title: Regionally selective atrophy after traumatic axonal injury.
abstract: OBJECTIVE
  To determine the spatial distribution of cortical and subcortical volume loss in patients with diffuse traumatic axonal injury and to assess the relationship between regional atrophy and functional outcome.
  
  
  METHODS
  Prospective imaging study. Longitudinal changes in global and regional brain volumes were assessed using high-resolution magnetic resonance imaging-based morphometric analysis.
  
  
  METHODS
  Inpatient traumatic brain injury unit.
  
  
  METHODS
  Twenty-five patients with diffuse traumatic axonal injury and 22 age- and sex-matched controls.
  
  
  METHODS
  Changes in global and regional brain volumes between initial and follow-up magnetic resonance imaging were used to assess the spatial distribution of posttraumatic volume loss. The Glasgow Outcome Scale-Extended score was the primary measure of functional outcome.
  
  
  RESULTS
  Patients underwent substantial global atrophy with mean whole-brain parenchymal volume loss of 4.5% (95% confidence interval, 2.7%-6.3%). Decreases in volume (at a false discovery rate of 0.05) were seen in several brain regions including the amygdala, hippocampus, thalamus, corpus callosum, putamen, precuneus, postcentral gyrus, paracentral lobule, and parietal and frontal cortices, while other regions such as the caudate and inferior temporal cortex were relatively resistant to atrophy. Loss of whole-brain parenchymal volume was predictive of long-term disability, as was atrophy of particular brain regions including the inferior parietal cortex, pars orbitalis, pericalcarine cortex, and supramarginal gyrus.
  
  
  CONCLUSIONS
  Traumatic axonal injury leads to substantial posttraumatic atrophy that is regionally selective rather than diffuse, and volume loss in certain regions may have prognostic value for functional recovery.
authors.affiliation: Department of Neurology, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-9036, USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Warner
authors.forename: Teddy S
authors.initials: TS
authors.lastname: Youn
authors.forename: Tommy
authors.initials: T
authors.lastname: Davis
authors.forename: Alvin
authors.initials: A
authors.lastname: Chandra
authors.forename: Carlos
authors.initials: C
authors.lastname: Marquez de la Plata
authors.forename: Carol
authors.initials: C
authors.lastname: Moore
authors.forename: Caryn
authors.initials: C
authors.lastname: Harper
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Madden
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Spence
authors.forename: Roderick
authors.initials: R
authors.lastname: McColl
authors.forename: Michael
authors.initials: M
authors.lastname: Devous
authors.forename: Richard D
authors.initials: RD
authors.lastname: King
authors.forename: Ramon
authors.initials: R
authors.lastname: Diaz-Arrastia
mesh_terms: D000293:Adolescent; D000328:Adult; D001284:Atrophy / Q000473:pathology; D001369:Axons / Q000473:pathology*; D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D020833:Diffuse Axonal Injury / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009929:Organ Size; D011446:Prospective Studies; D020127:Recovery of Function