Degeneration of an injured spinothalamic tract in a patient with mild traumatic brain injury

Abstract

Objectives: This study reports on a patient who developed degeneration of an injured spinothalamic tract (STT) detected on diffusion tensor tractography (DTT) following mild traumatic brain injury (TBI).

Case description: A 56-year-old female had suffered from head trauma resulting from a pedestrian car accident. The patient did not experience loss of consciousness or post-traumatic amnesia and the patient’s Glasgow Coma Scale score was 15. She had begun to feel pain in her left hand and foot at ~ 7 days after onset. The characteristics and severity of pain were as follows: constant tingling and pricking sensation without allodynia or hyperalgesia (Visual Analogue Scale score: 3~4). No specific focal lesion was observed on brain and spine MRI and an electromyography study showed no evidence of peripheral nerve injury or radiculopathy. At 6 months after onset, the central pain in the left hand and foot became aggravated, with a Visual Analogue Scale score of 6.

Results: On 1-month DTT, partial tearing was observed in both STTs. In contrast, both partially torn STTs had become atrophy on 9-month DTT.

Conclusions: This study recommends further studies conducted on the prognosis (regeneration or degeneration) of injured STTs and on the effect of change of an injured STT on central pain.

Keywords:

• Spinothalamic tract
• diffusion tensor imaging
• head trauma
• traumatic axonal injury

Abbreviations:

• DTI
• diffusion tensor imaging
• DTT
• diffusion tensor tractography
• FMRIB
• Functional Magnetic Resonance Imaging of the Brain
• STTspinothalamic tract
• TBI
• traumatic brain injury
• VAS
• visual analogue scale

Declaration of Interest

This work was supported by the Medical Research Center Program (2015R1A5A2009124) through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.