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Zhang Y, Wei T, Yu H, Li W, Luo W, Liu B. Neuroimaging and clinical features of bilateral Wallerian degeneration of middle cerebellar peduncles subsequent to pontine infarction. CNS Neurosci Ther 2024; 30:e14828. [PMID: 38946709 PMCID: PMC11215464 DOI: 10.1111/cns.14828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 06/02/2024] [Accepted: 06/21/2024] [Indexed: 07/02/2024] Open
Abstract
OBJECTIVE Wallerian degeneration (WD) of the middle cerebellar peduncles (MCPs) following pontine infarction is a rare secondary degenerative neurological condition. Due to its infrequency, there is limited research on its characteristics. METHODS This study aims to present three cases of WD of MCPs following pontine infarction and to analyze the prognosis, clinical manifestations, and neuroimaging features by amalgamating our cases with previously reported ones. RESULTS The cohort consisted of 25 cases, comprising 18 men and 7 women aged 29 to 77 years (mean age: 66.2 years). The majority of patients (94%) exhibit risk factors for cerebrovascular disease, with hypertension being the primary risk factor. Magnetic resonance imaging (MRI) can detect WD of MCPs within a range of 21 days to 12 months following pontine infarction. This degeneration is characterized by bilateral symmetric hyperintensities on T2/FLAIR-weighted images (WI) lesions in the MCPs. Moreover, restricted diffusion, with hyperintensity on diffusion-weighted imaging (DWI) and low apparent diffusion coefficient (ADC) signal intensity may be observed as early as 21 days after the infarction. Upon detection of WD, it was observed that 20 patients (80%) remained asymptomatic during subsequent clinic visits, while four (16%) experienced a worsening of pre-existing symptoms. CONCLUSIONS These findings underscore the importance of neurologists enhancing their understanding of this condition by gaining fresh insights into the neuroimaging characteristics, clinical manifestations, and prognosis of individuals with WD of bilateral MCPs.
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Affiliation(s)
- Yao Zhang
- Department of NeurologyThe First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan HospitalJinanChina
| | - Ting Wei
- Department of NeurologyThe First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan HospitalJinanChina
| | - Hui Yu
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, School of Clinical MedicineWeifang Medical UniversityWeifangChina
| | - Wenli Li
- Department of NeurologyThe First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan HospitalJinanChina
| | - Wenqian Luo
- Department of NeurologyThe First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan HospitalJinanChina
| | - Bin Liu
- Department of NeurologyThe First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan HospitalJinanChina
- Shandong Institute of NeuroimmunologyJinanChina
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Uchino A, Uemiya N. Wallerian degeneration of the ipsilateral middle cerebellar peduncle after lower pontine paramedian infarct diagnosed by magnetic resonance imaging. Radiol Case Rep 2023; 18:2823-2826. [PMID: 37388256 PMCID: PMC10300453 DOI: 10.1016/j.radcr.2023.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 07/01/2023] Open
Abstract
We reported a case of Wallerian degeneration of the unilateral middle cerebellar peduncle (MCP) that developed after ipsilateral paramedian lower pontine infarction. The patient was a 70-year-old woman with right hemiparesis and dysarthria. Using a 3-Tesla scanner, cranial magnetic resonance imaging was performed, and an infarct was found at the left paramedian lower pons. Seven months later, an abnormal signal was found at the central portion of the left MCP, indicative of Wallerian degeneration of the pontocerebellar tract (PCT). There was no abnormality at the contralateral MCP. Usually, Wallerian degeneration of the bilateral MCPs may develop after unilateral paramedian pontine infarction, because bilateral PCTs cross each other at the midline of the basis pontis. In the present case, however, Wallerian degeneration was found at only the ipsilateral MCP. The contralateral PCT was not affected because the PCT runs in the craniocaudal direction, and our patient had a lower pontine infarct. The location of the pontine infarct (affected PCT) and the Wallerian degeneration of the side of the MCP were well correlated.
