Objectives

We imaged the dentato-rubro-thalamic tract (DRTT) and cortico-ponto-cerebellar tract (CPCT) using diffusion tensor tractography (DTT) to evaluate the cortico-cerebellar-cortical circuit in a patient with tremor in both hands after mild TBI. We found bilateral DRTT injury in the DTT.

Method

A 50-year-old male presented with action tremor in both hands 1 week after mild TBI. One month before the visit, the patient had a head injury from a fall on a bus. The patient lost consciousness for 1 min and experienced post-traumatic amnesia for approximately 5 min after the accident. His Glasgow Coma Scale score was 15. The action tremor presented with a frequency of 3 Hz in both hands. No specific lesion was observed with a conventional brain MRI.

Results

DTT, performed 1.5 months after TBI, showed that the right DRTT was not reconstructed and the left DRTT had thinned. However, CPCT integrity was well-preserved in both hemispheres. The tremor disappeared after oral treatment with 30 mg/day indenol. The patient’s tremor would have been caused by disruption of the bilateral DRTT following mild TBI.

Conclusion

DRTT and CPCT analysis using DTT would be useful for diagnosing abnormal movement problems, including tremor and ataxia, in patients following mild TBI.

中文翻译：

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轻度脑外伤后故意震颤患者的齿-金-丘脑-丘脑损伤：一例报告。

目标

我们使用弥散张量束线描记法（DTT）对齿状-丘脑-丘脑-丘脑束（DRTT）和皮质-桥小脑束（CPCT）进行成像，以评估轻度TBI后两只手震颤的患者的皮质-小脑-皮质回路。我们在DTT中发现了双侧DRTT损伤。

方法

轻度TBI后1周，一名50岁的男性双手出现了震颤。探视前一个月，患者因跌落在公共汽车上而头部受伤。事故发生后，患者意识丧失1分钟，并经历了创伤后遗忘症约5分钟。他的格拉斯哥昏迷量表评分为15。双手出现的震颤频率为3 Hz。用常规脑MRI未观察到特定病变。

结果

TBI后1.5个月进行的DTT显示，右DRTT未重建，左DRTT变薄。但是，CPCT完整性在两个半球都得到了很好的保存。口服30毫克/天的茚三醇治疗后，震颤消失。轻度TBI后双侧DRTT破坏可能会导致患者震颤。

结论

使用DTT进行DRTT和CPCT分析对于诊断轻度TBI后的异常运动问题（包括震颤和共济失调）非常有用。