case_images: PMC10562570_01
case_images: MRI scans. (A) Axial FLAIR-weighted MRI scans demonstrate periventricular white matter lesions around the lateral ventricles. (B) Coronal FLAIR-weighted MRI with bithalamic hyperintense lesions. (C) Sagittal FLAIR-weighted MRI reveals a hypointense lesion in the pons.
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case_images: Brain MRI revealed lesions in the pons, cerebellum, thalamus, and periventricular white matter around the lateral ventricles (Figure 1). Despite the often self-limiting nature of ADEM, we hypothesised an association between focal demyelination in the thalamus and brainstem and delayed onset of symptoms (Figures 1B,C).
case_images: Timeline of medical history. ADEM, Acute disseminated encephalomyelitis; MRI, Magnetic resonance imaging; DBS, Deep brain stimulation; GPi, Globus pallidus internus.
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case_images: fig2
case_images: See Figure 2 for a timeline of the patient's medical history. Figure 2). As expected, our findings showed that the fibre tracts associated with the VTA of GPi DBS were connected to basal ganglia circuits and the superior frontal gyrus (SFG), which was characterised by the A6m region of the Brainnetome atlas. Furthermore, these fibre tracts were found to overlap with the dentato-rubro-thalamic tract (DRT), potentially indicating a modulation of the cerebello-thalamo-cortical network, as identified by the DBS tractography atlas (Figure 3).
case_images: Electrode position and VTA associated fibre tracts. (A) Coronal view. Patient-specific connectome with VTA (yellow circle) associated fibre tracts (blue tractography) overlapping the dentato-rubro-thalamic tract (DRT; red tractography) and projecting to the superior frontal gyrus (SFG). (B) Sagittal view. Fibre tracts extend to prefrontal and sensorimotor regions. The closest spatial proximity to the DRT appears to be within cerebello-pallidal and pallido-thalamic connections. The VTA was generated based on the DBS parameters of programme 5 (Table 1). The DBS tractography atlas and the Brainnetome atlas were utilised to define DRT and SFG, respectively.
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case_images: PMC10562570_01_fneur-14-1238743-g003.jpg
case_images: fig3
case_images: Figure 2). As expected, our findings showed that the fibre tracts associated with the VTA of GPi DBS were connected to basal ganglia circuits and the superior frontal gyrus (SFG), which was characterised by the A6m region of the Brainnetome atlas. Furthermore, these fibre tracts were found to overlap with the dentato-rubro-thalamic tract (DRT), potentially indicating a modulation of the cerebello-thalamo-cortical network, as identified by the DBS tractography atlas (Figure 3).