Long-term Tractography Evaluation of Corpus Callosum Impairment After Severe Traumatic Brain Injury in Patients With Isolated Intraventricular Hemorrhage on Admission CT: Two Illustrative Cases and a Literature Review

Abstract

Severe traumatic brain injury (TBI) is often associated with diffuse axonal injury. Diffuse axonal injury affecting the corpus callosum may present with intraventricular hemorrhage on baseline computed tomography (CT) scan. Posttraumatic corpus callosum damage is a chronic condition that can be diagnosed over the long term using various magnetic resonance imaging (MRI) sequences. Here, we present two cases of severe survivors of TBI with isolated intraventricular hemorrhage detected on an initial CT scan. After acute trauma management, long-term follow-up was performed. Diffusion tensor imaging and subsequent tractography revealed a significant decrease in the fractional anisotropy values and the number of corpus callosum fibers compared with those in healthy control patients. This study presents a possible correlation between traumatic intraventricular hemorrhage on admission CT and long-term corpus callosum impairment detected on MRI in patients with severe head injury by presenting demonstrative cases and conducting a literature review.

Keywords: Cerebral intraventricular hemorrhage; Corpus callosum; Diffuse axonal injury; Diffusion tensor imaging; Magnetic resonance imaging; Traumatic brain injury.

FIGURE 1. Case 1. (A) Admission computed tomography scan showing the presence of isolated intraventricular hemorrhage in the occipital horn of the left lateral ventricle (arrow); (B-G) A 13-months follow-up magnetic resonance imaging is demonstrated; (B) Sagittal T1 shows disruption of the body of the corpus callosum (arrow); (C) susceptibility-weighted imaging shows hemosiderin deposits in the body of the corpus callosum (arrow); (D) Sagittal corpus callosum tractography demonstrates a decrease in the number of fibers as well as distortion of the anatomy in comparison to a reconstruction of a control subject (E); (F) Axial corpus callosum tractography demonstrated bilateral corpus callosum impairment in comparison to a control subject (G).

FIGURE 2. Case 2. (A) The admission computed tomography scan shows the presence of isolated intraventricular hemorrhage located in the occipital horns of the lateral ventricles (arrows). (B, C) A 50-month follow-up magnetic resonance imaging is shown. (B) The susceptibility-weighted imaging demonstrates hemosiderin deposits in the body of the corpus callosum (arrows). (C) Corpus callosum tractography shows a significantly decreased number of fibers, especially in the body of the corpus callosum, compared to healthy control (D). (E) Axial corpus callosum tractography demonstrated bilateral corpus callosum impairment in comparison to a control subject (F).