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Affiliation(s)
- Akira Uchino
- Department of Radiology, Saitama Sekishinkai Hospital, 2-37-20 Irumagawa Sayama, Saitama 350-1305, Japan
| | - Nahoko Uemiya
- Department of Neuroendovascular Therapy, Saitama Sekishinkai Hospital, Saitama, Japan
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Antkowiak L, Rogalska M, Stogowski P, Anuszkiewicz K, Mandera M. Clinical Application of Diffusion Tensor Imaging in Chiari Malformation Type I- Advances and Perspectives. A Systematic Review. World Neurosurg 2021; 152:124-136. [PMID: 34147690 DOI: 10.1016/j.wneu.2021.06.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diffusion tensor imaging (DTI) application in Chiari malformation type I (CMI) is still poorly defined. This study aimed to systematically review the literature and propose perspectives toward the clinical application of DTI in CMI. METHODS PubMed and Embase were searched for English-language articles published until October 20, 2020. Clinical studies and case series, evaluating fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), or radial diffusivity values in patients with CMI, were included. RESULTS Eight articles were included. Lower FA values were found at the syrinx level, which decreased with syrinx extent and intensity of symptoms, reflecting myelopathy severity. Decreased AD and MD in the middle cerebellar peduncles in symptomatic patients with CMI might explain the presence of cerebellar signs. Increased FA in various supratentorial structures positively correlated with pain severity. Worse performance in neuropsychological tests correlated with decreased FA, increased MD, and radial diffusivity, reflecting axonal degeneration. Postoperative FA decrease in the brainstem compression area reflects successful decompression. A positive correlation was found between the extent of tonsillar ectopia and increased FA, MD, and AD values, which could act as an early indicator of acute brainstem compression. CONCLUSIONS DTI might provide a valuable insight into the neurobiological foundation of symptomatic CMI presentation. The severity of white matter injury evident on DTI could serve as a reliable predictor of postoperative outcomes, therefore facilitating selection of appropriate surgical candidates. Postinterventional DTI reassessment might enable differentiation between unsuccessful surgical technique and irreversible myelopathy. The extent of tonsillar ectopia reflects the severity of microstructural brainstem injury.
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Affiliation(s)
- Lukasz Antkowiak
- Department of Pediatric Neurosurgery, Medical University of Silesia, Katowice, Poland.
| | - Marta Rogalska
- Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Stogowski
- Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | | | - Marek Mandera
- Department of Pediatric Neurosurgery, Medical University of Silesia, Katowice, Poland
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Yin S, Jin CX, Zhang DP, Peng YF. Magnetic resonance imaging evaluation of Wallerian degeneration of bilateral middle cerebellar peduncles after pontine infarction. Saudi Med J 2019; 40:1278-1284. [PMID: 31828281 PMCID: PMC6969632 DOI: 10.15537/smj.2019.12.24491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/08/2019] [Indexed: 12/02/2022] Open
Abstract
We aimed to present a case of symmetrical Wallerian degeneration (WD) in the middle cerebellar peduncles (MCPs) after a unilateral paramedian pontine infarction, which was examined by multimodality magnetic resonance imaging (MRI). In addition, we summarize the small number of reported cases. In our clinic, we observed a case of symmetrical WD of bilateral MCPs that occurred 6 months after the onset of a pontine infarction. We searched the Wanfang (Chinese) and PubMed databases and found 23 reported cases of this condition with characteristic similar to our patient. From the 24 cases, the detection time of WD ranged from 3 to 33 weeks. Symmetrical WD in the bilateral MCPs can occur after unilateral paramedian pontine infarction. Most cases were in Stages 2 and 3 of the disease and showed good clinical prognoses.
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Affiliation(s)
- Suo Yin
- Department of Image, People's Hospital affiliated to Henan University of Chinese Medicine, Zhengzhou, China. E-mail.
