Difference in Injury of the Corticospinal Tract and Spinothalamic Tract in Patients with Putaminal Hemorrhage

Purpose: We investigated the difference in injury of the corticospinal tract (CST) and the spinothalamic tract (STT) in patients with putaminal hemorrhage, using diffusion tensor tractography (DTT). Methods: Thirty one consecutive patients with PH and 34 control subjects were recruited for this study. DTT scanning was performed at early stage of PH (7-63 days), and the CST and STT were reconstructed using the Functional Magnetic Resonance Imaging of Brain (FMRIB) Software Library program. Injury of the CST and STT was defined in terms of the configuration or abnormal DTT parameters was more than 2 standard deviations lower than that of normal control subjects. Results: Among 31 patients, all 31 patients (100%) had injury of the CTS, whereas 25 patients (80.6%) had injury of the STT: the incidence of CST injury was significantly higher than that of STT (p<0.05). In detail, 20 (64.5%) of 31 patients showed a discontinuation of the CST in the affected hemisphere; in contrast, 14 patients (45.2%) of 31 patients showed a discontinuation of the STT in the affected hemisphere. Regarding the FA value, 6 (19.4%) of 31 patients and 2 (6.4%) of 31 patients were found to have injury in the CST and STT, respectively. In terms of the fiber number, the same injury incidence was observed in 11 patients (35.5%) in both the CST and STT. Conclusion: The greater vulnerability of the CST appears to be ascribed to the anatomical characteristics; the CST is located anteriorly to the center of the putamen compared with the STT.