Posterior Limb Of Internal Capsule Research Articles

The Role of Diffusion Tensor Imaging According to Tensor Registration Algorithm in the Treatment of Neonatal Hypoxic-Ischemic Encephalopathy

This research aimed to analyze the diagnostic value of diffusion tensor imaging (DTI) based on tensor image registration algorithm for hypoxia-ischemic encephalopathy (HIE). In this study, 90 newborns diagnosed with HIE who were admitted to our hospital from October 30, 2016 to January 30, 2019 were selected as experimental group (EG) and were divided into mild group (EG 1), moderate group (EG 2), and severe group (EG 3). In addition, 45 normal newborns of the same period were selected as the control group (CG). All subjects underwent DTI, which was processed by image registration algorithm, and the regions of interest (ROIs) were manually selected, including anterior limb of internal capsule (ALIC), posterior limb of internal capsule (PLIC), frontal white matter (FWM), centrum semiovale, corpus callosum (CC), and lenticular nucleus. Fractional anisotropy (FA) values for each ROI were recorded. Receiver operating characteristic (ROC) curve was used to analyze the accuracy, sensitivity, specificity, and area under curve (AUC) of each ROI in diagnosing HIE. The results showed that the images processed by the registration algorithm were clearer than the original images, the signal-to-noise ratio (SNR) was increased, and the artifact was decreased, so that the lesions of newborns with HIE could be clearly observed. FA values in some ROIs in EG were significantly lower than those in CG (P < 0.05). FA values of all ROIs in the EG 3 were significantly lower than those in the EG 1 and the EG 2, with significant differences (P < 0.05). The FA values of the ALIC, the PLIC, and the centrum semiovale in the EG 2 were significantly lower than those in the EG 1, with significant differences (P < 0.05). The accuracy, sensitivity, specificity, and AUC area of the ALIC were higher, that is, 87.6%, 87.7%, 89.6%, and 0.879, respectively, indicating that with the aggravation of the condition of HIE, the morphological damage of the white matter fiber bundle became more serious and the FA value decreased. Therefore, DTI imaging is safe and feasible in the diagnosis of HIT lesions, especially with high accuracy, sensitivity, and specificity in the ALIC and FWM.

Myelination may be impaired in neonates following birth asphyxia

BackgroundMyelination is a developmental process that begins during the end of gestation, intensifies after birth over the first years of life, and continues well into adolescence. Any event leading to brain injury around the time of birth and during the perinatal period, such as birth asphyxia, may impair this critical process. Currently, the impact of such brain injury related to birth asphyxia on the myelination process is unknown. ObjectiveTo assess the myelination pattern over the first month of life in neonates with neonatal encephalopathy (NE) developing brain injury, compared to neonates without injury (i.e., healthy neonates and neonates with NE who do not develop brain injury). MethodsBrain magnetic resonance imaging (MRI) was performed around day of life 2, 10, and 30 in healthy neonates and near-term/term neonates with NE who were treated with hypothermia. We evaluated myelination in various regions of interest using a T2* mapping sequence. In each region of interest, we compared the T2* values of the neonates with NE with brain injury to the values of the neonates without injury, according to the MRI timing, by using a repeated measures generalized linear mixed model. ResultsWe obtained 74 MRI scans over the first month of life for 6 healthy neonates, 17 neonates with NE who were treated with hypothermia and did not develop brain injury, and 16 neonates with NE who were treated with hypothermia and developed brain injury. The T2* values significantly increased in the neonates with NE who developed injury in the posterior limbs of the internal capsule (day 2: p < 0.001; day 10: p < 0.001; and day 30: p < 0.001), the thalami (day 2: p = 0.001; day 10: p = 0.006; and day 30: p = 0.016), the lentiform nuclei (day 2: p = 0.005), the anterior white matter (day 2: p = 0.002; day 10: p = 0.006; and day 30: p = 0.002), the posterior white matter (day 2: p = 0.001; day 10: p = 0.008; and day 30: p = 0.03), the genu of the corpus callosum (day 2: p = 0.01; and day 10: p = 0.006), and the optic radiations (day 30: p < 0.001). ConclusionIn the neonates with NE who were treated with hypothermia and developed brain injury, birth asphyxia impaired myelination in the regions that are myelinated at birth or soon after birth (the posterior limbs of internal capsule, the thalami, and the lentiform nuclei), in the regions where the myelination process begins only after the perinatal period (optic radiations), and in the regions where this process does not occur until months after birth (anterior/posterior white matter), which suggests that birth asphyxia, in addition to causing the previously well-described direct injury to the brain, may impair myelination.

