Published online May 6, 2021. doi: 10.12998/wjcc.v9.i13.3194
Peer-review started: December 21, 2020
First decision: December 30, 2020
Revised: January 22, 2021
Accepted: March 10, 2021
Article in press: March 10, 2021
Published online: May 6, 2021
Processing time: 122 Days and 10.9 Hours
It is difficult to restore the cognitive functions of patients with impaired cognition caused by brain injury. Diffusion tensor imaging can visualize the integrity of neural tracts in the white matter (WM) three-dimensionally. It is unclear whether encephalitis following scrub typhus damages the WM. For the first time, we aimed to report diffusion tensor tractography (DTT) findings in a chronic patient with cognitive impairment following scrub typhus encephalitis, which revealed injury to the Papez circuit of the WM.
A 70-year-old male patient was affected by encephalitis caused by scrub typhus that occurred 23 years ago. He had poor cognition and his clinical examination findings were as follows: Mini-Mental Status Examination score, 14; and handgrip strength (right/left, kg), 32.3/31.3. DTT revealed serious injuries of the left thalamocingulate tract and right mammillothalamic tract in the Papez circuit, and a partial injury of the anterior part of the fornix.
Using DTT, we found a relationship between cognitive impairment and the integrity of the Papez circuit following scrub typhus.
Core Tip: Scrub typhus is one of the most common causes of acute encephalitis in endemic countries. It is still debated whether white matter (WM) is injured in the encephalitis of the scrub typhus. Diffusion tensor tractography allows us to investigate the integrity of WM three-dimensionally. The Papez circuit consists mainly of the WM and is known to play a critical role in cognition. Using a diffusion tensor tractography, we detected the injury of the Papez circuit in a patient with cognitive impairment following encephalitis of scrub typhus 23 years ago.