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Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Injuries of neural tracts in a patient with CADASIL: a diffusion tensor imaging study
1Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Taegu, 705-717, Republic of Korea. strokerehab@hanmail.net.
Insights
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) patients show neural tract injuries, as visualized by diffusion tensor tractography (DTT). These findings correlate with the patient's neurological symptoms.
Area of Science:
- Neuroimaging
- Neurology
- Genetics
Background:
- Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a genetic disorder affecting small blood vessels in the brain.
- CADASIL is characterized by recurrent strokes, cognitive decline, and psychiatric disturbances.
Observation:
- A 64-year-old male with diagnosed CADASIL presented with mild neurological deficits including weakness, dysarthria, and cognitive impairment.
- Brain MRI revealed characteristic white matter lesions. Diffusion tensor imaging (DTI) was employed to analyze neural tract integrity.
Findings:
- Diffusion tensor tractography (DTT) revealed abnormalities in multiple neural tracts, including the corticospinal tract, corticobulbar tract, and thalamoprefrontal tracts.
- These abnormalities included decreased fractional anisotropy (FA), increased mean diffusivity (MD), and reduced tract volume, indicating neural tract injury.
Implications:
- The study demonstrates that DTT can effectively visualize neural tract injuries in CADASIL patients.
- The observed tract injuries likely contribute to the clinical manifestations of CADASIL, highlighting the utility of DTT in understanding disease pathophysiology.
Background:
We report a patient with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), who showed injuries of the neural tracts, which was demonstrated by diffusion tensor tractography (DTT).
Case Presentation:
A 64-year-old male patient and seven age-matched control volunteers were recruited. Since approximately 1.5 years ago, he had felt mild weakness of the right arm and was diagnosed as CADASIL by the finding of the exon 11 mutation of the NOTCH3 gene approximately 10 months ago. T2-weighted and FLAIR brain MRI images obtained at admission showed high signal intensity lesions in the subcortical gray matter and periventricular white matter. He showed mild quadriparesis, mild dysarthria, mild cognitive impairment, and emotional problems. Diffusion tensor imaging was performed and nine neural tracts (corticospinal tract, corticobulbar tract, corticofugal tract from the supplementary motor area, corticofugal tract from the premotor cortex, thalmoprefrontal tract [TPT] to the dorsolateral prefrontal cortex, TPT to the ventrolateral prefrontal cortex, TPT to the orbitoprefrontal cortex, fornix, and cingulum) were reconstructed. Fractional anisotropy (FA), mean diffusivity (MD), and tract volume of each neural tract were measured. All neural tracts except for the left fornix showed at least one more abnormality in terms of DTT parameters (decrement of FA, increment of MD, or decrement of tract volume).
Conclusion:
We demonstrated injuries of the neural tracts in a patient with CADASIL. It appears that clinical manifestations in this patient were related to injuries of the neural tracts.