Detection of White Matter Ultrastructural Changes for Amyotrophic Lateral Sclerosis Characterization: A Diagnostic Study from Dti-Derived Data.

In amyotrophic lateral sclerosis (ALS), magnetic resonance imaging (MRI) allows investigation at the microstructural level, employing techniques able to reveal white matter changes. In the current study, a diffusion tensor imaging (DTI) analysis, with a collection of apparent diffusion coefficient (ADC) and fractional anisotropy (FA) indexes, was performed in ALS patients to correlate geno- and phenotype features with MRI data, to investigate an in-vivo correlation of different neuropathological patterns. All patients who underwent the MR-DTI analysis were retrospectively recruited. MRI scan was collected within three months from diagnosis. FA and ADC values were collected in corpus callosum (CC), corona radiata (CR), cerebral peduncle (CR), cerebellar peduncle (CbP) and corticospinal tract at posterior limb of internal capsule (CST). DTI analysis performed in the whole ALS cohort revealed significant FA reduction and ADC increase in all selected regions, as widespread changes. Moreover, we observed a higher value of FA in rCR in bulbar patients. A positive correlation between ALS Functional Rating Scale-Revised and FA in rCP was evident. In consideration of the non-invasiveness, the reliability and the easy reproducibility of the method, we believe that brain MRI with DTI analyses may represent a valid tool usable as a diagnostic marker in ALS.

Clinical and neuroimaging profile in postpartum hypernatremia

Introduction: Hypernatremia can cause encephalopathy, rhabdomyolysis, and osmotic demyelination. Postpartum hypernatremia is an uncommon occurrence. The present study attempts to highlight clinical and radiological profile of three patients who had postpartum hypernatremia and to provide differential diagnosis of magnetic resonance imaging findings of postpartum hypernatremia. Aim:To study clinical and radiological profile of three patients who had postpartum hypernatremia and to provide differential diagnosis of magnetic resonance imaging findings of postpartum hypernatremia. Material and Methods:The present study was conducted in a tertiary care centre in South India between March 2014 to March 2018. Three patients had hypernatremia presenting in postpartum period. Demographic data, clinical details, results of laboratory examinations and neuroimaging details of these patients were recorded. Result:All three patients had hypernatremia presenting with encephalopathy. Spasticity was seen in all patients. Quadriparesis was seen in two patients. One patient had generalized tonic clonic seizures. Two patients had hypokalemia. All the three patients had Hyperchloremia, Azotemia and raised serum osmolality. Phosphorous levels was high in one patient. Creatine kinase levels was high in one patient. All patients had hypermagnesemia and normal calcium levels. Thrombocytopenia was seen in one patient. On neuroimaging, splenium of corpus callosum, hippocampus and posterior limb of internal capsule were involved in all patients. Cerebral peduncles in two patients. Corona Radiata and cerebellar white matter were involved in one patient. Conclusion:Early identification and meticulous management of hypernatremia is of paramount importance. Neuroimaging Findings in postpartum hypernatremia is distinct. Keywords: Postpartum, Hypernatremia, Encephalopathy, Osmotic demyelination, rhabdomyolysis.

Optic tract and internal capsule lesion in a patient with Wernicke-Korsakoff syndrome

