Kwon HG, Yang JH, Kwon JH, Yang D. Association between scrub typhus encephalitis and diffusion tensor tractography detection of Papez circuit injury: A case report. World J Clin Cases 2021; 9(13): 3194-3199 [PMID: 33969108 DOI: 10.12998/wjcc.v9.i13.3194]
Corresponding Author of This Article
Dongseok Yang, MD, PhD, Full Professor, Department of Physical Medicine and Rehabilitation, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojin sunhwando-ro, Dong-gu 44033, Ulsan, South Korea. fnew11@gmail.com
Research Domain of This Article
Neuroimaging
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. May 6, 2021; 9(13): 3194-3199 Published online May 6, 2021. doi: 10.12998/wjcc.v9.i13.3194
Association between scrub typhus encephalitis and diffusion tensor tractography detection of Papez circuit injury: A case report
Hyeok Gyu Kwon, Jeong-Hee Yang, Jee-Hyun Kwon, Dongseok Yang
Hyeok Gyu Kwon, Department of Physical Therapy, College of Health Science, Eulji University, Sanseong-daero 13135, Gyeonggi-do, South Korea
Jeong-Hee Yang, Department of Plastic Surgery, Biomedical Research Institute, Seoul National University Hospital, Jongno-gu 03080, Seoul, South Korea
Jee-Hyun Kwon, Department of Neurology, University of Ulsan College of Medicine, Ulsan University Hospital, Dong-gu 44033, Ulsan, South Korea
Dongseok Yang, Department of Physical Medicine and Rehabilitation, University of Ulsan College of Medicine, Ulsan University Hospital, Dong-gu 44033, Ulsan, South Korea
Author contributions: Yang D designed the report, collected the patient’s clinical data, and wrote the paper; Kwon HG provided the conceptualization and methodology, and analyzed the images and imaging-related information; Yang JH reviewed and revised the paper; Kwon JH reviewed the images and revised the paper.
Supported byNational Research Foundation of Korea funded by the Ministry of Education, No. 2013R1A1A4A01013178.
Informed consent statement: Informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016) and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dongseok Yang, MD, PhD, Full Professor, Department of Physical Medicine and Rehabilitation, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojin sunhwando-ro, Dong-gu 44033, Ulsan, South Korea. fnew11@gmail.com
Received: December 21, 2020 Peer-review started: December 21, 2020 First decision: December 30, 2020 Revised: January 22, 2021 Accepted: March 10, 2021 Article in press: March 10, 2021 Published online: May 6, 2021
Abstract
BACKGROUND
It is difficult to restore the cognitive functions of patients with impaired cognition caused by brain injury. Diffusion tensor imaging can visualize the integrity of neural tracts in the white matter (WM) three-dimensionally. It is unclear whether encephalitis following scrub typhus damages the WM. For the first time, we aimed to report diffusion tensor tractography (DTT) findings in a chronic patient with cognitive impairment following scrub typhus encephalitis, which revealed injury to the Papez circuit of the WM.
CASE SUMMARY
A 70-year-old male patient was affected by encephalitis caused by scrub typhus that occurred 23 years ago. He had poor cognition and his clinical examination findings were as follows: Mini-Mental Status Examination score, 14; and handgrip strength (right/left, kg), 32.3/31.3. DTT revealed serious injuries of the left thalamocingulate tract and right mammillothalamic tract in the Papez circuit, and a partial injury of the anterior part of the fornix.
CONCLUSION
Using DTT, we found a relationship between cognitive impairment and the integrity of the Papez circuit following scrub typhus.
Core Tip: Scrub typhus is one of the most common causes of acute encephalitis in endemic countries. It is still debated whether white matter (WM) is injured in the encephalitis of the scrub typhus. Diffusion tensor tractography allows us to investigate the integrity of WM three-dimensionally. The Papez circuit consists mainly of the WM and is known to play a critical role in cognition. Using a diffusion tensor tractography, we detected the injury of the Papez circuit in a patient with cognitive impairment following encephalitis of scrub typhus 23 years ago.
