Journal of Yeungnam Medical Science

Case report

Recovery of the ascending reticular activating system and consciousness following comprehensive management in a patient with traumatic brain injury: a case report: Sung Ho Jang, Young Hyeon Kwon; J Yeungnam Med Sci. 2022;39(4):332-335. Published online August 12, 2021; DOI: https://doi.org/10.12701/yujm.2021.01172

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Abstract PDF: We report on changes in the ascending reticular activating system (ARAS) concurrent with the recovery of impaired consciousness following rehabilitation and cranioplasty in a patient with traumatic brain injury (TBI), which were demonstrated on diffusion tensor tractography (DTT). A 34-year-old male patient was diagnosed with a traumatic intracerebral hemorrhage after falling from a height of approximately 7 m and underwent a right frontoparietotemporal decompressive craniectomy and hematoma removal. At 5 months after onset, when starting rehabilitation, the patient showed impaired consciousness, with a Glasgow Coma Scale (GCS) score of 4. Comprehensive rehabilitative therapy was provided until 14 months after onset, and his GCS score improved to 8. Cranioplasty was performed using auto-bone at 14 months after onset. One month after cranioplasty, his GCS score improved to 12. On the 15-month DTT, the deviated lower dorsal ARAS was restored on both sides, and the right side had become thicker. The right lower ventral ARAS was reconstructed, and increased neural connectivity of the upper ARAS was detected in both the prefrontal cortices. Thus, changes in the ARAS were demonstrated in a patient with TBI during recovery of consciousness following rehabilitation and cranioplasty.

Case Reports

Visual recovery demonstrated by functional MRI and diffusion tensor tractography in bilateral occipital lobe infarction.: Jeong Pyo Seo, Sung Ho Jang; Yeungnam Univ J Med. 2014;31(2):152-156. Published online December 31, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.2.152

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We report on a patient who showed visual recovery following bilateral occipital lobe infarct, as evaluated by follow up functional magnetic resonance imaging (fMRI) and diffusion tensor tractography (DTT). A 56-year-old female patient exhibited severe visual impairment since onset of the cerebral infarct in the bilateral occipital lobes. The patient complained that she could not see anything, although the central part of the visual field remained dimly at 1 week after onset. However, her visual function has shown improvement with time. As a result, at 5 weeks after onset, she notified that her visual field and visual acuity had improved. fMRI and DTT were acquired at 1 week and 4 weeks after onset, using a 1.5-T Philips Gyroscan Intera. The fiber number of left optic radiation (OR) increased from 257 (1-week) to 353 (4-week), although the fiber numbers for right OR were similar. No activation in the occipital lobe was observed on 1-week fMRI. By contrast, activation of the visual cortex, including the bilateral primary visual cortex, was observed on 4-week fMRI. We demonstrated visual recovery in this patient in terms of the changes observed on DTT and fMRI. It appears that the recovery of the left OR was attributed more to resolution of local factors, such as peri-infarct edema, than brain plasticity.

Citations

Citations to this article as recorded by

Diffusion Tensor Imaging Studies on Recovery of Injured Optic Radiation: A Minireview
Eun Bi Choi, Sung Ho Jang
Neural Plasticity.2020; 2020: 1. CrossRef

Cystoperitoneal Shunting after Fenestration of an Enlarging Arachnoid Cyst.: Ik Chan Jeon, Min Su Kim, Seong Ho Kim, Sung Ho Jang; Yeungnam Univ J Med. 2008;25(2):160-164. Published online December 31, 2008; DOI: https://doi.org/10.12701/yujm.2008.25.2.160

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Abstract PDF: A two-month-old girl with a history of an incidental arachnoid cyst in the prenatal period (38 weeks) presented with persistent irritability. A follow-up computed tomographic (CT) scan revealed an enlarged arachnoid cyst with hydrocephalus. We performed craniotomy and fenestration, but the cyst size did not decrease, and hydrocephalus had worsened on a follow-up CT scan performed 13 months after fenestration. The patient was treated with cystoperitoneal shunting. Follow-up magnetic resonance imaging (MRI) performed 5 years later revealed that the arachnoid cyst had decreased in size and that the hydrocephalus had resolved. Enlarging arachnoid cysts are not common, and optimal surgical treatment is uncertain. Based on the features of this case, we believe cystoperitoneal shunting is an advisable surgical intervention for patients with enlarging arachnoid cysts presenting with hydrocephalus.

Original Article

Transcallosal Fibers from the Corticospinal Tract in Adults with Brain Injury: Sung Ho Jang, Sang Ho Ahn, Yun Woo Cho; Yeungnam Univ J Med. 2007;24(2 Suppl):S424-429. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S424

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Abstract PDF

Background
：Diffusion tensor image tractography (DTT) can visualize white matter tracts and provide us with a powerful vehicle for investigating the neuralpathway at the subcortical level. Using DTT, we attempted to demonstrate abnormal transcallosal fibers from the corticospinal tract in patients with brain injury. Materials and Methods：Four adults with brain injury (2 patients: stroke, 1 patient: brain tumor with hemorrhage, 1 patient: diffuse axonal injury) and 14 normal control subjects were enrolled in this study. DTT was performed using 1.5-T with a Synergy-L Sensitivity Encoding head coil. Three-dimensional reconstructions of the fiber tracts were obtained with FA<3.0, and an angle change >45o as termination criteria.
Results
：Transcallosal fibers were observed in two of 14 normal controls, and ascended to the cortex leaving the corpus callosum. All four patients showed transcallosal fibers which stemmed from the corticospinal tract of the unaffected hemisphere, and descended to or around the lesion at the subcortical area.
Conclusion
：It seems that transcallosal fibers which arise from the corticospinal tract of the unaffected hemisphere may act as pathological fibers for motor deficit compensation.

