• The Journal of Korean Physical Therapy
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• v.33 no.6
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• pp.304-306
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• 2021

Objectives: We report on a patient who showed mild bradykinesia due to injury of the corticofugal tract (CFT) from the secondary motor area following direct head trauma, which was demonstrated on diffusion tensor tractography (DTT). Case summary: A 58-year-old male patient underwent conservative management for subarachnoid hemorrhages caused by direct head trauma resulting from a fall from six-meter height at the department of neurosurgery of a local hospital. His Glasgow Coma Scale score was 3. He developed mildly slow movements following the head trauma and visited the rehabilitation department of a university hospital at ten weeks after the fall. The patient exhibited mild bradykinesia during walking and arm movements with mild weakness in all four extremities (G/G^-). Results: On ten-week DTT, narrowing of the right CFT from the supplementary motor area (SMA-CFT), and partial tearing of the left SMA-CFT, left CFTs from the dorsal premotor cortex (dPMC-CFT) and both corticospinal tracts (CSTs) at the subcortical white matter were observed. Conclusion: This case demonstrated abnormalities in both CSTs (partial tearing at the subcortical white matter and narrowing), both SMA-CFTs (narrowing and partial tearing) and left dPMC-CFT. We believe our findings suggest the necessity of assessment of the CFTs from the secondary motor area for patients with unexplained bradykinesia following direct head trauma.

• The Journal of Korean Physical Therapy
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• v.25 no.5
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• pp.260-265
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• 2013

Purpose: This study was conducted in order to evaluate the quantitative effectiveness of region of interest (ROI) setting in MR-DTI analysis with and without fMRI activation results. Methods: Ten right-handed normal volunteers participated in this study. DTI and fMRI datasets for each subject were obtained using a 1.5T MRI system. For neural fiber tracking, ROIs were drawn using two methods: The drawing points were located in the fMRI activation areas or areas randomly selected by users. In this study, the neural fiber tract targeted the corticospinal tract (CST) Quantitative analyses were performed and compared. The pixel numbers passing through the fiber tract in the individual brain volume were counted. The ratios between the ROI pixel numbers and the extracted fiber pixel numbers, and the ratios between the fiber pixel numbers and the whole-brain pixel numbers were also calculated. Results: According to our results, extracted CST fiber tract in which the ROI was drawn with fMRI activation areas showed higher distribution than drawing the ROI by users' hands. In addition, the quantitatively measured values represented higher pixel distribution: The counted average pixel numbers were 4553.8 and 1943.3. The average ratios of the ROI areas were 33.87 and 22.52. The average percentages of the individual whole-brain volume numbers were 2.06 and 0.87. Conclusion: Results of this study appear to indicate that use of this method can allow for more objectives and significant for study of the recovery of neural fiber mechanisms and brain rehabilitation.

• Investigative Magnetic Resonance Imaging
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• v.24 no.1
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• pp.51-54
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• 2020

Superficial siderosis is attributed to hemosiderin deposition in the subpial layers of the nervous system. The clinical features of infratentorial superficial siderosis (ISS) are hearing loss, cerebellar ataxia, and corticospinal tract signs and the most common cause of idiopathic ISS is a dural defect. As magnetic resonance imaging (MRI) has advanced, the diagnosis of infratentorial superficial siderosis can be confirmed by unique radiological findings in MRI. Here, we report on a female patient diagnosed with idiopathic ISS by means of clinical symptoms and radiological findings.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2006.08a
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• pp.153-153
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• 2006

• Journal of Biomedical Engineering Research
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• v.28 no.3
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• pp.317-324
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• 2007

