PMC3251609_01
Preoperative FLAIR images show the right perirubral mesencephalic traumatic haemorrhage.. Images are presented in radiological convention.
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A left-handed, 32 year-old male, after having a motorbike accident that caused brainstem bleeding (at the level of the red nucleus; Fig 2), developed a tremor having resting, postural, as well as intention components, bradykinesia, rigidity and a slight paresis of the left arm.
PMC3251609_02
Connectivity-based segmentation of the left thalamus of the patient having essential tremor.. Results are overlaid on the postoperative T1-weighted image. White voxels represent the location of the Stereotactic lesion. The colour coding of the thalamic segmentation is the same as that using in Figure 3. The lesion is in the area of the thalamus connected most strongly to the primary motor cortex: the putative Vim.
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T1-weighted image was registered to the preoperative T1-weighted image in order to identify the position of the lesion in relation to the diffusion-based connectivity results. The connectivity-based segmentation of the thalamus indicated that the surgical lesion was in the putative Vim nucleus, the region that showed the highest probability of connection to the primary motor cortex (Fig 5).
Connectivity of the thalamic lesion of the essential tremor patient, evaluated using multi-fiber probabilistic tractography.. The tracts reach the primary motor cortex, on one hand, and travelling to the cerebellum on the other hand. The image is thresholded at 250 particles (5%).
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Postoperative probabilistic tractography from the lesion showed that the lesioned thalamus was connected to the primary motor cortex, mainly to the medial structures, and downstream to the ipsilateral cerebellar hemisphere (Fig 6).