Progression of Pathological Changes in the Middle Cerebellar Peduncle by Diffusion Tensor Imaging Correlates With Lesser Motor Gains After Pontine Infarction

Background. Wallerian degeneration in pyramidal tract following supratentorial stroke has been detected by some studies using diffusion tensor imaging (DTI), but the Wallerian degeneration in middle cerebellar peduncle after pontine infarction and its potential clinical significance remain to be confirmed. Methods. Seventeen patients with a recent focal pontine infarct underwent 3 DTIs at week 1 (W1), week 4 (W4), and week 12 (W12) after onset. Seventeen age-matched and gender-matched controls underwent DTI one time. Mean diffusivity and fractional anisotropy (FA) were measured in the basis pontis and bilateral middle cerebellar peduncles. Neurological deficit, motor deficit, functional independence, and limbs ataxia were assessed with the National Institutes of Health (NIH) Stroke Scale, Fugl-Meyer scale, Barthel Index, and the second part of International Cooperative Ataxia Rating Scale. Results. FA values at the bilateral middle cerebellar peduncles decreased significantly from W1 to W12 progressively ( P < .01). The patients improved on the NIH Stroke Scale, Fugl-Meyer scale, and Barthel Index over time ( P < .01). Greater absolute value of percentage reduction of FA at the bilateral middle peduncles, however, was associated with the less absolute value of percentage reduction of the NIH Stroke Scale and less increase in the Fugl-Meyer scale, as well as greater ataxia over time. Conclusions. Wallerian degeneration in the middle cerebellar peduncle revealed by DTI may hinder the process of neurological recovery following a focal pontine infarct.

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White matter differences between essential tremor and Parkinson disease

Neurology ◽

10.1212/wnl.0000000000006694 ◽

2018 ◽

Vol 92 (1) ◽

pp. e30-e39 ◽

Cited By ~ 5

Author(s):

Meher R. Juttukonda ◽

Giulia Franco ◽

Dario J. Englot ◽

Ya-Chen Lin ◽

Kalen J. Petersen ◽

...

Keyword(s):

White Matter ◽

Parkinson Disease ◽

Essential Tremor ◽

Fractional Anisotropy ◽

Diffusion Tensor ◽

Mean Diffusivity ◽

Superior Cerebellar Peduncle ◽

Radial Diffusivity ◽

Cerebellar Peduncles ◽

Cerebellar Peduncle

ObjectiveTo assess white matter integrity in patients with essential tremor (ET) and Parkinson disease (PD) with moderate to severe motor impairment.MethodsSedated participants with ET (n = 57) or PD (n = 99) underwent diffusion tensor imaging (DTI) and fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity values were computed. White matter tracts were defined using 3 well-described atlases. To determine candidate white matter regions that differ between ET and PD groups, a bootstrapping analysis was applied using the least absolute shrinkage and selection operator. Linear regression was applied to assess magnitude and direction of differences in DTI metrics between ET and PD populations in the candidate regions.ResultsFractional anisotropy values that differentiate ET from PD localize primarily to thalamic and visual-related pathways, while diffusivity differences localized to the cerebellar peduncles. Patients with ET exhibited lower fractional anisotropy values than patients with PD in the lateral geniculate body (p < 0.01), sagittal stratum (p = 0.01), forceps major (p = 0.02), pontine crossing tract (p = 0.03), and retrolenticular internal capsule (p = 0.04). Patients with ET exhibited greater radial diffusivity values than patients with PD in the superior cerebellar peduncle (p < 0.01), middle cerebellar peduncle (p = 0.05), and inferior cerebellar peduncle (p = 0.05).ConclusionsRegionally, distinctive white matter microstructural values in patients with ET localize to the cerebellar peduncles and thalamo-cortical visual pathways. These findings complement recent functional imaging studies in ET but also extend our understanding of putative physiologic features that account for distinctions between ET and PD.

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Hypertrophic olivary degeneration concomitant with bilateral middle cerebellar peduncles Wallerian degeneration following unilateral pontine infarction

BMC Neurology ◽

10.1186/s12883-020-01984-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Bing Bao ◽

Xiangbin Wu ◽

Zhongbin Xia ◽

Yaoyao Shen

Keyword(s):

Wallerian Degeneration ◽

Corticospinal Tract ◽

Brain Magnetic Resonance Imaging ◽

Acute Onset ◽

Case Presentation ◽

Hypertrophic Olivary Degeneration ◽

Pontine Infarction ◽

Cerebellar Peduncles ◽

Magnetic Resonance Imaging Mri

Abstract Background Wallerian degeneration (WD) can occur in different projecting systems, such as corticospinal tract, dentate-rubro-olivary pathway, and corticopontocerebellar tract. However, the co-occurrence of hypertrophic olivary degeneration (HOD) and middle cerebellar peduncles (MCPs) degeneration secondary to unilateral pontine infarction in a single patient is extremely rare. Case presentation A 71-year-old man presented with acute onset of dizzness, slurred speech, and right-sided weakness. On the next day, his previous neurologic deficits deteriorated. Brain magnetic resonance imaging (MRI) revealed acute ischemic stroke of the left pons. After treatment with thrombolysis, antiplatelets, and rehabilitation training, his speaking and motor function improved moderately. At the 3-month follow-up, the MRI showed hyperintensity in the left medulla oblongata and bilateral MCPs on T2-weighted and FLAIR images, suggesting HOD as well as MCPs degeneration. Conclusions It is of great importance for us to know the anatomic knowledge of dentate-rubro-olivary and corticopontocerebellar pathways.

