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We investigated injuries of the optic radiations (ORs) in patients with mild traumatic brain injury (TBI) by using diffusion tensor tractography (DTT). Fifty-two consecutive patients who complained of visual problems showed abnormal visual evoked potential (VEP) latency but no abnormality on conventional brain MRI after mild TBI, and fifty normal control subjects were recruited for this study. Subjects' ORs were reconstructed using DTT, and three DTT parameters (fractional anisotropy [FA], apparent diffusion coefficient [ADC], and tract volume) were measured for each OR. Mean FA value and tract volume of the OR were significantly lower in the patient group than in the control group ( < 0.05). However, there was no significant difference in the ADC values of the OR between the patient and control groups ( > 0.05). A weak negative correlation was detected between VEP latency and OR fiber number ( = 0.204, < 0.05). DTT revealed that OR injuries were not detected on the conventional brain MRI scans of patients who complained of visual problems and had abnormal VEP latency after mild TBI. Our results suggest that DTT would be a useful technique for detecting OR injury in patients with mild TBI.

The fornix, which is involved in transfer of episodic memory, is an important structure of the Papez circuit between the medial diencephalon and the medial temporal lobe. Many studies using DTI have reported on injury of the fornix in patients with brain injury （Nakayama et al., 2006; Sugiyama et al., 2007; Wang et al., 2008; Chang et al., 2010）. However, only a few studies on recov- ery of an injured fornix in patients with brain injury, including traumatic brain injury and stroke, have been reported （Yeo et al., 2011; Yeo and Jang, 2013a, b）. In this study, using follow up DTT images, we reported on a patient who showed recovery of injured fornical crura following a neurosurgical operation for a brain tumor.

The human brain is known to be influenced by environmental stimuli（Feeney et al.,1982;Kaplan,1988）.Therefore,research on the brain activation pattern by external stimuli has been an important topic in neuroscience（Kaplan,1988）.Chewing gum has been known to have a positive effect on cognition,including alertness,attention,cognitive processing speed,

Objectives: Using diffusion tensor tractography (DTT), we demonstrated the spinothalamic tract (STT) injury in patients with central pain following whiplash injury. Our primary hypothesis is that fractional anisotropy (FA) and tract volume (TV) of the STT in injured people differ from non-injured people. Our secondary hypothesis is that the direction of the collision results in a different type of injury. Methods: Nineteen central pain patients following whiplash injury and 19 normal control subjects were recruited. The STT was reconstructed by the DTT, the FA and TV of the STT were measured. In addition, different characteristics of the STT injury according to the collision direction were investigated. Results: The FA value did not differ significantly between the patient and control groups (p > 0.05). However, the significantly lower value of the TV was observed in patient group than the control group (p < 0.05). The onset of central pain was significantly delayed (13.5 days) in patients who were involved in a frontal collision, compared to patients with rear-end collision (0.6 days) (p < 0.05). In contrast, the Visual Analogue Scale was higher in the patients with rear-end collision (p < 0.05). Conclusions: We found the STT injury mild traumatic brain injury (TBI) who suffered central pain after whiplash injury, using DTT. In addition, we demonstrated different characteristics of the STT injury according to the collision direction. We believe that injury of the STT would be usefully detected by DTT following whiplash injury.

The corticospinal tract （CST） is a major neuronal tract of motor function in the human brain （York, 1987; Davidoff, 1990; Jang, 2014）. Recovery of an injured CST is one of the motor recovery mechanisms in stroke patients （Hendricks et al., 2003; Jang et al., 2006, 2007; Swayne et al., 2008; Kwon et al., 2011, 2013; Kwon and Jang, 2012; Yeo and Jang, 2013; Rong et al., 2014）. Diffusion tensor tractography （DTT）, derived from diffusion tensor imaging （DTI）, and transcra- nial magnetic stimulation （TMS） have been widely used in demonstrating the recovery of an injured CST （Hendricks et al., 2003; Jang et al., 2006, 2007; Swayne et al., 2008; Pannek et al., 2009; Kwon et al., 2011, 2013; Kwon and Jang, 2012; Yeo and Jang, 2013; Rong et al., 2014）. DTT has the advan- tage of enabling visualization of the architecture and integ- rity of the CST at the subcortical level in three dimensions （Mori et al., 1999; Kunimatsu et al., 2004）.