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Shen Y, Jian W, Li J, Dai T, Bao B, Nie H. Bilateral wallerian degeneration of the middle cerebellar peduncles secondary to pontine infarction: A case series. J Neurol Sci 2018; 388:182-185. [PMID: 29627018 DOI: 10.1016/j.jns.2018.03.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 03/10/2018] [Accepted: 03/15/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Wallerian degeneration (WD) of middle cerebellar peduncles (MCPs) secondary to pontine infarction is rarely reported in the literature. Our aim in this study is to characterize its clinical and neuroradiological features. METHODS A retrospective review of 7 patients from a single institution was conducted. Only patients with pontine infarction and subsequent degeneration of the MCPs were included in the analysis. The features of clinical presentation and neuroimaging finding were summarized by our experienced neurologists. RESULTS Seven patients (5 male, 2 female), ranging in age from 50 to 77 years, satisfied the inclusion criteria. All patients had cardiovascular risk factors and hypertension was the most common one. Almost all of the patients had hemiparesis and dysarthria, and could achieved good clinical outcome. On the initial scan, hyperintense on T2- and diffusion-weighted images suggested the acute pontine infarction. On the follow-up scan, however, hyperintensities of bilateral MCPs on T2-weight and FLAIR images were apparently demonstrated in all patients. The specific lesions in the MCPs were attributed to bilateral WD of the pontocerebellar fibres secondary to pontine infarction. CONCLUSION WD should be taken into account when patients are initially diagnosed with paramedian pontine infarction and follow-up MRI manifest as symmetrical hyperintense in the MCPs.
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Affiliation(s)
- Yaoyao Shen
- Institute: Department of Neurology, The Affiliated Hospital of Jiujiang University, Address: No.57 Xunyang East Rode, Xunyang District, Jiujiang 332000, Jiangxi Province, China.
| | - Wen Jian
- Institute: Department of Neurology, The People's Hospital of Xinyu City, Address: No.369 Xinxin North Rode, Yushui District, Xinyu 338000, Jiangxi Province, China
| | - Juan Li
- Institute: Department of Neurology, The Second Affiliated Hospital of Nanchang University, Address: No.1 Mingde Rode, Donghu District, Nanchang 330006, Jiangxi Province, China
| | - Tingmin Dai
- Institute: Department of Neurology, The Affiliated Hospital of Jiujiang University, Address: No.57 Xunyang East Rode, Xunyang District, Jiujiang 332000, Jiangxi Province, China
| | - Bing Bao
- Institute: Department of Neurology, The Affiliated Hospital of Jiujiang University, Address: No.57 Xunyang East Rode, Xunyang District, Jiujiang 332000, Jiangxi Province, China
| | - Hongbing Nie
- Institute: Department of Neurology, The Affiliated Hospital of Jiujiang University, Address: No.57 Xunyang East Rode, Xunyang District, Jiujiang 332000, Jiangxi Province, China.
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Zhang ZY, Liu ZQ, Qin W, Chen YW, Liu ZJ. Clinical and Radiological Features of Wallerian Degeneration of the Middle Cerebellar Peduncles Secondary to Pontine Infarction. Chin Med J (Engl) 2018. [PMID: 29521288 PMCID: PMC5865311 DOI: 10.4103/0366-6999.226890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Wallerian degeneration (WD) of bilateral middle cerebellar peduncles (MCPs) can occur following pontine infarction, but its characteristics have not yet been clarified because of the low incidence. Thus, the present study discussed the clinical and radiological features to improve the awareness of this disease. Methods: Clinical and radiological information from consecutive individuals diagnosed with WD of bilateral MCPs following pontine infarction in three hospitals over the past 4 years between October 2012 and October 2016 were retrospectively investigated and compared with a control group (patients with pontine infarction had no secondary WD). Results: This study involved 30 patients with WD of MCPs, with a detection rate of only 4.9%. The primary infarctions (χ2 =24.791, P = 0.001, vs. control group) were located in the paramedian pons in 21 cases (70.0%), and ventrolateral pons in nine cases (30.0%). WD of the MCPs was detected 8–24 weeks after pons infarction using conventional magnetic resonance imaging (MRI); all secondary WDs were asymptomatic and detected incidentally. All WD lesions exhibited bilateral, symmetrical, and boundary blurring on MRI. The signal features were hypointense on T1-weighted imaging, hyperintense on T2-weighted imaging and fluid-attenuated inversion recovery, and slightly hyperintense or isointense on diffusion-weighted imaging and apparent diffusion coefficient maps. Secondary brainstem atrophy was found in six (20.0%) cases. A Modified Rankin Scale score 0–2 was found in 10 (33.3%) cases and score >2 in 20 (66.7%) cases at 90 days after discharge, and the short-term prognosis was worse than that in control group (χ2 =12.814, P = 0.001). Conclusions: Despite the rarity of bilateral and symmetrical lesions of MCPs, secondary WD should be highly suspected if these lesions occur within 6 months after pontine infarction, particularly paramedian pons. Conventional MRI appears to be a relatively sensitive method for detecting WD of MCPs, which might affect the short-term prognosis.
