Mild Traumatic Brain Injury and Conduction Aphasia from a Close Proximity Blast Resulting in Arcuate Fasciculus Damage Diagnosed on DTI Tractography

摘要

The authors present a case demonstrating that a blast injury was associated with both conduction aphasia and an abnormality in the left Arcuate Fasciculus (AF) on MR DTI (Diffusion Tensor Imaging). In addition, this study showed the presence of conduction aprosodia in the setting of damage to the homologous area in the right hemisphere (hereafter referred to as the right homologue of the AF). In prior research, diffusion tensor images have revealed injuries invisible to standard structural imaging. Our finding is consistent with a previous diffusion tensor study demonstrating that damage to the AF is associated with conduction aphasia. Based on the patient's length of posttraumatic amnesia this patient's second TBI would be classified as mild and unlikely to be associated with enduring cognitive deficits, and yet we have observed evidence from both DTI and behavior that there is enduring dysfunction. This case report suggests that further study of patients with complaints following blast injuries is warranted, particularly with advanced imaging techniques such as DTI. Of particular interest, change over time in white matter tracts, observed using sequential DTI, could show improvement of connectivity.