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Injury of the Arcuate Fasciculus in a Patient with Progressive Bulbar Palsy: A Diffusion Tensor Tractography Study

Sung Ho Jang and Min Cheol Chang

The researchersWe report on a patient with progressive bulbar palsy (PBP) who presented with Broca’s aphasia due to injury of the left arcuate fasciculus (AF), as demonstrated on diffusion tensor tractography (DTT). A 74-yearold right handed patient with PBP and six age-matched normal subjects were recruited for this study. The patient presented with Broca’s aphasia along with typical symptoms of PBP, including dysarthria, dysphasia, and mild quadriparesis. DTT was performed at five years after symptom onset. After originating from Wernicke’s area, the left AF of the patient was discontinued at the junction between the ascending and horizontal portions. The fractional anisotropy value and tract number of the left AF were more than two standard deviations lower than those of normal subjects. In contrast, the apparent diffusion coefficient value was more than two standard deviations higher than those of normal subjects. Using the configuration and parameters of DTT, the researcherswe demonstrated injury of the left AF in a patient with PBP. The injury of the left AF in this patient appeared to coincide with Broca’s aphasia. The researchersWe recommend evaluation of the AF using DTT in patients with motor neuron disease who present with aphasia.