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Affiliation(s)
- Zhi-Yong Zhang
- Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Zhi-Qin Liu
- Department of Neurology, Xi'an Central Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi 710003, China
| | - Wei Qin
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Ya-Wen Chen
- Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Zun-Jing Liu
- Department of Neurology, China-Japan Friendship Hospital, Beijing 100029, China
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Shen Y, Nie H. Wallerian degeneration of the bilateral middle cerebellar peduncles secondary to pontine infarction. Neurol Sci 2017; 39:961-963. [PMID: 29285691 DOI: 10.1007/s10072-017-3237-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 12/21/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Yaoyao Shen
- Department of Neurology, The Affiliated Hospital of Jiujiang University, No.57 Xunyang East Rode, Xunyang District, Jiujiang, 332000, Jiangxi Province, People's Republic of China
| | - Hongbing Nie
- Department of Neurology, The Affiliated Hospital of Jiujiang University, No.57 Xunyang East Rode, Xunyang District, Jiujiang, 332000, Jiangxi Province, People's Republic of China.
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Chen YJ, Nabavizadeh SA, Vossough A, Kumar S, Loevner LA, Mohan S. Wallerian Degeneration Beyond the Corticospinal Tracts: Conventional and Advanced MRI Findings. J Neuroimaging 2017; 27:272-280. [PMID: 28072502 DOI: 10.1111/jon.12404] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/04/2016] [Accepted: 10/11/2016] [Indexed: 12/21/2022] Open
Abstract
Wallerian degeneration (WD) is defined as progressive anterograde disintegration of axons and accompanying demyelination after an injury to the proximal axon or cell body. Since the 1980s and 1990s, conventional magnetic resonance imaging (MRI) sequences have been shown to be sensitive to changes of WD in the subacute to chronic phases. More recently, advanced MRI techniques, such as diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI), have demonstrated some of earliest changes attributed to acute WD, typically on the order of days. In addition, there is increasing evidence on the value of advanced MRI techniques in providing important prognostic information related to WD. This article reviews the utility of conventional and advanced MRI techniques for assessing WD, by focusing not only on the corticospinal tract but also other neural tracts less commonly thought of, including corticopontocerebellar tract, dentate-rubro-olivary pathway, posterior column of the spinal cord, corpus callosum, limbic circuit, and optic pathway. The basic anatomy of these neural pathways will be discussed, followed by a comprehensive review of existing literature supported by instructive clinical examples. The goal of this review is for readers to become more familiar with both conventional and advanced MRI findings of WD involving important neural pathways, as well as to illustrate increasing utility of advanced MRI techniques in providing important prognostic information for various pathologies.
