Diffusion tensor imaging and tractography in brown-sequard syndrome

Study design: Case report. Objective: To demonstrate the utility of diffusion tensor imaging (DTI) and tractography in two patients with Brown-Sequard syndrome after penetrating cervical cord injury. Setting: Milwaukee, WI, USA. Methods: Two patients, who presented with features of Brown-Sequard syndrome after sustaining stab wounds to the neck, underwent DTI and tractography of the cervical cord within a week of the injury. DTI metrics were measured within the left and right hemicord around the level of injury. Diffusion tensor tractography (DTT) was performed to visualize the site of injury and injured fiber tracts. Results: Axial fractional anisotropy (FA) maps at the site of injury showed unilateral damage to the cord structure, and FA was significantly reduced within the injured hemicord in both patients. Tractography allowed for visualization of the injured fiber tracts around the level of injury. Both DTI metrics and tractography showed an asymmetry that corresponded to the neurological deficits exhibited by the patients. Conclusion: This report illustrates the utility of DTI and DTT in delineating regions of cord injury in two patients with traumatic Brown-Sequard syndrome. Our results indicate that DTI provides clinically relevant information that supplements conventional MR imaging for patients with acute SCI. Spinal Cord (2012) 50, 928-930; doi:10.1038/sc.2012.94; published online 9 October 2012