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Another Piece of the Puzzle of Anomalous Connectivity in Joubert's Syndrome

Neuropediatrics ◽

10.1055/s-0041-1732310 ◽

2021 ◽

Author(s):

Avner Meoded ◽

Marcia Kukreja ◽

Gunes Orman ◽

Eugen Boltshauser ◽

Thierry A.G.M. Huisman

Keyword(s):

White Matter ◽

Diffusion Tensor ◽

Three Dimensional ◽

Axonal Guidance ◽

Molar Tooth ◽

Superior Cerebellar Peduncle ◽

Corticospinal Tracts ◽

Cerebellar Peduncles ◽

Cerebellar Peduncle ◽

Magnetic Resonance Imaging Mri

AbstractWe report on the conventional and diffusion tensor imaging (DTI) findings of a 2-year-old child with clinical presentation of Joubert's Syndrome (JS) and brainstem structural abnormalities as depicted by neuroimaging.Conventional magnetic resonance imaging (MRI) showed a “molar tooth” configuration of the brainstem. A band-like formation coursing in an apparent axial plane anterior to the interpeduncular fossa was noted and appeared to partially cover the interpeduncular fossa.DTI maps and three-dimensional (3D) tractography demonstrated a prominent red-encoded white matter bundle anterior to the midbrain. Probable aberrant course of the bilateral corticospinal tracts (CST) was also depicted. Absence of the decussation of the superior cerebellar peduncles and elongated thickened, horizontal superior cerebellar peduncle (SCP) reflecting the molar tooth sign were also shown.Our report and the review of the published cases suggest that DTI and tractography may be very helpful to differentiate between interpeduncular heterotopias and similarly located white matter bundles corroborating the underlying etiology of axonal guidance disorders in the complex group of ciliopathies including JS. Our case represents an important additional puzzle piece to explore the variability of these ciliopathies.

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Brainstem and Cranial Nerves: Pons

10.1093/med/9780197512166.003.0009 ◽

2021 ◽

pp. 82-91

Author(s):

Kelly D. Flemming ◽

Paul W. Brazis

Keyword(s):

Blood Supply ◽

Basilar Artery ◽

Cranial Nerve ◽

Cranial Nerves ◽

Middle Cerebellar Peduncle ◽

Corticospinal Tracts ◽

Imaginary Line ◽

Cerebellar Peduncles ◽

Cerebellar Peduncle ◽

Pontomedullary Junction

The pons extends from the pontomedullary junction to an imaginary line drawn from the exit of cranial nerve IV. Dorsal to the pons lies the cerebellum, which receives information and projects information back to the brainstem through the inferior, middle, and superior cerebellar peduncles. Important structures at this level include the corticospinal tracts, corticopontocerebellar fibers traveling through the middle cerebellar peduncle, the cerebellum, and cranial nerves V through VIII. Blood supply to the pons is from the basilar artery and its perforating vessels.

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“Cerebellar peduncle quarter notes” formed by the superior and middle cerebellar peduncles: comparison with a diffusion tensor study of spinocerebellar degeneration

Japanese Journal of Radiology ◽

10.1007/s11604-015-0409-2 ◽

2015 ◽

Vol 33 (4) ◽

pp. 210-215 ◽

Cited By ~ 1

Author(s):

Tomoko Ochi ◽

Toshiaki Taoka ◽

Toshiteru Miyasaka ◽

Takeshi Wada ◽

Masahiko Sakamoto ◽

...

Keyword(s):

Diffusion Tensor ◽

Spinocerebellar Degeneration ◽

Cerebellar Peduncles ◽

Cerebellar Peduncle

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Bilateral Wallerian Degeneration of the Pontocerebellar Tracts

Case Reports in Emergency Medicine ◽

10.1155/2015/970570 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Azad Hekimoglu ◽

Ihsaniye Suer Dogan ◽

Aynur Turan ◽

Mehmet Fevzi Oztekin ◽

Baki Hekimoglu

Keyword(s):

Magnetic Resonance Imaging ◽

Wallerian Degeneration ◽

Rare Entity ◽

Resonance Imaging ◽

Effective Technique ◽

Hyperintense Signal ◽

Pontine Infarction ◽

Cerebellar Peduncles ◽

History Of ◽

Wrong Diagnosis

Wallerian degeneration is the process of progressive demyelination and disintegration of the distal axonal segment following the transection of the axon or damage to the neuron. We report a case of a patient with Wallerian degeneration of the pontocerebellar tracts. She had a history of a pontine infarction 3 months ago. Wallerian degeneration of pontocerebellar tracts is seen bilaterally and symmetrically and is more visible in the middle cerebellar peduncles. Along the middle cerebellar peduncles hyperintense signal was detected on T2 weighted images. Wallerian degeneration of pontocerebellar tracts is a rare entity. It can occur bilaterally after a large pontine infarction. Magnetic resonance imaging seems to be the most effective technique for detection of Wallerian degeneration. In this report we want to mention this rare entity and to prevent wrong diagnosis.

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