Demonstration of Recovery of a Patient with a Cerebellar Peduncle Injury due to Intracerebral Hemorrhage: a Diffusion Tensor Imaging Study.

Background: Diffusion tensor tractography (DTT) allows us to visualize cerebellar peduncles three dimensionally.Objective: In the current study, we report a case with cerebellar peduncles injuries, due to an intracerebral hematoma (ICH) in the cerebellum that showed functional recovery over a 3-month period with associated changes in DTT findings. Design, Time and Setting: Case study between October 2008 and March 2009 at the department of physical medicine and rehabilitation.Participants: A 72-year-old female patient and nine age- and sex-matched control subjects were recruited. Method: Diffusion tensor imagings(DTIs) were acquired using a sensitivity-encoding head coil at 1.5 T. Main outcome measures: Three cerebellar peduncles, namely, the superior cerebellar peduncle (SCP), the middle cerebellar peduncle (MCP), and the inferior cerebellar peduncle (ICP) were evaluated using DTI-Studio software.Results:This patient could not even sit at 3-weeks post-onset, but was able to walk independently and perform most daily activities at 4-months post-onset. In 3-week DTT images, all six cerebellar peduncles were compressed by the hematoma. The posterior portions of all three left cerebellar peduncles were shortened, and in particular, the left MCP was interrupted in its mid-portion. In 4-month DTT images, all compressed cerebellar peduncles were restored. Furthermore, in the 3-week DTI images, FA values of all cerebellar peduncles, except for the right MCP, were decreased by two standard deviations below the normal control value, and in 4-month images, the FA value of the right ICP had increased to within two standard deviations of the normal control value. However, other FA values remained two standard deviations below that of the normal control value. Conclusions: Our results suggest that neuronal injury of the cerebellar peduncles (both SCPs, the left MCP, and both ICPs) at 3 weeks post-onset showed little recovery at 4 months post-onset. Conclusions: It appears that the functional recovery of this patient was due primarily to decompression of compressed cerebellar peduncles, and not to the recovery of injured cerebellar peduncles. The authors believe that evaluations of cerebellar peduncles by DTI would be helpful when cerebellar peduncle injury is suspected.