A 72-year-old man, presented with a one-week history of confusion and an anterograde amnesic disorder accompanied by confabulation, with lack of insight to his symptoms.&#x0D; Medical history included alcohol abuse and admitted twenty-years of alcohol ingestion (approximately 186 gr/day).&#x0D; Neurologic examination was notable for slightly decreased consciousness, disorientation to time, severe anterograde amnesia and unsteadiness of stance and gait with four limb ataxia.&#x0D; A metabolic blood panel including liver profile showed alanine aminotransferase mildly elevated (66 UI/L) with elevated gamma-glutamyl-transpeptidase (gGT: 426 UI/L). Tests for HIV, syphilis and vitamin B12 levels were negative.&#x0D; Review of initial brain MRI showed a symmetrical, increased fluid-attenuated inversion recovery (FLAIR) signal lesion extending through the hypothalamus, periaqueductal area, mamillary bodies, bilateral anterior thalami, chiasm, both optic tracts and posterior limbs of both internal capsules with restricted diffusion and patchy contrast enhancement (figure 1 1a-1b).&#x0D; A possible Wernicke-Korsakoff syndrome diagnosis was achived. Following the initial examination, the patient was initiated on prophylactic parenteral thiamine reposition.&#x0D; CSF analysis showed elevated proteins (174 mg/dl) and lactate concentration (2.9 mmol/L). Cytologic and immunocytochemical study showed no neoplastic processes. Screening of autoimmune antibodies in CSF and paraneoplastic antibodies in serum were negative.&#x0D; EEG and full-body CT scans were unremarkable.&#x0D; Thiamine serum levels were normal (16,5 ug/L) (blood sample collected previous to reposition). &#x0D; Finally, a neurocognitive test indicated malperformance in tasks related to immediate and delayed recall and disturbances in recent and remote memory with confabulation.&#x0D; A new brain MRI after supplementation showed regression of the previous lesion (figure 1 2a-2b).&#x0D; He was discharged one month later with residual anterograde amnesia and gait instability that are still present eleven months later, at the last follow up.&#x0D; &#x0D; &#x0D; Figure 1: (1) Axial FLAIR MRI sequence showing extensive, symmetrical, hyperintense lesion in chiasm and both optic tracts (1.a) and periaqueductal area, hypothalamus and posterior limb of internal capsules (1.b). (2) Axial FLAIR MRI sequence showing regression of the hyperintense lesion one month after thiamine reposition in chiasm and both optic tracts (2.a) and periaqueductal area, hypothalamus and posterior limb of internal capsules (2.b)&#x0D; &#x0D; Wernicke’s encephalopathy (WE) prototypical clinical triad consists of motor problems such as ataxia or gait incoordination, ocular signs (commonly ophthalmoparesis and nystagmus) and mental status changes1-3. Thiamine (vitamin B1) deficiency secondary to alcoholism is the most common etiologic factor3. If left untreated or undertreated, there is an increased risk of developing a chronic sequelae: the Korsakoff’s syndrome (KS), characterized with loss of working memory and confabulation with sparing of remote memories2-4. Both syndromes together are termed Wernicke-Korsakoff syndrome (WKS).&#x0D; Even though diagnosis of WKS remains primarily clinical3, brain MRI findings in previously reported typical locations1-3are highly specific of this syndrome, suggesting MRI is a valuable confirmation tool.&#x0D; Normal thiamine serum levels shouldn’t dismiss the initial suspicion, as its blood concentration does not necessarily reflect brain tissue’s concentration4.&#x0D; Our case suggests that, even when MRI lesions are not characteristic, intravenous thiamine reposition should be immediately initiated if WKS is suspected, considering the patient's outcome depends on prompt diagnosis and adequate treatment.

The prognosis of brain magnetic resonance imaging injury pattern for outcomes of hypothermia-treated infants.

Magnetic resonance imaging (MRI) can be a tool that allows the observation of structural injury patterns after cooling. The aim of this study was to determine the early pattern of brain injury in the MRIs of infants with hypoxic ischemic encephalopathy (HIE) after cooling and to search for any clinical factors related to abnormal MRI findings.The study retrospectively recruited 118 infants who were treated with therapeutic hypothermia (TH) between 2013 and 2016.Forty-three patients had normal brain MRI, and 75 had abnormal brain MRI findings. The TH-treated infants with abnormal brain MRI readings showed significantly more clinical seizures and the use of additional antiepileptic drugs (AEDs) than the normal MRI group. As a long-term outcome, more lesions in the basal ganglia and thalamus, posterior limb of internal capsule, or severe white matter lesions were associated with abnormal neurodevelopmental outcomes at 18 to 24 months of age.A higher frequency of clinical seizures and AED use were related to abnormal brain injury on MRI. A significant risk for poor long-term outcomes was found in the abnormal brain MRI group.

Brain Development in Infants of Mothers With Gestational Diabetes Mellitus: A Diffusion Tensor Imaging Study.

The objective of this study was to investigate clinical neurocognitive performance and microstructural white matter (WM) alterations in infants of mothers with gestational diabetes mellitus (GDM) using diffusion tensor imaging. Infants (corrected gestational age, 33.42-36.00 weeks) of mothers with GDM (n = 31) and gestational age- and sex-matched unexposed controls (n = 31) accomplished 3-T diffusion tensor imaging scans and neurocognitive tests. Diffusion tensor imaging measures, mainly referring to fractional anisotropy (FA) values, were compared between 2 groups, and within-group analysis of correlation between FA values and neurocognitive testing outcomes in GDM-exposed infants was conducted subsequently. Fractional anisotropy was significantly decreased in the splenium of corpus callosum, posterior limb of internal capsule, thalamus in infants of mothers with GDM when compared with controls (P < 0.05), reflecting microstructural WM abnormalities in the GDM group. Decreased FA was associated with worse neurocognitive performance in the exposed group (P < 0.05). Individuals of mothers with GDM showed microstructural WM abnormalities in different brain regions, which were significantly related to worse neurocognitive performance. This might reveal that GDM directly insults the brain development of the offspring.

