J Korean Neurosurg Soc.  2016 May;59(3):306-309. 10.3340/jkns.2016.59.3.306.

Injury of the Arcuate Fasciculus in the Nondominant Hemisphere by Subfalcine Herniation in Patients with Intracerebral Hemorrhage : Two Case Reports and Literature Review

• Jang SH
• Kim SH
• Chang MC

• KMID: 2192112
• DOI: http://doi.org/10.3340/jkns.2016.59.3.306

Abstract

Using diffusion tensor tractography (DTT), we demonstrated injury of the arcuate fasciculus (AF) in the nondominant hemisphere in two patients who showed subfalcine herniation after intracerebral hemorrhage (ICH) in the dominant hemisphere. Two patients (patient 1 and patient 2) with ICH and six age-matched control patients who have ICH on the left corona radiata and basal ganglia without subfalcine herniation were recruited for this study. DTT was performed at one month after onset in patient 1 and patient 2. AFs of both hemispheres in both patients were disrupted between Wernicke's and Broca's areas. The fractional anisotropy value and tract numbers of the right AFs in both patients were found to be more than two standard deviations lower than those of control patients. In contrast, the apparent diffusion coefficient value was more than two standard deviations higher than those of control patients. Using the configuration and parameters of DTT, we confirmed injury of the AF in the nondominant hemisphere in two patients with subfalcine herniation following ICH in the dominant hemisphere. Therefore, DTT would be a useful tool for detection of underlying injury of the AF in the nondominant hemisphere in patients with subfalcine herniation.

Keyword

Subfalcine herniation; Arcuate fasciculus; Nondominant hemisphere; Diffusion tensor tractography; Broca's aphasia

MeSH Terms

Anisotropy
Basal Ganglia
Cerebral Hemorrhage*
Diffusion
Humans

Figure

• 

  Fig. 1 A : Brain computed tomography images show an intracranial hemorrhage in the left corona radiata and basal ganglia and a left-to-right midline shift. T-2 weighted brain images show a leukomalatic lesion in the left corona radiata and basal ganglia. B : Diffusion tensor tractography (DTT) for the patient 1 and patient 2 shows disruptions of the arcuate fasciculus (AF) in both hemispheres. The right arcuate fasciculus in patient 1 and patient 2 are disrupted around the middle and posterior portions of the horizontal portion, respectively (arrow). The left arcuate fasciculus in both patients is disrupted at the junction between the ascending and horizontal portions. C : DTT for the control patients showed the preservation of the right AFs and the discontinuation of the left AFs after originating from Wernicke area.

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