Diffusion tensor tractography of the corticobulbar tract in a dysphagic patient with progressive supranuclear palsy: A case report

Rationale:This paper reports the changes over time in the corticobulbar tract (CBT) analyzed using diffusion tensor tractography (DTT) in a dysphagic patient with progressive supranuclear palsy (PSP). Patient concerns:A 53-year-old man initially presented with dysarthria, gait disturbance, and bradykinesia, and approximately 1-year later, downward gaze paralysis appeared. Initially, there was no dysphagia; however, approximately 2 years after visiting the hospital, symptoms of dysphagia, including difficulty swallowing pills, aspiration, and oral movement impairments appeared. The symptoms gradually progressed, and finally, mouth opening was severely damaged to the extent that it was difficult to orally feed. Interventions:We performed diffusion tensor imaging 3 times; at 3-month, 20-month, and 41-month from onset. Outcomes:On 3-month DTT, the left CBT was well reconstructed, whereas the right CBT showed partial tearing. In the 20-month DTT, both CBTs became thinner compared to the 3-month DTT. On 41-month DTT, both CBTs became much thinner than after 3-month and 20-month DTT. Lessons:We observed the degree of CBT injury over time in a dysphagic patient with PSP. These results suggest that the analysis of CBT using DTT is helpful in predicting the degree of dysphagia and prognosis in patients with PSP.

Automated summary

This paper describes the changes over time in the corticobulbar tract (CBT) using diffusion tensor tractography (DTT) in a dysphagic patient with progressive supranuclear palsy (PSP). The patient initially presented with dysarthria, gait disturbance, and bradykinesia, and later developed dysphagia symptoms. DTI imaging showed progressive thinning of the CBTs. This study suggests that analyzing the CBT using DTT can help predict the degree of dysphagia and prognosis in PSP patients.