: Neuromuscular electrical stimulation (NMES) is a popular rehabilitative modality to improve motor function of the extremities and trunk. In this study, we investigated changes of hand function and the contralateral corticospinal tract (CST) with treatment by NMES on the finger extensor muscles for 2 weeks, using serial diffusion tensor tractography (DTT). : Thirteen right handed normal subjects were recruited. Treatment was applied to the left hand (the NMES side), and the right hand was the control side. NMES was applied for 30 min/day, 7 days per week, for 2 weeks. Hand motor function was evaluated twice at pre-NMES and post-NMES training using grip strength (GS), Purdue pegboard test (PPT) and tip pinch. The fractional anisotropy (FA), mean diffusivity (MD) and tract volume (TV) of the CST in both hemispheres were measured using DTT. : On the control side, the clinical scores did not differ significantly between pre- and post-NMES training ( > 0.05). However, on the NMES side, PPT and tip pinch improved significantly ( < 0.05), although GS did not. TV of the right CST increased significantly at post-NMES training ( < 0.05) whereas FA and MD did not differ significantly ( > 0.05). By contrast, FA, MD and TV on the left CST did not change significantly ( > 0.05). : We demonstrated facilitation of the contralateral CST with improvement of fine motor activity by 2 weeks of NMES training of peripheral muscles in normal subjects. We think our results can be applied to the normal subjects and patients with brain injury to improve the fine motor function of the hand and facilitate the normal CST or healing of the injured CST.

We report on a patient with mild traumatic brain injury (TBI) who was diagnosed with conversion disorder for severe weakness of an arm, which was demonstrated using diffusion tensor tractography (DTT) and transcranial magnetic stimulation (TMS). A 23-year-old right-handed female suffered from head trauma resulting from a pedestrian car accident. She underwent rehabilitative management for memory impairment and central pain. At 14 months after onset, she complained of severe weakness of her right arm, which was detected in the morning after sleeping (right shoulder abductor: 3/5, elbow flexor: 3/5, wrist extensor: 1/5, finger flexor: 1/5, and finger extensor: 1/5). Electromyography study for peripheral neuropathy performed at 2 weeks after onset of weakness showed no abnormality. On a 14-month DTT configuration, the integrities of the left corticospinal tract (CST), supplementary motor area-corticofugal tract (SMA-CFT), and dorsal premotor cortex (dPMC)-CFT were well-preserved. Significant differences were not observed for the fractional anisotropy (FA), mean diffusivity (MD), and tract volume (TV) values of the CST, SMA-CFT, and dPMC-CFT in both hemispheres between the patient and ten right-handed age- and sex-matched normal subjects (p > 0.05). On a 14-month TMS study, MEPs obtained at the right abductor pollicis brevis muscle showed no abnormality. Using DTT and TMS, conversion disorder was demonstrated in a patient with mild TBI, who showed severe weakness of an arm. Our results suggest the usefulness of an evaluation of the CST and CFTs from the secondary motor areas using DTT, and the CST using TMS for patients who complain of motor weakness due to conversion disorder.

A 54-year-old male suffered from direct head trauma resulting from a fall while working. At approximately two months after the accident, he began to feel pain (burning sensation) and swelling of the dorsum of the right hand and wrist. He showed the following clinical features among the clinical signs and symptoms of revised diagnostic criteria for complex regional pain syndrome (CRPS): spontaneous pain, mechanical hyperalgesia, vasodilation, skin temperature asymmetries, skin color changes, swelling, motor weakness. No specific lesion was observed on brain MRI taken at ten weeks after onset. Plain X-ray, electromyography, and nerve conduction studies for the right upper extremity detected no abnormality. A three-phase bone scan showed hot uptake in the right wrist in the delayed image. On two-month diffusion tensor tractography, partial tearing of the corticospinal tract (CST) was observed at the subcortical white matter in both hemispheres (much more severe in the left CST). In addition, the fiber number of the right CST was significantly decreased than that of seven normal control subjects. CRPS I of the right hand in this patient appeared to be related to traumatic axonal injury of the left CST following mild traumatic brain injury.

At 10 weeks after onset when she started rehabilitation, brain MRI showed a leukomalatic lesion in the right fronto-parieto-occipito-temporal lobes, subcortical white mater, and midbrain [Figure 1]A. The patient showed a vegetative state, with a Glasgow Coma Scale score of 6 (eye opening: 1, best verbal response: 1, and best motor response: 4) (full score: 15), Coma Recovery Scale-Revised score of 3 (auditory: 0, visual: 0, motor: 2, verbal: 1, communication: 0, and arousal: 0) (full score: 23), Mini-Mental State Examination score of non-checkable (full score: 30), Functional Ambulation Category score of 0 (full score: 5) and Motricity Index score of 21 (right extremities), and 14 (left extremities) (full score: 100) (Teasdale and Jennett, 1974; Folstein et al., 1975; Demeurisse et al., 1980; Cunha et al., 2002; Giacino et al., 2004). [...]the phenomenon that the thalamocortical connections from the thalamic ILN to the opposite hemisphere has not been clarified in patients with disorders of consciousness as well as normal subjects (Jang et al., 2014; Jang and Kwon, 2019). [...]studies on the anatomy and function of the thalamocortical connections from the thalamic ILN to the opposite hemisphere in both normal and pathologic conditions should be warranted. Approval for the study was obtained from the Institutional Review Board of Yeungnam University Hospital (approval No.