Mini-Basketball Training Program Improves Social Communication and White Matter Integrity in Children with Autism.

Impairments in social communication (SC) represent one of the core symptoms of autism spectrum disorder (ASD). While previous studies have demonstrated that exercise intervention improves SC in children with ASD, there is currently no neuroscientific evidence supporting its benefits. Therefore, we evaluated the outcomes of a long-term exercise intervention on SC and white matter integrity (WMI) in children with ASD, and further explored the neural mechanism of exercise intervention on SC in these children. Twenty-nine children aged 3–6 years with ASD were assigned to either exercise group (n = 15) or control group (n = 14). The exercise group received a scheduled mini-basketball training program (5 sessions per week, forty minutes per session) for 12 consecutive weeks, while the control group was instructed to maintain their daily activities. Groups were assessed before and after intervention on SC and WMI. SC scores were lower in the exercise group post-intervention. Compared with the control group, WMI of the exercise group showed higher fractional anisotropy in the body of corpus callosum, fornix, right cerebral peduncle, left posterior limb of internal capsule, right retrolenticular part of internal capsule, left anterior corona radiate and left superior fronto-occipital fasciculus; lower mean diffusivity in the left anterior corona radiate and the bilateral corticospinal tract. Furthermore, increased WMI was associated with lower scores on a measure of social cognition in the overall sample. This study is the first to provide evidence that exercise intervention improves SC and white matter integrity in children with autism.

Correlation between early magnetic resonance imaging brain abnormalities in term infants with perinatal asphyxia and neuro developmental outcome at one year

Background: Hypoxic ischemic encephalopathy is an important cause of permanent brain damage in neonates with perinatal asphyxia. Magnetic resonance imaging (MRI) is valuable in predicting prognosis following HIE.Methods: Prospective observational cohort study was conducted in tertiary level referral hospital in term infants born with perinatal asphyxia. MRI brain was done between 5 to 14 days of age. Anthropometry and neurological examinations were recorded at birth, discharge and follow-up. Denver developmental screening test II was performed at follow up.Results: Out of 174 neonates born with PA, enrolled 64 underwent MRI brain. Out of these 14% had stage I, 70% stage II and 16 % stage III HIE as per Sarnat staging. At follow up, abnormalities in tone were noted in 36% infants, which included spastic quadriplegia in 34% and atonic cerebral palsy in 2%. DDST II was normal in 32 and suspect in 18 (36%) infants; with global developmental delay in 14 (28%) and predominantly motor development delay in 4 (8%). Abnormal lesions were seen in the corpus callosum in 34 (68%), posterior limb of internal capsule in 14 (28%), basal ganglia in 11 (22%), watershed region in 6 (12%), thalamus in 4 (8%) and corticospinal tract in 1 (2%) infants were associated with statistical significant poor neurodevelopment outcome p&lt;0.05. Diffusion weighted MRI showed abnormalities in the posterior limb of internal capsule (PLIC) in 27 (54%), BG in 8 (16%) and thalamus in 2 (4%) infants was associated with statistically significant poor neurodevelopmental outcome (NDO) (p&lt;0.05).Conclusions: Lesion in BG, thalamic region and PLIC in conventional MRI and abnormality in DW imaging in PLIC and BG were found to correlate with poor NDO at one year of life.

Urea Cycle Disorders: A Neuroimaging Pattern Approach Using Diffusion and FLAIR MRI.

