Diffusion tensor imaging reveals diffuse white matter injuries in locked-in syndrome patients

PLoS One. 2019 Apr 10;14(4):e0213528. doi: 10.1371/journal.pone.0213528. eCollection 2019.

Abstract

Locked-in syndrome (LIS) is a state of quadriplegia and anarthria with preserved consciousness, which is generally triggered by a disruption of specific white matter fiber tracts, following a lesion in the ventral part of the pons. However, the impact of focal lesions on the whole brain white matter microstructure and structural connectivity pathways remains unknown. We used diffusion tensor magnetic resonance imaging (DT-MRI) and tract-based statistics to characterise the whole white matter tracts in seven consecutive LIS patients, with ventral pontine injuries but no significant supratentorial lesions detected with morphological MRI. The imaging was performed in the acute phase of the disease (26 ± 13 days after the accident). DT-MRI-derived metrics were used to quantitatively assess global white matter alterations. All diffusion coefficient Z-scores were decreased for almost all fiber tracts in all LIS patients, with diffuse white matter alterations in both infratentorial and supratentorial areas. A mixture model of two multidimensional Gaussian distributions was fitted to cluster the white matter fiber tracts studied in two groups: the least (group 1) and most injured white matter fiber tracts (group 2). The greatest injuries were revealed along pathways crossing the lesion responsible for the LIS: left and right medial lemniscus (98.4% and 97.9% probability of belonging to group 2, respectively), left and right superior cerebellar peduncles (69.3% and 45.7% probability) and left and right corticospinal tract (20.6% and 46.5% probability). This approach demonstrated globally compromised white matter tracts in the acute phase of LIS, potentially underlying cognitive deficits.

MeSH terms

  • Adult
  • Aged
  • Auditory Pathways / diagnostic imaging
  • Auditory Pathways / physiopathology
  • Brain Injuries / diagnosis
  • Brain Injuries / diagnostic imaging
  • Brain Injuries / physiopathology
  • Brain Stem / diagnostic imaging*
  • Brain Stem / physiopathology
  • Central Nervous System / diagnostic imaging
  • Central Nervous System / physiopathology
  • Cognition Disorders / diagnosis
  • Cognition Disorders / diagnostic imaging
  • Cognition Disorders / physiopathology
  • Diffusion Tensor Imaging*
  • Female
  • Humans
  • Locked-In Syndrome / diagnosis
  • Locked-In Syndrome / diagnostic imaging*
  • Locked-In Syndrome / physiopathology
  • Male
  • Middle Aged
  • Normal Distribution
  • Pyramidal Tracts / diagnostic imaging
  • Pyramidal Tracts / physiopathology
  • White Matter / diagnostic imaging*
  • White Matter / injuries
  • White Matter / physiopathology

Associated data

  • Dryad/10.5061/dryad.6j2c875

Grants and funding

The authors received no specific funding for this work.