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Affiliation(s)
- Yin Jie Chen
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Seyed Ali Nabavizadeh
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Arastoo Vossough
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sunil Kumar
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Laurie A Loevner
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Suyash Mohan
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Abstract
OPINION STATEMENT The thalamus plays an important role in different brain functions including memory, emotions, sleep-wake cycle, executive functions, mediating general cortical alerting responses, processing of sensory (including taste, somatosensory, visual, and auditory) information and relaying it to the cortex, and sensorimotor control. Thalamic stroke, both in isolation and in combination with infarcts involving other structures, are not rare. The functional complexity of the thalami nuclei and the not uncommon normal variations of arteries supply the thalamus induce wide variations in presentation of thalami infarcts. In patients with an unusual collection of deficits difficult to explain by a single lesion, in particular where there is impaired vigilance, thalamic disease should be considered which may mimic several different neurological conditions. By researching the literature, we found that the characteristic stroke syndrome of paramedian thalamic infarction is probably underdiagnosed. In addition to thalamic infarct, thalamic lesions can be caused by deep cerebral venous thrombosis with neuropsychological and radiological features that should be considered in the differential diagnosis of intracranial artery occlusion or bleeding, especially in young patients.
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Affiliation(s)
- Xiang Yan Chen
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, new territory, Hong Kong
| | - Qiaoshu Wang
- Department of Neurology, Shanghai First People's Hospital, Medical College, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Xin Wang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao, People's Republic of China
| | - Ka Sing Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, new territory, Hong Kong.
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Morales H, Tomsick T. Middle cerebellar peduncles: Magnetic resonance imaging and pathophysiologic correlate. World J Radiol 2015; 7:438-447. [PMID: 26751508 PMCID: PMC4697118 DOI: 10.4329/wjr.v7.i12.438] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/05/2015] [Accepted: 10/27/2015] [Indexed: 02/06/2023] Open
Abstract
We describe common and less common diseases that can cause magnetic resonance signal abnormalities of middle cerebellar peduncles (MCP), offering a systematic approach correlating imaging findings with clinical clues and pathologic mechanisms. Myelin abnormalities, different types of edema or neurodegenerative processes, can cause areas of abnormal T2 signal, variable enhancement, and patterns of diffusivity of MCP. Pathologies such as demyelinating disorders or certain neurodegenerative entities (e.g., multiple system atrophy or fragile X-associated tremor-ataxia syndrome) appear to have predilection for MCP. Careful evaluation of concomitant imaging findings in the brain or brainstem; and focused correlation with key clinical findings such as immunosuppression for progressive multifocal leukoencephalopahty; hypertension, post-transplant status or high dose chemotherapy for posterior reversible encephalopathy; electrolyte disorders for myelinolysis or suspected toxic-drug related encephalopathy; would yield an appropriate and accurate differential diagnosis in the majority of cases.
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11
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Sylaja RN, Goyal M, Watson T, Hill MD. Wallerian-Like Degeneration After Ischemic Stroke Revealed by Diffusion - Weighted Imaging. Can J Neurol Sci 2014; 34:243-4. [PMID: 17598606 DOI: 10.1017/s0317167100006120] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A 22-year-old female was seen in the emergency within one hour of acute onset of right sided headache followed by weakness of the left side of body. On neurological examination, she was mildly drowsy, had forced right gaze deviation, dysarthria, left hemiplegia and left hemisensory loss. Computed tomography (CT) scan revealed early ischemic changes in the right middle cerebral artery (MCA) territory. The CT angiography done showed evidence of dissection of the supraclinoid segment of the right internal carotid artery with reduced flow distally into the MCA, which was confirmed by a conventional angiogram. In view of the intracranial carotid dissection, the patient was not treated with intravenous tissue plasminogen activator. Magnetic resonance imaging (MRI) of the brain done on the next day revealed evidence of acute ischemic lesions in the right MCA and anterior cerebral artery territory on diffusion-weighted imaging (DWI), with normal brainstem. [Figure 1] A repeat MRI performed 13 days after ictus showed hyperintense signal on DWI in the right cerebral peduncle which was hypointense on apparent diffusion coefficient (ADC) map suggestive of Wallerian-like degeneration. [Figure 2] The signal changes were less conspicuous on T2-weighted images. She had antigravity strength in the left leg but remained weak in her left arm at one month.
