Prefronto-thalamic tract injury and cognitive outcome according to external ventricular drainage location in stroke patients

Abstract

Objectives

We investigated the characteristics of prefronto-thalamic tract (PF-TT) injuries in stroke patients using diffusion tensor tractography (DTT) and assessing cognitive outcome according to location of the external ventricular drainage (EVD).

Methods

Forty-five consecutive stroke patients who underwent EVD and 24 control subjects were recruited. The patients were classified into three groups: group A (EVD on the lesion or one side, 17 patients), group B (EVD on the hemisphere opposite to the lesion, 12 patients), and group C (EVD on both sides, 16 patients). Mini-Mental State Examination (MMSE) results were performed at the beginning (average 2.27 months from onset) and end (average 4.19 months from onset) of rehabilitation. Three parts of the PF-TT (dorsolateral PF-TT[DLPF-TT], ventrolateral PF-TT[VLPF-TT], orbitofronto-thalamic tract[OF-TT]) were reconstructed and the fractional anisotropy (FA) and tract volume (TV) measurements were obtained.

Results

With the EVD on the stroke-affected side, the values of FA and TV of all three parts of the PF-TTs in three patient groups were lower than those of the control group (p < 0.05). With the EVD on the unaffected side, the FA values of the DLPF-TT in groups B and C and the OF-TT in group C were lower than those of the control group (p < 0.05). There was no difference in initial MMSE score among three patient groups; however, group A had a higher mean follow-up MMSE score than that of groups B and C (p < 0.05).

Conclusions

Patients who underwent EVD of the affected hemisphere showed better results in terms of the PF-TT injury and cognitive outcome than patients who underwent EVD through the unaffected hemisphere or through both hemispheres.

Keywords:

• External ventricular drainage
• cognitive function
• prefronto-thalamic tract
• diffusion tensor tractography
• stroke

Disclosure statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Author contribution

Jang SH conceived and designed the study and was involved in funding and data acquisition, manuscript development, and manuscript writing. Kim JH participated in the design of the study and collection of data. Kwon HG was involved in data acquisition, manuscript development, and Statistical analysis. Kim MS participated in manuscript development, data acquisition, manuscript writing, and manuscript authorization. All authors reviewed the manuscript.

Additional information

Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean Government (MSIP) (No. 2018R1A2B6000996).