A patient who gradually progressed to corticobasal syndrome after traumatic brain injury

Abstract

Background

Traumatic brain injury (TBI) occurs when an external force injury the brain, and leads adult disabilities and death. A recent retrospective investigation found that TBI history was associated with a 1.6 higher risk for FTD diagnosis. Traumatic white matter injury has been already accepted as a critical contributor to post-TBI neurological dysfunction. Now, we report changes of neurological features and serial followed up brain magnetic resonance images (MRI) in a patient with TBI.

Method

A 48-year-old man visited the dementia clinic because of cognitive impairment. A month ago, an electric pole, which had been repairing by the patient, was broken and then it crashed to his head. Brain CT on the 7th day after the accident and brain MRI after one month were performed. First neuropsychological assessment was analyzed one year later since the accident occurred. B-CT and B-MRI were also performed in 4 years later.

Result

Brain CT on the 7th day after the accident and brain MRI after one month, showed multifocal old infarctions, extensive rarefactions involving both periventricular and subcortical white matter, and moderate to severe diffuse brain atrophy. One year later since the accident occurred, he showed personality changes and the aggravated cognitive impairments. According to his wife, before he was injured, he easily memorized several phone numbers well. First neuropsychological assessment showed memory impairments (verbal and visual) and frontal executive dysfunctions. Fluency was decreased and naming difficulty was observed. He showed poor personal hygiene and delusion. Weight loss and dysphagia appeared since 4th year after the accident. He could not use his right arm and hand at will, and his parkinsonism seemed to be progressed. Brain CT and MRI still showed confluent cerebral white matter lesions and diffuse cerebral atrophy. He muttered only meaningless words and showed delusions.

Conclusion

He showed changes in cognitive impairments, abnormal behavior and personality changes, parkinsonism, and aphasia in order after TBI. Brain MRI revealed an extensive white matter leukoaraiosis and brain atrophy. We thought that extensive white matter leukoaraiosis is associated with delayed various and complex complications after TBI.