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Affiliation(s)
- R N Sylaja
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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12
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Eshetu T, Meoded A, Jallo GI, Carson BS, Huisman TA, Poretti A. Diffusion tensor imaging in pediatric Chiari type I malformation. Dev Med Child Neurol 2014; 56:742-8. [PMID: 24825432 DOI: 10.1111/dmcn.12494] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2014] [Indexed: 11/29/2022]
Abstract
AIM Chiari type I malformation (C1M) may be symptomatic or asymptomatic as an incidental finding. In this retrospective study, we applied diffusion tensor imaging (DTI) to study the brainstem and cerebellar white matter tracts in C1M. METHOD Diffusion tensor imaging (DTI) data were acquired on a 1.5T MR-scanner using balanced pairs of diffusion gradients along 20 non-collinear directions. Measurements from regions of interest in each pontine corticospinal tract, medial leminscus, and middle cerebellar peduncle (MCP) and in the lower brainstem were obtained for fractional anisotropy and mean, axial, and radial diffusivity. Values in symptomatic and asymptomatic children, and children with and without hydromyelia were compared using analysis of variance. RESULTS Fifteen children with C1M (10 males, five females; six symptomatic [four with hydromyelia] and nine asymptomatic) were included. Median age was 6 years 5 months (range 2y 10mo-15y 4mo). No significant differences in DTI scalars were found in the lower brainstem. In both MCPs, axial diffusivity values were lower in symptomatic than in asymptomatic children (p=0.049 and p=0.035 respectively) and higher in children with hydromyelia versus without hydromyelia (p=0.018 and p=0.006 respectively). In the left MCP, mean diffusivity values were lower in symptomatic than in asymptomatic children (p=0.047). INTERPRETATION Our results show that microstructural tissue alterations may be present in C1M. Additionally, our study suggests a specific role for the MCPs in C1M. Further large-scale studies are warranted.
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Affiliation(s)
- Tadesse Eshetu
- Division of Neuroradiology, The Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA
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Gala F, Becker A, Pfeiffer M, Kollias S. Acute Wallerian degeneration of middle cerebellar peduncles due to basilar artery thrombosis. Indian J Radiol Imaging 2013; 23:164-7. [PMID: 24082483 PMCID: PMC3777328 DOI: 10.4103/0971-3026.116581] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Wallerian degeneration (WD) is the process of demyelination and disintegration of the distal axonal segment following the interruption of the axonal integrity or damage to the neuron. We report a patient having WD of middle cerebellar peduncles due to pontine infarction caused by basilar artery thrombosis. We review the anatomy and discuss the pathogenesis of this condition.
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Affiliation(s)
- Foram Gala
- Department of Neuroradiology, University Hospital of Zurich, Switzerland ; Lifescan Imaging Centre, Mumbai, India
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Kang CK, Park CA, Kim KN, Hong SM, Park CW, Kim YB, Cho ZH. Non-invasive visualization of basilar artery perforators with 7T MR angiography. J Magn Reson Imaging 2010; 32:544-50. [DOI: 10.1002/jmri.22250] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Bermejo Garcés R, Cabada Giadas T, Bacaicoa Saralegui MC, Ciriza Esandi M, Solchaga Alvarez S. [Bilateral wallerian degeneration of the pontocerebellar fibers secondary to pontine stroke: a report of 4 cases]. RADIOLOGIA 2009; 52:71-5. [PMID: 19942239 DOI: 10.1016/j.rx.2009.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 09/29/2009] [Accepted: 09/30/2009] [Indexed: 11/24/2022]
Abstract
Wallerian degeneration occurs after demyelination of the distal neuronal axons due to proximal damage of any type. We present the magnetic resonance findings in four patients with brainstem stroke and signs of Wallerian degeneration in the pontocerebellar tracts. We reviewed the magnetic resonance studies in four patients with subacute or chronic stage pontine lesions and the signal alterations at the level of the medial cerebellar peduncles. We correlated the findings in T2-weighted sequences and diffusion-weighted sequences with the time of evolution and etiology of the stroke.
