• Sung Ho Jang and Young Hyeon Kwon.
• Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Daegu, Republic of Korea.
• Medicine (Baltimore). 2017 Nov 1; 96 (45): e8436.

RationaleWe report on a patient who showed neural reorganization between injured cingula and the brainstem cholinergic nuclei following cerebral concussion.Patient ConcernsThe main concern of the patient is memory impairment.DiagnosesCerebral concussion.OutcomesWhen she visited our hospital at 2 years after onset, cognitive function was evaluated using 2 scales; the Wechsler Intelligence Scale, and the Seoul neuropsychological screening battery: total IQ 97, verbal immediate recall 5.70 percentile, visual immediate recall 30.75 percentile, verbal delayed recall 3.13 percentile, visual delayed recall 11.00 percentile, verbal recognition <0.01 percentile, and visual recognition 13.70 percentile. Conventional brain magnetic resonance imaging did not show any abnormality. On 2-year diffusion tensor tractography for the cingulum, both anterior cingula were discontinued over the genu of the corpus callosum. One neural fiber bundle originating from the middle portion of the left cingulum descended through the left subcortical white matter, and connected to the left pedunculopontine nucleus (Ch 5) in the midbrain and the left laterodorsal tegmental nucleus (Ch 6) in the upper pons.LessonsReorganization of cholinergic innervations between cholinergic nuclei in the basal forebrain and brainstem following injury of the anterior cingulum was demonstrated in a patient with cerebral concussion.

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