Morphometric MRI findings in the thalamus and brainstem in children after moderate to severe traumatic brain injury.

Generalized whole brain volume loss is well documented in moderate to severe traumatic brain injury. Whether this atrophy occurs in the thalamus and brainstem has not been systematically studied in children. Magnetic resonance imaging (MRI) quantitative analysis was used to investigate brain volume loss in the thalamus and brainstem in 16 traumatic brain injury subjects (age range 9-16 years) compared with 16 age and demo-graphically matched controls. Based on multiple analysis of covariance, controlling for age and head size, reduced volume in the thalamus and the midbrain region of the brainstem were found. General linear model analyses revealed a relation between processing speed on a working memory task and midbrain and brain stem volumes. Reduced volume in thalamic and brainstem structures were associated with traumatic brain injury. Reduction in midbrain and thalamic volume is probably a reflection of the secondary effects of diffuse axonal injury and reduction in cortical volume from brain injury.

Feeling sounds after a thalamic lesion.

OBJECTIVE: The ventrolateral nucleus of the thalamus (VL), based on its connectivity with the cerebellum and motor cortex, has long been considered to be involved with motor functions. We show that the human VL also plays a prominent role in sensory processing. METHODS: Structural magnetic resonance imaging and diffusion tensor imaging were used to localize a small lesion restricted to the right VL in a patient with contralesional sensory processing deficits. Systematic assessments of anatomic brain organization and behavioral measurements of somatosensory and visual processing were conducted at several time points after stroke. RESULTS: Initially, the patient was more likely to detect events on the contralesional side when a simultaneous ipsilesional event was presented within the same, but not different, sensory modality. This perceptual phenomenon, which we refer to as unisensory antiextinction, persisted for several months before transforming into a form of synesthesia in which auditory stimuli produced tactile percepts. Tractography performed on the diffusion tensor imaging data showed altered connections from the lesioned thalamus to the cerebral cortex, suggesting a neural basis for these sensory changes. INTERPRETATION: These results demonstrate a role for the VL in sensory processing and suggest that reorganization of thalamocortical axonal connectivity can lead to major changes in perception.

Late proton MR spectroscopy in children after traumatic brain injury: correlation with cognitive outcomes.

BACKGROUND AND PURPOSE: Proton MR spectroscopy has demonstrated reduced levels of N-acetylaspartate (NAA) in normal-appearing occipital and frontal regions of patients with acute nonpenetrating traumatic brain injury (TBI). We studied the relationship of frontoparietal NAA, choline (Cho), and creatine (Cr) to test the hypothesis that reduction in NAA is predictive of cognitive outcome. METHODS: Proton spectra were collected by using conventional 2D chemical shift imaging in five healthy children and seven children (6 weeks to 3 years) with severe (n=4), moderate (n=2), or mild (n=1) TBI. Spectra in the anterior and posterior regions of the left and right frontoparietal areas were averaged for analysis by using LCModel, with a phantom-established basis function, for quantification of NAA, Cho, and Cr concentrations. Intellectual function, expressive language, and arithmetic capability were measured within 4 months of imaging. RESULTS: NAA/Cho concentration was lower in TBI patients than in control subjects, but no group differences were present for Cho or Cr. Hemispheric levels for NAA, Cho, and Cr were higher on the left than on the right, but we found no effect of region and no interactions. Cognition was lower in the TBI group than the control group and correlated with NAA levels. Left frontal Cho was also correlated with arithmetic scores, whereas Cr was not significantly correlated. CONCLUSION: NAA levels remain low after TBI and are related to cognitive function. Neurometabolite values are greater in the left frontoparietal region than in the right, and the left frontal Cho level is related to arithmetic ability.