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Figure 5–14. Loss of white matter tracts in traumatic brain injury (TBI).

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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).

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