The application of diffusion tensor imaging (DTI) and fiber tractography to Wallerian degeneration (WD) is important because this technique is a very potent tools for quantitatively evaluating fiber tracts in vivo brain. We analyzed a case and control using tracts of interest (TOI) analysis to quantify WD. We scanned a case of old infarction and an age-matched healthy volunteer. T1 magnetization prepared rapid acquisition gradient echo (MPRAGE), fluid attenuated inversion recovery (FLAIR) and 12-direction diffusion tensor imaging (DTI) were obtained and analyzed using TOI analysis. The value of mean diffusity ($D_{av}$) and fracional anisotrophy (FA) were analyzed statistically by MWU test. A p-value of less than 0.05 was considered to indicate statistical significance. A comparison of the global fiber diffusion characteristics shows WD of both the corpus callosum and the ipsilateral superior longitudinal fasciculus. The corpus callosum in particular showed trans-hemispherical degeneration. Local fiber characteristics along the geodesic paths show WD in the corpus callosum, ipsilateral superior longitudinal fasciculus, ipsilateral corticospinal tract, and ipsilateral corticothalamic tract. We have demonstrated changes in $D_{av}$ and FA values and a clear correspondence with the WD in various tracts. TOI analysis successfully revealed radial WD in white matter tracts from a region of encephalomalacia and primary gliosis, although they were only slightly affected.

• Investigative Magnetic Resonance Imaging
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• v.13 no.1
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• pp.40-46
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• 2009

Purpose : The purpose of this study was to investigate the quantitative evaluation of the corticospinal tract (CST) at the multiple levels by using functional MRI (fMRI) co-registered to diffusion tensor tractography (DTT). Materials and Methods : Ten normal subjects without any history of neurological disorder participated in this study. fMRI was performed at 1.5 T MR scanner using hand grasp-release movement paradigm. DTT was performed by using DtiStudio on the basis of fiber assignment continuous tracking algorithm (FACT). The seed region of interest (ROI) was drawn in the area of maximum fMRI activation during the motor task of hand grasp-release movement on a 2-D fractional anisotropy (FA) color map, and the target ROI was drawn in the cortiocospinal portion of anterior lower pons. We have drawn five ROIs for the measurement of FA and apparent diffusion coefficient (ADC) along the corona radiata (CR) down to the medulla. Results : The contralateral primary sensorimotor cortex (SM1) was mainly found to be activated in all subjects. DTT showed that tracts originated from SM1 and ran to the medulla along the known pathway of the CST. In all subjects, FA values of the CST were higher at the level of the midbrain and posterior limb of internal capsule (PLIC) than the level of others. Conclusion : Our study showed that co-registered fMRI and DTT has elucidated the state of CST on 3-D and analyzed the quantitative values of FA and ADC at the multiple levels. We conclude that co-registered fMRI and DTT may be applied as a useful tool for clarifying and investigating the state of CST in the patients with brain injury.

• Korean Journal of Clinical Laboratory Science
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• v.50 no.2
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• pp.211-215
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• 2018

The aim of this study was to preserve the corticospinal tract during surgery and assess more accurately the motor performance in brain tumor patients around the motor cortex. TceMEP is not entirely reliable, even though there has been no change in waveforms due to a mixture of false positive and false negative signals. For a more detailed examination, DCS was employed to selectively stimulate the motor cortex. In both cases, the indications could find the region to which the cortex was responsible, and constantly check and examine the changes in amplitude, thereby preserving the motor pathway and performing surgery. On the other hand, patients who did not implement the DCS but did implement the TceMEP experienced a decrease in their postoperative motor performance. DCS is a very useful examination and it is a method that can reduce the post-surgery disorder that may occur in patients with the TceMEP in brain tumor surgery.

• Journal of Korean Medicine Rehabilitation
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• v.18 no.3
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• pp.19-39
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• 2008

