title: Injury of the cingulum in patients with putaminal hemorrhage: a diffusion tensor tractography study.
abstract: OBJECTIVE
  Little is known about the pathophysiological mechanisms of cognitive impairment in patients with putaminal hemorrhage (PH). Using diffusion tensor tractography, we investigated injury of the cingulum in patients with PH.
  
  
  METHODS
  We recruited 63 patients with PH, who were classified according to three groups, based on integrity of the cingulum to the lower portion of the genu of the corpus callosum: group A; preserved integrity, group B; discontinuation of integrity in the affected hemisphere, and group C; discontinuation of integrity in both hemispheres.
  
  
  RESULTS
  Thirty four patients (54.0%) belonged to group A, 16 patients (25.4%) to group B, and the remaining 13 patients (20.6%) to group C. Regarding the Mini-Mental State Examination, significant differences were observed between group A and group C, and between group B and group C without significant difference between group A and group B (p < 0.05). In terms of the volume of hematoma, significant differences were observed among the three groups (p < 0.05). Regarding the most anterior point of the hematoma, significant differences were observed between group A and groups B and C (p < 0.05); in contrast, regarding the most point of hematoma, significant differences were observed between group C and groups A and B, respectively (p < 0.05).
  
  
  CONCLUSIONS
  We found that the anterior cingulum is vulnerable to PH. Therefore, our results suggest the necessity for evaluation of the cingulum in patients with PH particularly if the hematoma is large or close to the anterior margin or midline of the brain.
authors.affiliation: Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University Daegu, South Korea.
authors.forename: Hyeok Gyu
authors.initials: HG
authors.lastname: Kwon
authors.affiliation: Department of Neurosurgery, College of Medicine, Yeungnam University Daegu, South Korea.
authors.forename: Byung Yeon
authors.initials: BY
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, College of Medicine, Yeungnam University Daegu, South Korea.
authors.forename: Seong Ho
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, College of Medicine, Yeungnam University Daegu, South Korea.
authors.forename: Chul Hoon
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Department of Neurosurgery, College of Medicine, Yeungnam University Daegu, South Korea.
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Jung
authors.affiliation: Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University Daegu, South Korea.
authors.forename: Han Do
authors.initials: HD
authors.lastname: Lee
authors.affiliation: Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University Daegu, South Korea.
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Jang
keywords: cingulum; cognitive function; diffusion tensor tractography; location of hematoma; putaminal hemorrhage