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Cortical Contusions and Their Most Likely Region of Occurrence

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Figure 5–13. Lesion tracings are projected on selected axial slices of a template brain derived from 12 healthy control subjects.The color scale indicates degree of lesion overlap across patients (max = 5). Lower right sagittal image indicates slice location of the three axial images, with the most ventral axial image appearing in the upper left, the middle axial image in the upper right, and the most dorsal axial image in the lower left.Source. Reprinted from Levine B, Kovacevic N, Nica EI, et al: "The Toronto Traumatic Brain Injury Study: Injury Severity and Quantified MRI." Neurology 70:771–778, 2008. Used with permission.

Figure 5–14. Loss of white matter tracts in traumatic brain injury (TBI).(Top left) Severe TBI in a child with extensive frontal encephalomalacia. (Top right) Similarly aged and demographically matched child with normal scan. These anatomical scans do not permit a visualization of the extent of the loss of connectivity that occurs from damage. Note the dramatic differences in the complexity of the connectivity emanating from similar frontal regions when comparing a damaged frontal lobe with that of a typically developing child. Diffusion tensor imaging tractography projections are superimposed on an axial T1 anatomical magnetic resonance image in a 12-year-old female who had sustained a severe TBI (Glasgow Coma Score = 5) as a result of falling backward off the back of a pickup truck, striking the back of her head on the pavement but sustaining significant contracoup frontal contusions. The same color schema applies as discussed previously. These images show that the frontal injury results in marked thinning and loss of frontal projecting tracts emanating from the frontal polar region of the brain. This illustration dramatically shows the loss of brain interconnectiveness as a consequence of focal damage distal to the endpoint of where fiber tracts project (see Oni et al. 2010 for additional information).

Figure 5–15. Regions of significant cortical loss in pediatric traumatic brain injury compared with brains of typically developing children, reflecting adjustments made for age and gender.The P-value color scale indicates group differences ranging from dark blue (P <0.005) to light blue (P <0.00001). Results are displayed on a customized averaged pediatric subject. (A) Lateral view (with surfaces inflated to reveal the extent of significant regions) showing group differences bilaterally for temporal and frontal lobe (P <0.005). (B) Lateral view (now shown as pial surfaces) indicating the same significant regions as displayed in A. (C) Midsagittal pial surfaces showing significant cortical regional differences.

Figure 5–16. Cortical thinning related to impaired prospective memory in traumatic brain injury.Areas of cortical thinning that were associated with event-based prospective memory (EB-PM) performance in pediatric traumatic brain injury are shown in sagittal, inferior, medial, and coronal views. As in Figure 5–15, the P-value color scale indicates group differences ranging from dark blue (P <0.005) to light blue (P <0.00001). Bilateral middle and inferior frontal, middle and inferior temporal, and parahippocampal and cingulate gyri thicknesses were found to be significantly related to EB-PM performance. Regions of significant brain-behavior relation appear to be spatially larger in the left hemisphere. Involvement of the temporal lobes and parahippocampal gyri highlights the inherent role of retrieval processes in supporting PM functioning.

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