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Affiliation(s)
- R Bermejo Garcés
- Servicio de Radiodiagnóstico, Hospital de Navarra, Pamplona, España.
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Liang Z, Zeng J, Zhang C, Liu S, Ling X, Wang F, Ling L, Hou Q, Xing S, Pei Z. Progression of pathological changes in the middle cerebellar peduncle by diffusion tensor imaging correlates with lesser motor gains after pontine infarction. Neurorehabil Neural Repair 2009; 23:692-8. [PMID: 19244384 DOI: 10.1177/1545968308331142] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Wallerian degeneration in pyramidal tract following supratentorial stroke has been detected by some studies using diffusion tensor imaging (DTI), but the Wallerian degeneration in middle cerebellar peduncle after pontine infarction and its potential clinical significance remain to be confirmed. METHODS Seventeen patients with a recent focal pontine infarct underwent 3 DTIs at week 1 (W1), week 4 (W4), and week 12 (W12) after onset. Seventeen age-matched and gender-matched controls underwent DTI one time. Mean diffusivity and fractional anisotropy (FA) were measured in the basis pontis and bilateral middle cerebellar peduncles. Neurological deficit, motor deficit, functional independence, and limbs ataxia were assessed with the National Institutes of Health (NIH) Stroke Scale, Fugl-Meyer scale, Barthel Index, and the second part of International Cooperative Ataxia Rating Scale. RESULTS FA values at the bilateral middle cerebellar peduncles decreased significantly from W1 to W12 progressively (P<.01). The patients improved on the NIH Stroke Scale, Fugl-Meyer scale, and Barthel Index over time (P<.01). Greater absolute value of percentage reduction of FA at the bilateral middle peduncles, however, was associated with the less absolute value of percentage reduction of the NIH Stroke Scale and less increase in the Fugl-Meyer scale, as well as greater ataxia over time. CONCLUSIONS Wallerian degeneration in the middle cerebellar peduncle revealed by DTI may hinder the process of neurological recovery following a focal pontine infarct.
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Affiliation(s)
- Zhijian Liang
- Department of Neurology and Stroke Centre, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
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Valencia MP, Castillo M. MRI findings in posttraumatic spinal cord Wallerian degeneration. Clin Imaging 2007; 30:431-3. [PMID: 17101416 DOI: 10.1016/j.clinimag.2006.05.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2006] [Accepted: 05/18/2006] [Indexed: 11/26/2022]
Abstract
We present MRI findings in a patient who presented with a remote cervical cord injury and with onset of new symptoms. Imaging showed findings compatible with Wallerian degeneration (WD) above and below the level of the original injury. We review the pathogenesis of spinal cord WD and its implications.
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Affiliation(s)
- Maria Pilar Valencia
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
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Mejdoubi M, Catalaa I, Cognard C, Manelfe C. Bilateral wallerian degeneration of the middle cerebellar peduncles due to unilateral pontine infarction. J Neuroradiol 2006; 33:263-5. [PMID: 17041532 DOI: 10.1016/s0150-9861(06)77273-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report the case of a patient with bilateral and symmetrical T2 hyperintensities of the middle cerebellar peduncles. She had a history of left pontine infarction 8 months before. This was attributed to bilateral Wallerian degeneration. MR Spectroscopy showed decreased N-acetyl aspartate/Creatine (NAA/Cr) ratio in the cerebellar peduncles as well as in the whole cerebellum. We hypothesize that this could reflect neuronal degeneration following a stroke.
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Affiliation(s)
- M Mejdoubi
- Department of Neuroradiology, Toulouse University Hospital, place du Dr Baylac, 31059 Toulouse cedex 9.
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