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Traumatic axonal injury
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
As TAI may be very widespread, any attempt to diagnose axonal damage must be based on extensive systematic sampling of the brain. As with most other forms of generalised cerebral pathology, areas of the brain differ in their susceptibility and one or two samples can give little indication of what is going on in the brain as a whole (Graham et al. 2004). In trauma, it is the midline and paramidline structures that are particularly vulnerable to TAI, which means that parasagittal cerebral white matter (such as posterior and anterior frontal parasagittal white matter), corpus callosum (anterior, body and splenium), posterior limb of the internal capsule and upper brainstem (midbrain including the decussation of the superior cerebellar peducles) and upper pons (including the middle cerebellar peduncles) must all be sampled as a minimum with representation of both sides in the cerebrum. It should be appreciated that TAI is accentuated in the more posterior corpus callosum. It could be stated that the absence of TAI in the splenium effectively rules out dTAI subject to sufficient survival (Leclercq et al. 2002).
Paper 3
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Adrenoleukodystrophy is X-linked, affecting young male patients. It classically has a posterior distribution affecting the occipitoparietal region, particularly the periventricular area. There is involvement of the splenium of the corpus callosum. Peripheral enhancement is frequently seen.
Neurosurgical Techniques and Strategies
Published in David A. Walker, Giorgio Perilongo, Roger E. Taylor, Ian F. Pollack, Brain and Spinal Tumors of Childhood, 2020
Jonathan E. Martin, Ian F. Pollack, Robert F. Keating
For tumors extending further anterior into the third ventricle, a transcallosal approach can also be employed. For a posterior transcallosal approach, the patient can be positioned either prone or three-quarters prone, with a trajectory of approach slightly more anterior than the occipital transtentorial approach.87 Despite concerns for posterior disconnection syndrome, sectioning of the distal 1 cm of the splenium is generally well tolerated, and provides an expansive view of the posterior third ventricle.
Treatment strategies of ruptured intracranial aneurysms associated with moyamoya disease
Published in British Journal of Neurosurgery, 2021
Xu Zhao, Xiaofei Wang, Minqing Wang, Qinghu Meng, Chengwei Wang
A 46-year-old woman was hospitalized for a sudden onset of severe headache accompanied by vomiting. A CT scan revealed hemorrhage in the splenium of corpus callosum with intraventricular extension. An external ventricular drain was placed and the patient experienced progressive recovery. Then an angiography study indicated MMD with a peripheral aneurysm located at the distal PChA. Because endovascular embolization was technically difficult or impossible due to the tortuosity and small diameter of the parent artery, pure revascularization (left multiple burr holes) was performed about 2 months later when the hemorrhage was dissolved. The patient had no recurrent intracranial hemorrhage thereafter. A follow-up angiography performed 10 months after surgery showed disappearance of the aneurysm and Grade B collateral vessels provided by the procedure (Figure 2).
Dynamic changes in white matter following traumatic brain injury and how diffuse axonal injury relates to cognitive domain
Published in Brain Injury, 2021
Daphine Centola Grassi, Ana Luiza Zaninotto, Fabrício Stewan Feltrin, Fabíola Bezerra Carvalho Macruz, Maria Concepción García Otaduy, Claudia Costa Leite, Vinícius Monteiro Paula Guirado, Wellingson Silva Paiva, Celi Santos Andrade
Moreover, we found significant correlations between DTI metrics and cognitive performances. There were positive correlations between FA values in the genu of the CC with attention at both evaluated phases, as well as negative correlation between MD values and working memory at timepoint 2. The mechanics of head trauma places the ventral and lateral surfaces of the frontal lobes in particular vulnerability for damage (68,69). Given the frontal projections of the genu, it is not surprising that executive functions mediated by these areas could be correlated with microstructural abnormalities as detected by DTI in our study. The splenium is also frequently injured in head trauma due to specific anatomical features such as its close proximity to the fixed falx that determines how the shearing forces propagates in this region. There were significant correlations between DTI indices extracted from the splenium and several cognitive domains, including attention, verbal fluency, working memory and IQ at six months post-trauma. Our results also indicated positive correlations between FA values in both SLFs and IQ at the same timepoint, in addition to negative correlations between the other DTI metrics and verbal fluency and IQ. The correlations were more pronounced in the left SLF, what may be related to the by far more prevalent functional language dominance in the left cerebral hemisphere (70). Furthermore, there were more pronounced correlations in our study at six-moths post-injury, suggesting this interval as the optimal timing of DTI data acquisition for evaluation of cognitive outcomes.
Diagnosing and managing post-stroke aphasia
Published in Expert Review of Neurotherapeutics, 2021
Shannon M. Sheppard, Rajani Sebastian
In addition to broad language comprehension and production deficits, stroke can also cause reading and writing deficits. Alexia refers to reading deficits and agraphia refers to writing deficits. In cases of pure alexia, patients demonstrate reading impairments in the absence of any other deficits [34,35]. Pure alexia is associated with simultaneous damage to 1) left occipital cortex, which causes right homonymous hemianopsia where visual information is initially processed in the right occipital cortex, and 2) splenium of the corpus callosum, which then prevents visual information in the right hemisphere from crossing over to the left hemisphere, where language is processed [36]. Pure agraphia refers to cases where writing impairments are present in the absence of other difficulties [35]. Spelling deficits are associated with damage to left inferior parietal cortex and left occipitotemporal cortex [37].