Tractography of Cortico-Ponto-Cerebellar Pathways A 34 years old man with prolonged epilepsia partialis continua Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology

Vignette 12 years old: occipital focal seizures and headache complicated by left homonymous hemianopsia 18 years old: left lower limb myoclonic jerks 20 years old: epilepsia partialis continua and focal motor seizures involving the left lower limb 25 years old: progressive left hemiparesis 28 years old: epilepsia partialis continua and focal motor seizures involving the left hemiface and upper limb 34 years old: left ataxic hemiparesis. Two-year seizure-freedom with high-dose IgG Michelucci, et al. © 2015 American Academy of Neurology

Imaging Michelucci, et al. Figure 1. Clinical features over a 22-year history Michelucci, et al. © 2015 American Academy of Neurology

Imaging Michelucci, et al. Figure 2. MRI and tractography evolution Coronal T1-weighted images performed in 2007 (A) and 2011(B) show progressive right cerebral and left cerebellar atrophy consistent with crossed cerebellar diaschisis. Right CPC axonal loss was demonstrated by specific DTI software for tractography in 2011 (D) as compared to 2007 (C). Michelucci, et al. © 2015 American Academy of Neurology

Diffusion Tensor Tractography of Cortico-Ponto-Cerebellar Pathways in Rasmussen Encephalitis Tractography of cortico-ponto-cerebellar (CPC) pathways demonstrated marked involvement of the right tract We suggest that a dying back mechanism of efferent CPC fibers may cause crossed cerebellar atrophy We infer that crossed cerebellar atrophy is a distinctive feature of long-term Rasmussen encephalitis evolution. References 1. Varadkar S., Bien C.G., Kruse C.A., Jensen F.E., Bauer J., Pardo C.A., Vincent A., Mathern G.W., Cross J.H. Rasmussen's encephalitis: clinical features, pathobiology, and treatment advances. Lancet Neurology 2014; 13:195-205. 2. Kamali A., Kramer L.A., Frye R.E., Butler I.J., Hasan K.M. Diffusion Tensor Tractography of the Human Brain Cortico-Ponto-Cerebellar Pathways: A Quantitative Preliminary Study. Journal of Magnetic Resonance Imaging 2010;32:809–817. Michelucci, et al. © 2015 American Academy of Neurology