This study aimed to assess characteristic regions of MRI involvement utilizing diffusion weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) at urea cycle disorder (UCD) diagnosis to determine the possible association between initial MRI patterns within 10days of the first hyperammonemia episode, serum ammonia levels, and severity of neurological outcome based on clinical follow-up of >30 days. Ten patients with UCDs (4 females; median age: 5.4 years, age range: 6 days-54 years) were included who underwent MRI during a first episode of hyperammonemia. The topographical distribution of the DWI and FLAIR abnormalities in the cerebral cortex, deep gray matter, white matter, posterior limb of internal capsule, cerebral peduncle, and cerebellum was evaluated. Possible correlations between the brain injury patterns on DWI/FLAIR images, serum ammonia levels, and severity of neurological outcome were investigated by a trend correlation. The UCD cohort (n = 10) involved four ornithine transcarbamoylase deficiencies, four argininosuccinic aciduria, one carbomoylphosphate synthetase deficiency, and one citrullinemia type-1. The observed trend in the distribution of DWI abnormalities as the severity of neurological sequela outcome increased was with diffuse cerebral cortex or corpus striatum involvement. Patients with initial peak serum ammonia ≥450 µmol/L had a grade 2 to 4 outcome, and those with peak ammonia <450 µmol/L had a grade 0 or 1 outcome. The presence of more severe neurological outcome could be associated with diffuse cerebral cortex or corpus striatum involvement on DWI and high serum ammonia levels in patients with UCD.

Serial MRI studies over 12\u2009months using manual and atlas-based region of interest in patients with amyotrophic lateral sclerosis

BackgroundAmyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by loss of upper and lower motor neurons. There is a need for an imaging biomarker to track disease progression. Previously, magnetic resonance imaging (MRI) has shown loss of grey and white matter in the brain of patients with ALS compared to controls. We performed serial diffusion tractography imaging (DTI) study of patients with ALS looking for changes over time.MethodsOn all subjects (n = 15), we performed three MRI studies at 6 month intervals. DTI changes were assessed with tract-based spatial statistics (TBSS) and region of interest (ROI) studies. Cortic-spinal tract (CST) was selected for our ROI at the upper level; the posterior limb of internal capsule (PLIC), and a lower level in the pons.ResultsThere was no significant change in DTI measures over 12 months of observation. Better correlation of manual and atlas-based ROI methods was found in the posterior limb of the internal capsule than the pons.ConclusionWhile previous DTI studies showed significant differences between ALS subjects and controls, within individual subjects there is little evidence of progression over 12 months. This suggests that DTI is not a suitable biomarker to assess disease progression in ALS.

Disrupted white matter functional connectivity in aMCI APOEε4 carriers: a resting-state study.

The ε4 allele of the APOE gene is thought to increase risk from amnestic mild cognitive impairment (aMCI) to Alzheimer's disease. Cognitive decline in the condition is increasingly considered to worsen functional disconnections in brain network composed of gray matter and white matter. Nevertheless, Whether APOEε4 targets specific white matter functional connectivity in patients with aMCI remains mostly unexplored, mainly due to the challenges of detecting BOLD signals in white matter. Here, we applied a novel approach to investigate APOEε4-related specific bundles and cortical area alterations in aMCI subjects, in order to characterize white matter-gray matter functional connectivity differences throughout the brain. We analyzed 75 patients with aMCI and 76 demographically matched normal controls. The aMCI APOEε4 carriers showed decreased functional connectivity located at left corticospinal tract, bilateral posterior limb of internal capsule, and right temporopolaris, which was different from the regions of aMCI-related changes. We further found that recognition scores were positively associated with the right temporopolaris in aMCI APOEε4 carriers. Collectively, the data provide new evidence that APOEε4 genotype exerts a negative impact on neural activity in both gray and white matter in aMCI, which potentially contributes to functional disconnection and memory decline. A novel method provides full-scale measuring effect of disease conditions on functional architecture throughout the brain. Trial registration: https://www.ClinicalTrials.gov (Identifier: NCT02225964). Registered January 2014.

Patients with chronic migraine without history of medication overuse are characterized by a peculiar white matter fiber bundle profile

BackgroundWe investigated intracerebral fiber bundles using a tract-based spatial statistics (TBSS) analysis of diffusion tensor imaging (DTI) data to verify microstructural integrity in patients with episodic (MO) and chronic migraine (CM).MethodsWe performed DTI in 19 patients with MO within interictal periods, 18 patients with CM without any history of drug abuse, and 18 healthy controls (HCs) using a 3 T magnetic resonance imaging scanner. We calculated diffusion metrics, including fractional anisotropy (FA), axial diffusion (AD), radial diffusion (RD), and mean diffusion (MD).ResultsTBSS revealed no significant differences in the FA, MD, RD, and AD maps between the MO and HC groups. In comparison to the HC group, the CM group exhibited widespread increased RD (bilateral superior [SCR] and posterior corona radiata [PCR], bilateral genu of the corpus callosum [CC], bilateral posterior limb of internal capsule [IC], bilateral superior longitudinal fasciculus [LF]) and MD values (tracts of the right SCR and PCR, right superior LF, and right splenium of the CC). In comparison to the MO group, the CM group showed decreased FA (bilateral SCR and PCR, bilateral body of CC, right superior LF, right forceps minor) and increased MD values (bilateral SCR and right PCR, right body of CC, right superior LF, right splenium of CC, and right posterior limb of IC).ConclusionOur results suggest that chronic migraine can be associated with the widespread disruption of normal white matter integrity in the brain.

