Recovery of aphasia and change of injured arcuate fasciculus in the dominant hemisphere in stroke patients.

OBJECTIVES: We investigated the relation between recovery of aphasia and change of injured fasciculus (AF) in the dominant hemisphere using diffusion tensor tractography (DTT) in stroke patients with aphasia. METHODS: Sixteen consecutive right-handed stroke patients with aphasia with injury of the left AF were recruited for this study. The Western Aphasia Battery for assessment of aphasia and DTTs of the AF were used within 30 days of stroke onset and again three months after. DTTs of both AFs were reconstructed, and fractional anisotropy (FA) and voxel number of the AF were measured. RESULTS: A moderate positive correlation was observed between aphasia quotient (AQ) and voxel number of the left AF (r = 0.626, p < 0.01). However, no correlation was observed between AQ and FA of the left AF, and voxel number and FA of the right AF. In addition, the language quotient (LQ) of WAB was not correlated with FA and voxel number of the both AFs. CONCLUSIONS: We found a relation between recovery of aphasia from early to chronic stage of stroke and recovery of the injured AF in the dominant hemisphere irrespective of change of the AF in the non-dominant hemisphere. Our results suggest that facilitation of the injured AF in the dominant hemisphere could be an important strategy in neuro-rehabilitation for stroke patients with aphasia.

Diffusion Tensor Tractography for Detection of Concomitant Traumatic Brain Injury in Patients With Traumatic Spinal Cord Injury.

OBJECTIVES: We investigated concomitant traumatic brain injury in patients with traumatic spinal cord injury (TSCI) who had head trauma history, using diffusion tensor tractography (DTT). DESIGN: Retrospective survey. PARTICIPANTS: We recruited 14 consecutive patients with TSCI and coexisting head trauma history at the time of TSCI and 30 control subjects. METHODS: The corticospinal tract (CST), corticoreticulospinal tract (CRT), cingulum, and fornix were reconstructed using DTT, and DTT parameters (fractional anisotropy and fiber volume) and configuration were estimated. RESULTS: The values of fractional anisotropy and fiber volume in the CST, CRT, cingulum, and fornix of the patient group were significantly lower than those of the control group (P < .05). On configurational analysis of DTT for each tract, the neural tracts for motor function (the CST and CRT) had more injury than the neural tracts for cognitive function (the cingulum and fornix). No association between the severity of TSCI and traumatic brain injury was observed in terms of DTT parameters. CONCLUSIONS: Using DTT, we found injury of the neural tracts in patients with head trauma history at the time of TSCI. Our results suggest that brain evaluation using DTT can be recommended for the patients with head trauma history at the time of TSCI irrespective of the results of conventional brain MRI.

Comparison between ultrasound-guided interfascial pulsed radiofrequency and ultrasound-guided interfascial block with local anesthetic in myofascial pain syndrome of trapezius muscle.

Myofascial pain syndrome (MPS) of the trapezius muscle (TM) is a frequently occurring musculoskeletal disorder. However, the treatment of MPS of the TM remains a challenge. We investigated the effects of ultrasound (US)-guided pulsed radiofrequency (PRF) stimulation on the interfascial area of the TM. In addition, we compared its effect with that of interfascial block (IFB) with 10 mL of 0.6% lidocaine on the interfascial area of the TM. Thirty-six patients with MPS of the TM were included and randomly assigned into 2 groups. Eighteen patients underwent PRF stimulation on the interfascial area of the TM (PRF group) and 18 patients underwent IFB with lidocaine on the same area (IFB group). Pain intensity was evaluated using a numerical rating scale (NRS) at pretreatment, 2, 4, and 8 weeks after treatment. At pretreatment and 8 weeks after treatment, quality of life was assessed using the Short Form-36 Health Survey (SF-36), which includes the physical component score (PCS) and the mental component score (MCS). One patient in the PRF group was lost to follow-up. Patients in both groups showed a significant decrease in NRS scores at 2, 4, and 8 weeks after treatments and a significant increase in PCS and MCS of the SF-36 at 8 weeks after treatments. Two weeks after each treatment, the decrements of NRS scores were not significantly different between the 2 groups. However, 4 and 8 weeks after the procedures, we found that the NRS score was significantly lower in the PRF group than in the IFB group. At 8 weeks after the treatments, PCS and MCS of the SF-36 in the PRF group were significantly higher than those in the IFB group. For the management of MPS of the TM, US-guided interfascial PRF had a better long-term effect on reducing the pain and the quality of life compared to US-guided IFB. Therefore, we think US-guided PRF stimulation on the interfascial area of the TM can be a beneficial alternative to manage the pain following MPS of the TM.