Objectives : It has been reported that CG was effective in decreasing injury to neural tissues. To investigate neural responses in the injured spinal cord, an extract of CG was examined to determine its effect on neural responses in the injured spinal cords of rats. Methods : After CG treatment was applied to the spinal cord of rats given a contusion injury, the re-growth responses of injured neural tissues and corticospinal tract axons was observed by measuring the number of GAP-43, Cdc2, and phospho-Erk1/2 proteins, CST axons, GFAP-stained astrocytes, and Glial scarring in the injured spinal cord. Results : Levels of GAP-43, Cdc2, and phospho-Erk1/2 proteins were found to have increased in the injured spinal cord region. The number of GFAP-stained astrocytes also increased within and around the injury cavity. Glial scarring, which was identified by CSPG immunofluorescence staining, was reduced by CG treatment. Anterograde tracing by Dil dye showed that the elongation of the CST axons in the dorso-medial white matter area was almost completely prevented at the injury site. Collateral sprouting was observed in the spinal cord rostrally close to the injury site, and CG treatment further increased axonal arborization in the corresponding region. In vivo migration of CST axons and astrocytes using an implanted polymer tube system showed more of an increase in enhanced migration of axons and astrocytes in CG-treated group compared to the injury control group. Conclusions : These results suggest that CG activated neural responses - including astrocyte migration - and promotes axonal regenerative activity in the injured spinal cord area.

• Journal of Korean Neurosurgical Society
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• v.46 no.1
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• pp.1-4
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• 2009

Objective: To report an unsuspected adaptive plasticity of single upper motor neurons and of primary motor cortex found after microsurgical connection of the spinal cord with peripheral nerve via grafts in paraplegics and focussed discussion of the reviewed literature. Methods: The research aimed at making paraplegics walk again, after 20 years of experimental surgery in animals. Amongst other things, animal experiments demonstrated the alteration of the motor endplates receptors from cholinergic to glutamatergic induced by connection with upper motor neurons. The same paradigm was successfully performed in paraplegic humans. The nerve grafts were put into the ventral-lateral spinal tract randomly, with out possibility of choosing the axons coming from different areas of the motor cortex. Results: The patient became able to selectively activate the re-innervated muscles she wanted without concurrent activities of other muscles connected with the same cortical areas. Conclusion: Authors believe that unlike in nerve or tendon transfers, where the whole cortical area corresponding to the transfer changes its function a phenomenon that we call "brain plasticity by areas". in our paradigm due to the direct connection of upper motor neurons with different peripheral nerves and muscles via nerve grafts motor learning occurs based on adaptive neuronal plasticity so that simultaneous contractions of other muscles are prevented. We propose to call it adaptive functional "plasticity by single neurons". We speculate that this phenomenon is due to the simultaneous activation of neurons spread in different cortical areas for a given specific movement, whilst the other neurons of the same areas connected with peripheral nerves of different muscles are not activated at the same time. Why different neurons of the same area fire at different times according to different voluntary demands remains to be discovered. We are committed to solve this enigma hereafter.

• Korean Journal of Radiology
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• v.22 no.7
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• pp.1142-1151
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• 2021

Objective: To evaluate microstructural damage in high myopia (HM) patients using 3T diffusion kurtosis imaging (DKI). Materials and Methods: This prospective study included 30 HM patients and 33 age- and sex-matched healthy controls (HCs) with DKI. Kurtosis parameters including kurtosis fractional anisotropy (FA), mean kurtosis (MK), axial kurtosis (AK), and radial kurtosis (RK) as well as diffusion metrics including FA, mean diffusivity, axial diffusivity (AD), and radial diffusivity derived from DKI were obtained. Group differences in these metrics were compared using tract-based spatial statistics. Partial correlation analysis was used to evaluate correlations between microstructural changes and disease duration. Results: Compared to HCs, HM patients showed significantly reduced AK, RK, MK, and FA and significantly increased AD, predominately in the bilateral corticospinal tract, right inferior longitudinal fasciculus, superior longitudinal fasciculus, inferior fronto-occipital fasciculus, and left thalamus (all p < 0.05, threshold-free cluster enhancement corrected). In addition, DKI-derived kurtosis parameters (AK, RK, and MK) had negative correlations (r = -0.448 to -0.376, all p < 0.05) and diffusion parameter (AD) had positive correlations (r = 0.372 to 0.409, all p < 0.05) with disease duration. Conclusion: HM patients showed microstructural alterations in the brain regions responsible for motor conduction and vision-related functions. DKI is useful for detecting white matter abnormalities in HM patients, which might be helpful for exploring and monitoring the pathogenesis of the disease.