The Use of Gray-White-Matter Ratios May Help Predict Survival and Neurological Outcomes in Patients Resuscitated From Out-of-Hospital Cardiac Arrest.

The gray-white-matter ratio (GWR) measured on brain computed tomography (CT) following return of spontaneous circulation (ROSC) has been reported to be helpful in the prognostication of mortality or comatose status of cardiac arrest victims. However, whether the use of GWR in predicting the outcomes in out-of-hospital cardiac arrest (OHCA) survivors in Taiwan population remains uninvestigated. This retrospective observational study conducted in a single tertiary medical center in Taiwan enrolled all the non-traumatic OHCA adults (> 18 years old) with sustained ROSC (≥ 20 minutes) during the period from 2006 to 2014. Patients with following exclusion criteria were further excluded: no brain CT within 24 hours following ROSC; the presence of intracranial hemorrhage, severe old insult, brain tumor, ventriculoperitoneal shunt, and severe image artifact. The GWR values were obtained from the density measurement of bilateral putamen, caudate nuclei, posterior limbs of internal capsule, corpus callosum, medial cortex and medial white matter of cerebrum in Hounsfield unit with region of interest of 0.11 cm2, and further compared between the patients who survived to hospital discharge or not and the patients with and without good neurological outcome (good: cerebral performance category [CPC] of 1-2, poor: CPC of 3-5), respectively. A total of 228 patients were included in the final analysis with 59.2% in male gender and mean age of 65.8-year-old. There were 106 patients (46.5%) survived to hospital discharge and 40 patients (17.5%) discharged with good neurological outcomes. The GWR values of patients who survived to hospital discharge was significantly higher than ones of those who failed (e.g. basal ganglion: 1.239 vs. 1.199, p < 0.001). Patients with good neurological outcome also had higher GWR values than those with poor outcome (e.g. basal ganglion: 1.243 vs. 1.208, p = 0.010). The Area Under Curve of Receiver of Characteristic curve demonstrated fair predicting ability of GWR for survival and neurological outcomes. The use of GWR measured on bran CT within 24 hours following ROSC can help in predicting survival-to-hospital discharge and neurological outcome in OHCA survivors.

Cerebello-cerebral connectivity in idiopathic generalized epilepsy.

The present study aims to investigate structural and functional connectivity (SC and FC) in cerebello-cerebral circuit in idiopathic generalized epilepsy (IGE). Diffusion tensor imaging and resting-state imaging data were collected from 57 patients with IGE and 66 controls in the present study. First, we performed bidirectional probabilistic fiber tracking between cerebellum and cerebral cortex, consisting of cerebellar efferent and afferent fibers. Then, strength of structural connectivity (SCS), fractional anisotropy (FA), mean diffusivity (MD), and radial diffusivity (RD) were extracted and compared between groups. Finally, cerebellar FC with cerebral cortex was evaluated with seeding at dentate nucleus. Between-group comparisons were performed using t tests with a significant level setting at p < 0.05 with threshold-free cluster enhancement correction. The patients with IGE showed decreased SCS in cerebellar efferent fibers to sensorimotor cortex in anterior corona radiate and increased SCS in efferent fibers to occipital cortex in posterior corona radiata. The SCS in cerebellar afferent fibers in corticospinal tract from frontal and in retrolenticular part of the internal capsule from occipital cortices were increased in IGE, and SCS in afferent fibers in posterior limb of internal capsule from parietal cortex was decreased. Decreased FA and increased MD and RD were observed in cerebello-cerebral tracts. Besides, decreased cerebellar FC with putamen and motor cortex was observed in IGE. The patients with IGE demonstrated distinct alterations in efferent and afferent pathways between cerebellum and different cerebral cortices, which might be the pathological anatomical basis for cerebellar modulation effect on epileptic activities and contribute to motor deficits. • IGE showed decreased SCS in cerebellar efferent fibers to the sensorimotor cortex and increased SCS in efferent fibers to the occipital cortex. • Patients demonstrated increased SCS in cerebellar afferent fibers from the frontal and the occipital cortex and decreased SCS in afferent fibers from parietal cortex. • Decreased FC between motor-related regions and dentate nucleus was observed in IGE.

