Apathy Due to Injury of the Prefrontocaudate Tract Following Mild Traumatic Brain Injury.

In this study, we report on a patient who developed apathy resulting from injury to the prefrontocaudate tract following mild traumatic brain injury (TBI), which was observed on diffusion tensor tractography (DTT). A 46-year-old female patient was involved in a bus accident. Her history included intracerebral hemorrhage (ICH) in the left putamen 4 years ago before the head trauma, and her family reported that she had fully recovered. She developed apathy after the TBI, worsening over time. Decreased neural connectivity of the left caudate nucleus (CN) to the left upper medial prefrontal cortex (PFC) resulting from the ICH was observed on the pre-TBI-DTT, whereas on the post-TBI-DTT (28 months after TBI), the neural connectivity of the left CN to the left upper medial PFC was increased, whereas that to the left lower medial PFC and orbitofrontal cortex was decreased. In the right hemisphere, decreased neural connectivity of the CN to the medial PFC and orbitofrontal cortex was observed on the post-TBI-DTT compared with the pre-TBI-DTT. Injury of the prefrontocaudate tract was observed in a patient with old ICH who developed apathy following mild TBI, using DTT.