Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 705-717, Republic of Korea.
BMC Neurol. 2021 Apr 20;21(1):166. doi: 10.1186/s12883-021-02199-4.
We report on a patient with an intracerebral hemorrhage (ICH), who showed delayed development of aphasia, which was demonstrated via follow up diffusion tensor tractography (DTT) to be related to neural degeneration of the arcuate fasciculus (AF).
A 51-year-old, right-handed male presented with right hemiparesis, which occurred at the onset of a spontaneous ICH in the left corona radiata and basal ganglia. Brain magnetic resonance images showed a hematoma in the left subcortical area at one month after onset and hemosiderin deposits in the left subcortical area at nine years after onset. At four weeks after onset, he exhibited severe aphasia, and Western Aphasia Battery (WAB) testing revealed an aphasia quotient in the 39.6 percentile (%ile). However, his aphasia improved to nearly a normal state, and at three months after onset, his aphasia quotient was in the 90.5 %ile. At approximately eight years after onset, he began to show aphasia, and his aphasia increased slowly with time resulting in a WAB aphasia quotient in the 12.5 %ile at nine years after onset. The integrity of the left AF over the hematoma was preserved on 1-month post-onset DTT. However, the middle portion of the left AF in the middle of the hemosiderin deposits showed discontinuation on 9-year post-onset DTT. The fractional anisotropy value of the left AF was higher on the 9-year post-onset DTT (0.48) than that on the 1-month post-onset DTT (0.35), whereas the mean diffusivity value was lower on the 9-year post-onset DTT (0.10) than that on the 1-month post-onset DTT (0.32). The fiber number of the left AF was decreased to 175 on the 9-year post-onset DTT from 239 on the 1-month post-onset DTT.
We report on a patient with ICH who showed delayed development of aphasia, which appeared to be related to degeneration of the AF in the dominant hemisphere. Our results suggest that DTT would be useful in ruling out neural degeneration of the AF.
我们报告了一例颅内出血（ICH）患者，其表现出语言障碍的延迟发展，通过后续的弥散张量追踪（DTT）显示与弓状束（AF）的神经退行性变有关。
一名 51 岁的右利手男性，因自发性左放射冠和基底节区 ICH 起病时出现右侧偏瘫。发病 1 个月后的脑磁共振成像显示左侧皮质下区域有血肿，发病 9 年后出现左侧皮质下区域含铁血黄素沉积。发病 4 周后，他出现严重的失语症，西方失语症成套测验（WAB）测试显示失语症商数为 39.6 百分位（%ile）。然而，他的失语症逐渐恢复到接近正常状态，发病 3 个月后，他的失语症商数为 90.5%ile。大约发病 8 年后，他开始出现失语症，且随着时间的推移，他的失语症逐渐加重，发病 9 年后的 WAB 失语症商数为 12.5%ile。发病 1 个月后的 DTT 显示血肿处左侧 AF 的完整性得以保留。然而，在发病 9 年后的 DTT 中，位于含铁血黄素沉积中间的左侧 AF 的中段显示中断。发病 9 年后的左侧 AF 分数各向异性值（FA 值）（0.48）高于发病 1 个月后的 DTT（0.35），而平均弥散系数值（MD 值）（0.10）低于发病 1 个月后的 DTT（0.32）。发病 9 年后的左侧 AF 纤维数量从发病 1 个月后的 239 条减少到 175 条。
我们报告了一例 ICH 患者，其表现出语言障碍的延迟发展，这似乎与优势半球 AF 的退行性变有关。我们的结果表明 DTT 有助于排除 AF 的神经退行性变。
