addition to the presence of a PLIC lesion and a TMS-negative response were related to poor motor outcomes in patients with an AChA infarction. Consequently, radiologic and TMS studies can be considered for motor outcome prognosis prediction in patients with an AChA infarction.

Infantile Ascending Hereditary Spastic Paralysis with Extrapyramidal and Extraocular Manifestations Associated with a Novel ALS2 Mutation.

Infantile Ascending Hereditary Spastic Paralysis with Extrapyramidal and Extraocular Manifestations Associated with a Novel ALS2 Mutation.

L4-to-L4 nerve root transfer for hindlimb hemiplegia after hypertensive intracerebral hemorrhage.

There is no effective treatment for hemiplegia after hypertensive intracerebral hemorrhage. Considering that the branches of L4 nerve roots in the lumbar plexus root control the movement of the lower extremity anterior and posterior muscles, we investigated a potential method of nerve repair using the L4 nerve roots. Rat models of hindlimb hemiplegia after a hypertensive intracerebral hemorrhage were established by injecting autogenous blood into the posterior limb of internal capsule. The L4 nerve root on the healthy side of model rats was transferred and then anastomosed with the L4 nerve root on the affected side to drive the extensor and flexor muscles of the hindlimbs. We investigated whether this method can restore the flexible movement of the hindlimbs of paralyzed rats after hypertensive intracerebral hemorrhage. In a beam-walking test and ladder rung walking task, model rats exhibited an initial high number of slips, but improved in accuracy on the paretic side over time. At 17 weeks after surgery, rats gained approximately 58.2% accuracy from baseline performance and performed ankle motions on the paretic side. At 9 weeks after surgery, a retrograde tracing test showed a large number of fluoro-gold-labeled motoneurons in the left anterior horn of the spinal cord that supports the L4-to-L4 nerve roots. In addition, histological and ultramicrostructural findings showed axon regeneration of motoneurons in the anterior horn of the spinal cord. Electromyography and paw print analysis showed that denervated hindlimb muscles regained reliable innervation and walking coordination improved. These findings suggest that the L4-to-L4 nerve root transfer method for the treatment of hindlimb hemiplegia after hypertensive intracerebral hemorrhage can improve the locomotion of hindlimb major joints, particularly of the distal ankle. Findings from study support that the L4-to-L4 nerve root transfer method can effectively repair the hindlimb hemiplegia after hypertensive intracerebral hemorrhage. All animal experiments were approved by the Animal Ethics Committee of the First Affiliated Hospital of Nanjing Medical University (No. IACUC-1906009) in June 2019.