الفهرس 
PATHOANATOMY
Neurological assessment of stroke severityOnly 14 pages are availabe for public view
 |  | from | 161 |  |  |
| | | from | 161 | | |
Abstract
Summary and Conclusion
The DTI is a noninvasive magnetic resonance imaging (MRI) technique
that is similar in physical idea and diagnostic criteria to the DWI, yet it
provides more per voxel information that allows the white matter microstructural
&the virtual reconstruction of the fiber tracts.
Corticospinal tract reconstruction in the acute phase of stroke is a
feasible technique that allows the direct visualization of the tract & its
relationship to the volume of the infarction as well as the degree of
involvement and the expected motor prognostic outcome.
The aim of this study was to assess the role of diffusion tensor imaging
fiber tractography in prediction of the degree of functional disabilities after
acute cerebral lacunar infarctions.
The present study was performed on thirty patients with acute Lacunar
infarction (18 male and 12 female) admitted to the neurovascular unit and ICUs
of the Neurology Department and The Center of Neurology and Psychiatry,
Tanta University Hospitals with variable degrees of neurological
manifestations in the period from 1st of November 2017 till the end of
November 2018. Twenty age and sex matched healthy subjects were included
in study as a control group.
All patients underwent complete history taking, general and full
neurological examination then conventional MRI Imaging followed by
diffusion tensor imaging and tractography then the degree of patient’s
dependence will be done 1 and 3 months post-stroke using the Modified
Barthel Index (MBI), the cognitive assessment was done using The Montreal
Summary and Conclusion
119
Cognitive Assessment Scale (MoCA) then we classified patients according to
MBI into dependent group and independent group.
The most frequent sites of infarctions were the temporal region (20%),
posterior limb of the internal capsule (16%) and the brain stem (16%) with left
cerebral hemisphere predominance (53.33%).
We measure Fractional anisotropy, fiber number and mean diffusivity in
ipsilateral and contralateral side, the FA values in affected areas were
significantly increased (p-value 0.024) in comparison to the unaffected areas.
We found NIHSS was significantly high in dependent group, while
MOCA revealed significant decrease in cognition among dependent group
when compare with independent and control groups.
We found significant negative correlation between FA values and CST
fiber numbers.
Infarction volume range from 0.9mm3 to 4mm3 and significant negative
correlation between MBI and volume of infarction.
We found Significant positive correlation between the FA values and
MBI (r = 0.307and p-value 0.037).
Summary and Conclusion
120
In conclusion
• Diffusion tensor imaging is a noninvasive magnetic resonance
imaging technique which can visualize the changes in the integrity of
the CST after cerebral small arteries infarctions which cannot be
detected by conventional MRI.
• Combining clinical scores with information about corticospinal tract
(CST) integrity can improve predictions about motor outcome as the
extent of CST damage on DTI and the overlap between the CST and
a lesion are key prognostic factor that determines motor performance
and outcome.
• Accurate early prediction of recovery would help rationalize
rehabilitation goals and improve the design of trials testing strategies
to facilitate recovery.
• The severity of motor impairments correlates with functional
disability and quality of life.