0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Images in Neurology |

Callosal Disconnection Syndrome in a Patient With Corpus Callosum Hemorrhage A Diffusion Tensor Tractography Study

Min Cheol Chang, MD; Sang Seok Yeo, MS; Sung Ho Jang, MD
Arch Neurol. 2012;69(10):1374-1375. doi:10.1001/archneurol.2012.48.
Text Size: A A A
Published online

Extract

A 40-year-old right-handed man underwent conservative treatment for corpus callosum hemorrhage due to rupture of an aneurysm of the right pericallosal artery. At 15 months after onset, the patient presented with manifestations of callosal disconnection syndrome: alien hand syndrome characterized by apparently purposeful actions of left hand contrary to intention, left ideomotor and ideational apraxia, left tactile anomia, left somatosensory deficit, and right neglect.

The diffusion tensor images were acquired using a sensitivity-encoding head coil on a 1.5-T Philips Gyroscan Intera system (Hoffman-LaRoche Ltd) and using a single-shot echoplanar imaging sequence with a navigator echo. Sixty contiguous slices (96 × 96 acquisition matrix; 192 × 192 reconstruction matrix; field of view, 240 × 240 mm2; repetition time, 10 726 milliseconds; echo time, 76 milliseconds; b = 600 mm2 s−1; number of excitations, 1; and thickness, 2.5 mm) were acquired for each of the 32 noncollinear diffusion-sensitizing gradients. Fiber tracking was performed using the fiber assignment continuous tracking algorithm implemented within the diffusion tensor imaging task card software (Philips Extended MR WorkSpace 2.6.3). A region of interest was placed on the entire corpus callosum on sagittal fractional anisotropy color maps. The termination criteria used were a fractional anisotropy of less than 0.3 and an angle change of greater than 45°. Corpus callosum fibers showed extensive disruption, except for small corpus callosum fibers in the left frontal lobe, which were observed to pass through the genu, and for corpus callosum fibers passing through the posterior splenium, which were connected to both occipital cortices (Figure).

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Graphic Jump Location

Figure. A, Computed tomographic images of the brain of a 40-year-old right-handed man at onset showing hemorrhages in the basal forebrain and corpus callosum. B, T2-weighted magnetic resonance images of the brain of the same patient at 15 months after onset showing leukomalactic lesions at the basal forebrain, anterior cingulate gyrus, and corpus callosum, which extended from the genu to the anterior portion of the splenium. C, Diffusion tensor tractography for corpus callosum fibers. The corpus callosum fibers of a normal control (a 45-year-old man) extended bilaterally to frontal, parietal, and occipitotemporal cortices. By contrast, the corpus callosum fibers of the patient revealed extensive disruptions, except for small corpus callosum fibers in the left frontal lobe passing through the genu (blue arrow) and corpus callosum fibers passing through the posterior splenium and connecting with both occipital cortices (yellow arrow). A indicates anterior; L, left; and R, right.

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

468 Views
2 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
Jobs
JAMAevidence.com

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: Does This Patient Have a Severe Upper Gastrointestinal Bleed?

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Results

brightcove.createExperiences();