Jang Sung Ho, Kim Seong Ho, Lee Han Do
a Department of Physical Medicine and Rehabilitation, College of Medicine , Yeungnam University , Namku , Taegu , Republic of Korea.
b Department of Neurosurgery, College of Medicine , Yeungnam University , Namku , Taegu , Republic of Korea.
Brain Inj. 2017;31(11):1548-1551. doi: 10.1080/02699052.2017.1376761. Epub 2017 Sep 28.
We report on a patient with improvement of akinetic mutism (AM), who showed recovery of an injured prefronto-caudate tract following traumatic brain injury (TBI), which was demonstrated by follow-up diffusion tensor tractographies (DTTs).
A 72-year-old female had suffered from head trauma resulting from falling down the stairs. She was diagnosed as subdural hematoma on the right frontal lobe and subarachnoid haemorrhage. At 5 weeks after head trauma, when starting rehabilitation, she showed no spontaneous movement or speech. She participated in a comprehensive rehabilitative management programme, including movement therapy and dopaminergic drugs, for improvement of AM. During 5 week's intensive rehabilitation, she showed gradual improvement of AM: she became able to perform some daily activities by herself including eating, dressing and walking.
On 5-week DTT, the neural connectivity of the caudate nucleus (CN) to the medial prefrontal cortex (PFC; Broadmann area [BA]: 10 and 12) and the orbitofrontal cortex (BA: 11 and 13) was decreased in both hemispheres; in contrast, the neural connectivity of the CN to the medial PFC was increased on the left side on 10-week and 6-month DTT.
Recovery of an injured prefronto-caudate tract concurrent with the improvement of AM was demonstrated in a patient with TBI, using follow-up DTTs.
我们报告了一例运动不能性缄默症（AM）有所改善的患者，该患者在创伤性脑损伤（TBI）后受损的额前 - 尾状核束恢复，这在后续的弥散张量纤维束成像（DTT）中得到证实。
一名72岁女性因从楼梯上摔倒而头部受伤。她被诊断为右侧额叶硬膜下血肿和蛛网膜下腔出血。头部受伤5周后开始康复治疗时，她没有自主运动或言语。她参加了包括运动疗法和多巴胺能药物在内的综合康复管理计划，以改善运动不能性缄默症。在为期5周的强化康复过程中，她的运动不能性缄默症逐渐改善：她能够自己完成一些日常活动，包括吃饭、穿衣和行走。
在5周的DTT检查中，双侧尾状核（CN）与内侧前额叶皮质（PFC；布罗德曼区[BA]：10和12）以及眶额皮质（BA：11和13）的神经连接减少；相比之下，在10周和6个月的DTT检查中，左侧尾状核与内侧前额叶皮质的神经连接增加。
在一名创伤性脑损伤患者中，通过后续的DTT检查证实了受损的额前 - 尾状核束恢复与运动不能性缄默症的改善同时发生。
