Abstract Details

Title Motor Tract Variations and Walking Recovery after Thalamic Hemorrhage: Analyses by Diffusion Tensor Tractography

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P15 - Poster Session 15 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-007

Objective To observe the recovery process of patients with thalamic hemorrhage using diffusion tensor tractography (DTT).

Background The thalamus is involved in several neural networks, complicating the mechanisms of walking disturbance in thalamic hemorrhage. I analyzed such cases using DTT.

Design/Methods Four patients with thalamic hemorrhage were examined. All were wheelchair-bound on admission. The data for DTT were obtained during the period of recovery rehabilitation and analyzed using the region of interest (ROI) method by a deterministic approach. The tracts observed were as follows: (1) corticospinal tract (CST), (2) corticoreticular tract (CRT), and (3) cerebellar pathway originating from the dentate nucleus via the superior cerebellar peduncle (Den-SCP).

Results All patients become ambulatory upon discharge. One patient was able to walk without any assistive device, whereas three needed a cane and short leg brace. (1) The density of ipsilesional CST decreased or was disrupted in all patients. One patient had transcallosal CST fibers from cotralesional cortex and was able to walk without assistive devices upon discharge. (2) Ipsilesional CRT with transcallosal fibers was observed in three patients. Two exhibited walking recovery regardless of the disruption of ipsilesional CST. (3) Den-SCPs appeared as nondecussating fibers by the method used in this study. The density of ipsilesional Den-SCP decreased in all patients. These fibers ascended to the ipsilesional frontal lobe. Compared with contralesional Den-SCP, they were distributed in forward areas of the frontal lobe.

Conclusions Thalamic hemorrhage affects multiple pathways involving the gait control system. Even patients with disrupted ipsilesional CST regained walking ability. The reconstruction of neural networks for walking may be complementary coordinated by multiple alternative pathways. Longitudinal studies are needed to interpret these findings.

Authors/Disclosures
Aki Arai, MD, PhD (Honjo General Hospital) PRESENTER	Dr. Arai has nothing to disclose.

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