title: Infratentorial gray matter atrophy and excess in primary craniocervical dystonia.
abstract: BACKGROUND
  Primary craniocervical dystonia (CCD) is generally attributed to functional abnormalities in the cortico-striato-pallido-thalamocortical loops, but cerebellar pathways have also been implicated in neuroimaging studies. Hence, our purpose was to perform a volumetric evaluation of the infratentorial structures in CCD.
  
  
  METHODS
  We compared 35 DYT1/DYT6 negative patients with CCD and 35 healthy controls. Cerebellar volume was evaluated using manual volumetry (DISPLAY software) and infratentorial volume by voxel based morphometry of gray matter (GM) segments derived from T1 weighted 3 T MRI using the SUIT tool (SPM8/Dartel). We used t-tests to compare infratentorial volumes between groups.
  
  
  RESULTS
  Cerebellar volume was (1.14 ± 0.17) × 10(2) cm(3) for controls and (1.13 ± 0.14) × 10(2) cm(3) for patients; p = 0.74. VBM demonstrated GM increase in the left I-IV cerebellar lobules and GM decrease in the left lobules VI and Crus I and in the right lobules VI, Crus I and VIIIb. In a secondary analysis, VBM demonstrated GM increase also in the brainstem, mostly in the pons.
  
  
  CONCLUSIONS
  While gray matter increase is observed in the anterior lobe of the cerebellum and in the brainstem, the atrophy is concentrated in the posterior lobe of the cerebellum, demonstrating a differential pattern of infratentorial involvement in CCD. This study shows subtle structural abnormalities of the cerebellum and brainstem in primary CCD.
authors.affiliation: Neuroimaging Laboratory, UNICAMP, University of Campinas, Campinas, Brazil. Electronic address: milacallegari@gmail.com.
authors.forename: Camila C
authors.initials: CC
authors.lastname: Piccinin
authors.affiliation: Neuroimaging Laboratory, UNICAMP, University of Campinas, Campinas, Brazil.
authors.forename: Maria C A
authors.initials: MC
authors.lastname: Santos
authors.affiliation: Department of Neurology, UNICAMP, University of Campinas, Campinas, Brazil.
authors.forename: Luiza G
authors.initials: LG
authors.lastname: Piovesana
authors.affiliation: Department of Neurology, UNICAMP, University of Campinas, Campinas, Brazil.
authors.forename: Lidiane S
authors.initials: LS
authors.lastname: Campos
authors.affiliation: Neuroimaging Laboratory, UNICAMP, University of Campinas, Campinas, Brazil.
authors.forename: Rachel P
authors.initials: RP
authors.lastname: Guimarães
authors.affiliation: Neuroimaging Laboratory, UNICAMP, University of Campinas, Campinas, Brazil.
authors.forename: Brunno M
authors.initials: BM
authors.lastname: Campos
authors.affiliation: Department of Medical Genetics, UNICAMP, University of Campinas, Campinas, Brazil.
authors.forename: Fabio R
authors.initials: FR
authors.lastname: Torres
authors.affiliation: Neuroimaging Laboratory, UNICAMP, University of Campinas, Campinas, Brazil; Department of Neurology, UNICAMP, University of Campinas, Campinas, Brazil.
authors.forename: Marcondes C
authors.initials: MC
authors.lastname: França
authors.affiliation: Department of Radiology, UNICAMP, University of Campinas, Campinas, Brazil.
authors.forename: Augusto C
authors.initials: AC
authors.lastname: Amato-Filho
authors.affiliation: Department of Medical Genetics, UNICAMP, University of Campinas, Campinas, Brazil.
authors.forename: Iscia
authors.initials: I
authors.lastname: Lopes-Cendes
authors.affiliation: Neuroimaging Laboratory, UNICAMP, University of Campinas, Campinas, Brazil; Department of Neurology, UNICAMP, University of Campinas, Campinas, Brazil.
authors.forename: Fernando
authors.initials: F
authors.lastname: Cendes
authors.affiliation: Neuroimaging Laboratory, UNICAMP, University of Campinas, Campinas, Brazil; Department of Neurology, UNICAMP, University of Campinas, Campinas, Brazil.
authors.forename: Anelyssa
authors.initials: A
authors.lastname: D'Abreu
mesh_terms: D000368:Aged; D001284:Atrophy / Q000473:pathology; D002531:Cerebellum / Q000473:pathology*; D020821:Dystonic Disorders / Q000473:pathology*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged
keywords: Cerebellum; Craniocervical dystonia; Infratentorial; SUIT tool; Voxel based morphometry