背景:几种大脑结构,包括眶前额叶皮质,腹外侧前额叶皮质,背外侧前额叶皮质,杏仁核,和前扣带皮质,被认为是情绪调节基础的神经回路中的关键结构。我们报告了一名患者,该患者在创伤性脑损伤(TBI)后表现出行为变化和核心神经束变性以进行情绪调节。
方法:一名51岁男性患者发生车祸。病人失去知觉约30天,他的格拉斯哥昏迷评分是3分。他接受了立体定向引流治疗外伤性脑室内和脑出血。发病后大约6.5年,他开始表现出抑制行为,如愤怒地大喊大叫,随着时间的推移而恶化。发病后大约8年,他表现出严重的抑郁症状和抑制,包括暴力。
方法:表现出迟发性行为改变(去抑制和抑郁)的患者。
方法:在TBI发病后3个月和8年采集扩散张量成像数据。
结果:患者表现为情绪调节的核心神经束退化,这与TBI后的行为变化延迟有关。在3个月和8年的扩散张量描记术(DTT)中,右前前丘脑背外侧,腹外侧前丘脑束,眶前丘脑束,钩肌束,并且两个扣带都被重建,而其他神经束没有被重建。与3个月的DTT相比,8年DTT上所有重建的神经束都是狭窄的,除了左扣带,显示两个前扣带之间有新的跨call纤维。在8年DTT上,所有重建的神经束的各向异性分数和束体积均低于3个月DTT,除了左侧扣带的束流体积。
结论:背外侧,腹外侧,和眶前丘脑束,钩肌束,当TBI患者出现迟发性行为问题时,使用后续DTT的扣带是有用的。
BACKGROUND: Several brain structures, including the orbital prefrontal cortex, ventrolateral prefrontal cortex, dorsolateral prefrontal cortex, amygdala, and anterior cingulate cortex, are considered key structures in the neural circuitry underlying emotion regulation. We report on a patient showing behavior changes and degeneration of core neural tracts for emotional regulation following traumatic brain injury (TBI).
METHODS: A 51-year-old male patient suffered an in-car accident. The patient lost consciousness for approximately 30 days, and his Glasgow Coma Scale score was 3. He underwent stereotactic drainage for traumatic intraventricular and intracerebral hemorrhages. At approximately 6.5-year after onset, he began to show disinhibition behaviors such as shouting with anger, which worsened over time. At approximately 8-year after onset, he showed severe depression signs and disinhibition, including violence.
METHODS: The patient who showed delayed-onset behavioral changes (disinhibition and depression).
METHODS: Diffusion tensor imaging data were acquired at 3 months and 8 years after TBI onset.
RESULTS: The patient showed degeneration of core neural tracts for emotional regulation that was associated with delayed behavioral changes following TBI. On both 3-month and 8-year diffusion tensor tractographies (DTTs), the right dorsolateral prefronto-thalamic tract, ventrolateral prefronto-thalamic tract, orbital prefronto-thalamic tract, uncinate fasciculus, and both cinguli were reconstructed whereas other neural tracts were not reconstructed. Compared with the 3-month DTT, all reconstructed neural tracts on the 8-year DTT were narrow, except for the left cingulum, which showed new transcallosal fibers between both anterior cingula. The fractional anisotropy and tract volume of all reconstructed neural tracts were lower on the 8-year DTT than the 3-month DTT, except for the tract volume of left cingulum.
CONCLUSIONS: The evaluation of dorsolateral, ventrolateral, and orbital prefronto-thalamic tract, uncinate fasciculus, and cingulum using follow-up DTTs is useful when a patient with TBI shows delayed-onset behavioral problems.