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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.
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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).

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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.




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