Abstract TP94: White Matter Tract Integrity After Vascular Insult: Longitudinal Analysis of Hemorrhagic vs Ischemic Lesions

Introduction: White matter tract (WMT) injury occurs in patients with acute cerebrovascular disorders. In this study, we elucidate longitudinal differences in mechanism of injury and repair between ischemic stroke (ISC) and intracerebral hemorrhage (ICH). Methods: Twenty patients (10 ISC and ICH) were prospectively imaged at 1, 3, and 12 months of onset on a 3T MRI. 3D anatomical and DTI images were obtained and integrity of the corticospinal tract (CST) assessed at the ipsi and contralesional posterior limb of internal capsule (PLIC). Fractional anisotropy (FA), mean diffusivity (MD) and pixel volume were recorded. A linear regression model was applied for statistical analysis. Results: ISC group had 4 men, 6 women whereas ICH group had 7 men, 3 women, both with average age 52. Baseline NIHSS in ISC was 11 (IQR=4.5-20) and ICH 6 (IQR=2-13). All lesions were unilateral, hemispheric, completely subcortical or with a significant subcortical component. The average lesion and hematoma volume at 1 month was 37 and 39 cc in ISC and ICH, respectively. The MD in the PLIC of the ISC increased from 1 to 3m (P &lt;0.05) then plateaued, whereas it decreased in ICH over the entire 12m (Fig 1A). The rFA showed a similar pattern of initial injury and then improvement over time in both ISC and ICH (Fig 1B). The ISC group showed 12% WM atrophy in the PLIC at 12m, wheras 13% expansion (P &lt; 0.05) in ICH over this period, after an initial contraction of 14% at 1m (fig 1C-D). Structural changes of the PLIC correlated with changes in mRS/NIHSS (p&lt;0.05). Conclusions: ISC and ICH display unique patterns of WMT changes over one year in which ICH injury reflects a compression of the CST that resolves over time, while in ISC our data show degeneration and microstructural injury. These changes reflect different mechanisms of injury and remodeling on a cellular level. A better understanding of these changes could improve recovery therapies. Larger studies are needed to better characterize long term WMT changes in IS and ICH.

Abstract WMP71: Parent Artery Plaque in Acute Lacunar Stroke: A Prospective, Multicenter, Observational Study

Purpose: We aimed to investigate the prevalence and clinical relevance of the parent artery plaque in acute lacunar stroke. Methods: This prospective, multi-center, observational study included patients with first-ever ischemic stroke within 72 hours of symptom onset. Patients were evaluated by three-dimensional T1-weighted high-resolution magnetic resonance imaging (HR-MRI) and conventional MRI sequences. We examined the presence of intracranial plaque, infarction patterns, and infarct volumes in all the patients with acute lacunar stroke. The outcome measurement was 90-day poor functional outcome (modified Rankin Scale &gt;2). Results: Of the 756 patients included, 341(45.1%) patients had an acute lacunar stroke. There were 201 (58.9%, 201/341) patients with an infarct in deep basal ganglia area. Among them, 64 (31.8%, 64/201) patients had middle cerebral artery (MCA) plaques identified on HR-MRI. The patients with MCA plaque had a similar infarct volume ( 0.93ml vs. 0.88ml , p =0.9) with those without MCA plaque. However, they more likely had an infarct involving posterior limb of internal capsule (42.2%, 27/64 vs. 25.5%, 35/137, p =0.017 ) and had a higher prevalence of cerebral microbleed (68.8%, 44/64 vs. 40.1%, 55/137, p &lt;0.001 ), and moderate to severe perivascular spaces in basal ganglia (BG-PVS)(57.8%, 37/64vs.35.0%, 48/137, p =0.002) . After adjusting for age and National Institute of Health Stroke Scale (NIHSS) at admission, the presence of MCA plaque was independently associated with 90-day poor functional outcome (OR:3.44, [95% CI,1.26-9.42]). There were 102 (29.9%, 102/341) patients with an infarct in pons. Among them, 66 (64.7%, 66/102) patients had basilar artery (BA) plaques. Patients with BA plaque had a higher prevalence of moderate to severe BG-PVS (42.4%, 28/66 vs. 22.2%, 8/36, p =0.041). There were no differences between the patients with and without BA plaque regarding infarction volume and 90-day functional outcome. Conclusions: Parent artery plaque is common in patients with acute lacunar stroke. We propose the deep basal ganglia area infarct with MCA plaque as a unique lacunar stroke subtype with poor prognosis. Our data did not show the presence of BA plaque have an effect on the lacunar stroke prognosis.

