Successful cognitive rehabilitation for acute right frontal aslant tract injury with impaired working memory and inattention using diffusion tensor tractography.

Background: Language impairments caused by left frontal aslant tract (FAT) damage have a good prognosis. However, the prognosis of cognitive dysfunction after right FAT injury is unknown. The present study describes successful cognitive rehabilitation for impaired working memory and inattention together with diffusion tensor tractography (DTT).

Methods: A patient in his 40s with acute stroke underwent magnetic resonance imaging, computed tomography perfusion scans, DTT, and 11 neuropsychological tests for attention, frontal lobe, memory, visuospatial, intelligence, and cognitive functions. Three weeks of cognitive rehabilitation, including direct attention and metacognitive strategy training, and visual working memory tasks were performed. DTT and neuropsychological assessments were compared before and after rehabilitation.

Results: Neuropsychological scores in the Trail Making Test, Clinical Assessment for Attention, and Frontal Assessment Battery increased with step-by-step rehabilitation, leading to early reinstatement as a system engineer. DTT revealed that the FAT posterior segment adjacent to the lesion increased its distal branching in the inferior frontal gyrus.

Conclusion: In this case study, cognitive rehabilitation for three weeks restored impaired working memory and attention while enhancing right FAT integrity. Visualizing white matter using DTT in the acute phase provides essential insights for selecting appropriate training tasks to facilitate functional recovery from neuropsychological disturbances.