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• W2912605133 abstract "A.Wallerian degeneration. This case illustrates the precise radio-anatomic correlation made possible by modern high-resolution 3D imaging as it unequivocally evidences in vivo the corticospinal tract decussation. To our knowledge, no prior case with such precise anatomic detail was previously published. Our patient presented diffuse infiltrative glioblastoma, visualized as large areas of FLAIR (fluid-attenuated inversion-recovery) hyperintensities (Fig. 1A). Among the several lesions observed, one was located on the medial aspect of the primary motor cortex, before the central sulcus (Fig. 1B), and demonstrated hemorrhagic content on susceptibility-weighted image (Fig. 1B). Six months after the diagnosis, follow-up MRI revealed T2-FLAIR linear hyperintensity within the brainstem and bulbo-medullar junction (Fig. 2) with notable crossing of the midline (Fig. 1, Fig. 2), corresponding to the corticospinal tract ipsilateral to the hemorrhagic lesion with precise visualization of its decussation in the inferior part of the bulb. Usually not identified on conventional imaging, corticospinal tract decussation can be exceptionnally visualized due to wallerian degeneration (WD). WD is common following lesions of cerebral motor pathways, usually appearing 5–10 weeks after brain injury [1Inoue Y. Matsumura Y. Fukuda T. Nemoto Y. Shirahata N. Suzuki T. et al.MR imaging of Wallerian degeneration in the brainstem: temporal relationships.AJNR Am J Neuroradiol. 1990; 11: 897-902PubMed Google Scholar, 2Matsumura Y. Fukuda T. Inoue Y. Nemoto Y. Yahata S. Shakudo M. et al.MR images of wallerian degeneration–relation between the time and MR findings of wallerian degeneration.Nihon Igaku Hoshasen Gakkai Zasshi. 1989; 49: 1168-1170PubMed Google Scholar]. It can be seen earlier following an infarct, within hours or days, resulting from excitotoxicity mechanisms [[3]Moritani T. Smoker W.R.K. Sato Y. Numaguchi Y. Westesson P-LA. Diffusion-weighted imaging of acute excitotoxic brain injury.AJNR Am J Neuroradiol. 2005; 26: 216-228PubMed Google Scholar]. Hyperintensities along the corticospinal tract on T2-FLAIR and diffusion weighted images have been described: through the internal capsule, the anterior part of the mid-brain and the pons (Fig. 2), and at last crossing the midline in the olivary bodies of the medulla [[4]Liebeskind D.S. Wallerian degeneration of the corticospinal tracts.Neurology. 2004; 62: 828https://doi.org/10.1212/01.WNL.0000115396.43457.52Crossref PubMed Scopus (5) Google Scholar]. Although WD is usually reversible in case of peripheral nerve injury, it generally progresses to chronicity and atrophy in central nervous system injuries [[5]Gaudet A.D. Popovich P.G. Ramer M.S. Wallerian degeneration: gaining perspective on inflammatory events after peripheral nerve injury.J Neurotrauma. 2011; 8: 110https://doi.org/10.1186/1742-2094-8-110Crossref Scopus (557) Google Scholar]. This entity can be deceptive, and should not be misinterpreted for glial infiltration, as treatment differs. Finally, WD is important to identify and mention on MR as it was shown to be a prognosis marker and correlate with persistent functional disability [[6]Sawlani V. Gupta R.K. Singh M.K. Kohli A. MRI demonstration of Wallerian degeneration in various intracranial lesions and its clinical implications.J Neurol Sci. 1997; 146: 103-108Abstract Full Text Full Text PDF PubMed Scopus (82) Google Scholar].Fig. 2MRI FLAIR weighted axial images. (A) Hyperintensity of the corticospinal tract at the mid-brain level (arrow). (B) Hyperintensity of the corticospinal tract at the pons level (arrow).View Large Image Figure ViewerDownload Hi-res image Download (PPT) None. Clément Cholet – Reports no disclosures. Delphine Leclercq – Reports no disclosures. Bruno Law-ye – Reports no disclosures. The authors state that the subject has given their informed consent. This study was approved by our local Ethics Committee. Crossing the line: Brainstem lesion in a patient with glioblastomaJournal of Clinical NeuroscienceVol. 46PreviewA 62-year-old man without significant past medical history presented a progressive right hemiparesis. Physical examination revealed spastic rigidity in the right upper and lower limb as well as increased deep tendon reflexes on the same side. Sensory testing was normal. Brain MRI was performed and the patient was diagnosed with diffuse glioblastoma. Six months later, a follow-up MR revealed T2-FLAIR (Fluid-attenuated Inversion-recovery) linear hyperintensity within the brainstemand bulbo-medullar junction with notable crossing of the midline (Figs. Full-Text PDF" @default.
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• W2912605133 title "Crossing the line: Brainstem lesion in a patient with glioblastoma" @default.
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• W2912605133 doi "https://doi.org/10.1016/j.jocn.2017.08.058" @default.
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