Cerebellar Peduncle Injuries in Patients with Mild Traumatic Brain Injury

Abstract

Background: The cerebellum is connected to the brain stem by three pairs of cerebellar peduncles (CPs)—superior (SCP), middle (MCP), and inferior (ICP)—which carry proprioceptive information to regulate movement and maintain balance and posture. Injury or damage to the CPs caused by tumors, infarcts, or traumatic brain injuries (TBI) results in poor coordination and balance problems. Current data on CP-related injuries and their effect on balance control are sparse and restricted to a few case studies. There have been no studies to date that have investigated CP injuries in a large sample of patients with balance problems following a mild TBI. Hence, we investigated CP-related injuries in patients with balance problems following mild TBI using diffusion tensor tractography (DTT). Methods: Twenty-one patients with TBI and 21 normal subjects were recruited for this study. Balance was evaluated using the Balance Error Scoring System (BESS). Three DTT-related parameters—fractional anisotropy (FA), apparent diffusion coefficient (ADC), and fiber number (FN) of the CPs—were measured. Results: The FN values of the SCP and ICP in the patient group were significantly lower than those in the control group (p 0.05). Conclusions: Using DTT, we demonstrated injuries to the SCP and ICP in mild TBI patients with balance problems. Our results suggest that DTT could be a useful tool for detecting injuries to the CPs that may not be identified on conventional brain magnetic resonance imaging in mild TBI patients.

Keywords

• balance
• cerebellar peduncles
• cerebellum
• diffusion tensor tractography
• mild traumatic brain injury