Citations

Citations to this article as recorded by

Usefulness of DTI-based three dimensional corticospinal tractography in children with hemiplegic cerebral palsy
Ji Hyun Yeo, Su Min Son, Eun Sil Lee, Han Ku Moon
Korean Journal of Pediatrics.2009; 52(1): 99. CrossRef

Review

Motor Recovery in Stroke Patients.: Sung Ho Jang, Yong Hyun Kwon; Yeungnam Univ J Med. 2005;22(2):119-130. Published online December 31, 2005; DOI: https://doi.org/10.12701/yujm.2005.22.2.119

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Abstract PDF: Stroke is a leading cause of chronic physical disability. The recent randomized controlled trials have that motor function of chronic stroke survivors could be improved through physical or pharmacologic intervention in the stroke rehabilitation setting. In addition, several functional neuroimaging techniques have recently developed, it is available to study the functional topography of sensorimotor area of the brain. However, the mechanisms involved in motor recovery after stroke, are still poorly understood. Four motor recovery mechanisms have been suggested, such as reorganization into areas adjacent to the injured primary motor cortex (M1), unmasking of the motor pathway from the unaffected motor cortex to the affected hand, attribution of secondary motor areas, and recovery of the damaged contralateral corticospinal tract. Understanding the motor recovery mechanisms would provide neurorehabilitation specialists with more information to allow for precise prognosis and therapeutic strategies based on the scientific evidence; this may help promote recovery of motor function. This review introduces several methodologies for neuroimaging techniques and discusses theoretical issues that impact interpretation of functional imaging studies of motor recovery after stroke. Perspectives, for future research are presented.

Case Report

Evidence of Cortical Reorganization in a Monoparetic Patient with Cerebral Palsy Detected by Combined Functional MRI and TMS.: Yong Hyun Kwon, Sung Ho Jang, Mi Young Lee, Woo Mok Byun, Yoon Woo Cho, Sang Ho Ahn; Yeungnam Univ J Med. 2005;22(1):96-103. Published online June 30, 2005; DOI: https://doi.org/10.12701/yujm.2005.22.1.96

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Abstract PDF: The motor recovery mechanism of a 21-year-old male monoparetic patient with cerebral palsy, who had complained of a mild weakness on his right hand since infancy, was examined using functional Magnetic Resonance Imaging (fMRI) and Transcranial Magnetic Stimulation (TMS). The patient showed mild motor impairment on the right hand. MRI located the main lesion on the left precentral knob of the brain. fMRI was performed on this patient as well as 8 control subjects using the Blood Oxygen Level Dependent technique at 1.5 T with a standard head coil. The motor activation task consisted of finger flexion- extension exercises at 1 Hz cycles. TMS was carried out using a round coil. The anterior portion of the coil was applied tangentially to the scalp at a 1.0 cm separation. Magnetic stimulation was carried out with the maximal output. The Motor Evoked Potentials (MEPs) from both Abductor Pollicis Brevis muscles (APB) were obtained simultaneously. fMRI revealed that the unaffected (right) primary sensori-motor cortex (SM1), which was centered on precentral knob, was activated by the hand movements of the control subjects as well as by the unaffected (left) hand movements of the patient. However, the affected (right) hand movements of the patient activated the medial portion of the injured precentral knob of the left SM1. The optimal scalp site for the affected (right) APB was located at 1 cm medial to that of the unaffected (left) APB. When the optimal scalp site was stimulated, the MEP characteristics from the affected (right) APB showed a delayed latency, lower amplitude, and a distorted figure compared with that of the unaffected (left) APB. Therefore, the motor function of the affected (right) hand was shown to be reorganized in the medial portion of the injured precentral knob.

Original Article

Microsurgical DREZotomy for treatment of intractable central pain in patient with spinal cord injury.: Zee Ihn Lee, Seong Ho Kim, Sang Ho Ahn, Sung Ho Jang; Yeungnam Univ J Med. 2002;19(1):49-54. Published online June 30, 2002; DOI: https://doi.org/10.12701/yujm.2002.19.1.49

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Abstract PDF: The central pain in patient with spinal cord injury is a common and disabling sequelae. The microsurgical DREZ(Dorsal Root Entry Zone)otomy is a surgical procedure effective in the treatment of intractable pain and spasticity in spinal cord injured patients. It consists of a microsurgical lesions performed in the ventrolateral region of the dorsal root entry zone at the selected levels. This report presents one case with incomplete paraplegia patient, who had chronic central neuropathic pain ineffective to many conservative treatments in bilateral T10 and right T11 segments and both lower extremities, is relieved from the pain after microsurgical DREZotomy. In conclusion, microsurgical DREZotomy is one method of effective treatments for spinal cord injured patients with intractable central neuropathic pain.

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