Diffusion MRI Fiber Tractography and Benzodiazepine SPECT Imaging for Assessing Neural Damage to the Language Centers in an Elderly Patient after Successful Reperfusion Therapy

• Published in: Geriatrics (Basel) Vol. 9; no. 2; p. 30
• Main Authors: Mutoh, Tatsushi, Yoshida, Yasuyuki, Tatewaki, Yasuko, Chin, Hongkun, Tochinai, Ryota, Moroi, Junta, Ishikawa, Tatsuya
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.04.2024; MDPI
• Subjects: acute ischemic stroke; Aphasia; Apraxia; benzodiazepine receptor imaging; Benzodiazepines; Brain damage; Care and treatment; Case Report; Causes of; Complications and side effects; Consciousness; Development and progression; Diabetes; Diagnosis; diffusion tensor imaging; Ischemia; Language; Magnetic resonance imaging; Medical imaging; Older people; Patients; post-stroke aphasia; Prognosis; reperfusion therapy; Risk factors; SPECT imaging; Stroke; Stroke (Disease); Tomography; Japan; benzodiazepine receptor imaging; diffusion tensor imaging; post-stroke aphasia; acute ischemic stroke; reperfusion therapy
• ISSN: 2308-3417; 2308-3417
• DOI: 10.3390/geriatrics9020030

Intravenous thrombolysis and mechanical thrombectomy are the first-line reperfusion therapies for acute ischemic stroke. Here, we describe the utility of diffusion magnetic resonance imaging (MRI) fiber tractography and I-iomazenil benzodiazepine receptor single-photon emission computed tomography to estimate the prognosis of post-stroke aphasia after successful reperfusion therapy. An 81-year-old man was admitted to the hospital approximately 3.5 h after the onset of symptoms, including decreased consciousness, right hemiparesis, and aphasia. An MRI revealed acute cerebral infarction due to M1 segment occlusion. Intravenous alteplase thrombolysis followed by endovascular thrombectomy resulted in recanalization of the left middle cerebral artery territory. A subsequent MRI showed no new ischemic or hemorrhagic lesions. Although the patient's motor hemiparesis gradually recovered, motor aphasia persisted. Diffusion MRI fiber tractography performed 2 weeks after admission revealed partial injury to the left arcuate fasciculus, indicated by lower fractional anisotropy values than on the contralateral side. A decreased benzodiazepine receptor density was also detected in the left perisylvian and temporoparietal cortices. The patient showed no clear signs of further improvement in the chronic stage post-stroke and was discharged to a nursing home after 3 months. The application of functional neuroimaging techniques to assess neuronal damage to the primary brain regions 2 weeks after reperfusion therapy for large-vessel occlusion may allow for an accurate prognosis of post-stroke aphasia. This may have a direct clinical implication for navigating subacute-to-chronic phases of rehabilitative care.