Correlation between diffusion tensor imaging measures and the reading and cognitive performance of Arabic readers: dyslexic children perspective.

To investigate the correlation between the diffusion tensor imaging (DTI) measures and the reading, spelling, writing, rapid naming, memory, and motor abilities in Arabic dyslexic children. This could verify the influence of possible white matter alterations on the abilities of those children. Twenty native Arabic-speaking children with dyslexia (15 males and 5 females; 8.2years ± 1) underwent DTI of the brain on 1.5T scanner. Diffusion-weighted images were acquired in 32 noncollinear direction. Tractography of the arcuate fasciculus (AF) was performed. Region of interest (ROI)-based approach was also used. Regions encompass superior longitudinal fasciculus (SLF), anterior and superior corona radiata (CR), and posterior limb of internal capsule (PLIC) were analyzed. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were measured. The aptitudes of those children were evaluated by the dyslexia assessment test. These abilities were statistically correlated with the FA and ADC of the AF and other ROIs. The reduction of FA of right AF was related to worse overall reading and related abilities performance. The ADC of right SLF was negatively correlated with memory abilities. The ADC of right PLIC was positively correlated with writing performance. Other relations were also found. White matter microstructural DTI measurements in the right AF, right PLIC, SLF, and left anterior and superior CR are correlated to reading, spelling, writing, memory, and rapid naming abilities of the participants. The DTI measures could be promising regarding their use as a biomarker for follow-up in developmental dyslexia.

Acute hemiballismus in the absence of subthalamic nucleus lesion

A 68-year-old male, known hypertensive on irregular medication presented with sudden onset of involuntary movements of the left upper limb, in the form of severely violent, arrhythmic, and flinging large amplitude movements for 2 days, suggestive of hemiballismus. Magnetic resonance image of brain revealed a subacute nonhemorrhagic infarct in the posterior limb of the right internal capsule, but no lesion was noted in the subthalamic region. In traditional teaching, hemiballismus has been characterized as almost pathognomonic of a lesion in the subthalamic nucleus (STN). While a lesion occurring directly in the subthalamic nuclei can explain the onset of the movement disorder, a lesion occurring anywhere along the cortico-striatal pathway can also produce similar symptoms. The prognosis is benign in most cases, with almost all patients responding well to treatment and many having spontaneous remission. Our patient improved significantly following Tetrabenazine. Hemiballismus is as such a rare movement disorder. An elderly patient with sudden onset hemiballismus, indicating a vascular insult confirmed by subacute infarct in the posterior limb of the internal capsule, without any lesion in STN merits the report of this rare case.

Cerebral deep vascular architectures and subcortical infarcts

The lenticulostriate arteries (LSA) supply the lateral half of the head of the caudate nucleus, entire putamen, anterior limb, genu and the superior part of the internal capsule (IC) and a part of the corona radiata. The LSA consists with medial, intermediate and lateral branches. The medial branches perfuse the lateral segment of the globus pallidus, the head of the caudate nucleus and the anterior limb of the IC. The intermediate branches supply the anterior half of the LSA territory, while the lateral branches supply the posterior half. The anterior cerebral artery (ACA) perforators, predominantly Heubner's artery, perfuse the inferomedial part of the caudate head, the anteromedial part of putamen, the anterior part of the lateral segment of the globus pallidus and anterior limb of the internal capsule. Such territories can be represented by the anterior and ventral basal ganglions. The anterior choroidal artery (AChA) gives off three main groups of branches including the lateral branches that supply the medial temporal lobe, the medial branches that supply the cerebral peduncle and the superior branches that supply the internal capsule and the basal ganglia. The superior branches are further discriminated into proximal branches that supply the anterior one third of the posterior limb of internal capsule (PLIC) and the medial segment of the globus pallidus and distal branches that supply the posterior two-third of PLIC, retro-lenticular part of the internal capsule and the lateral thalamic nuclei. The superficial penetrating arteries, i.e. medullary arteries, arise from the cortical branches of the middle cerebral artery (MCA) and supply the deep white matter. Infarcts caused by the medullary artery occlusion are located in the centrum-semiovale and half of them were caused by embolic mechanism. The centrum-semiovale corresponds to cortical border-zone (BZ) while the corona radiate corresponds to internal BZ.