Fronto-temporal vulnerability to disconnection in paediatric moderate and severe traumatic brain injury

E. Molteni, E. Pagani, S. Strazzer, F. Arrigoni, E. Beretta, G. Boffa, S. Galbiati, M. Filippi, M. A. Rocca

Research output: Contribution to journalArticle

Abstract

Background: In patients with moderate and severe paediatric traumatic brain injury (TBI), we investigated the presence and severity of white matter (WM) tract damage, cortical lobar and deep grey matter (GM) atrophies, their interplay and their correlation with outcome rating scales. Methods: Diffusion tensor (DT) and 3D T1-weighted MRI scans were obtained from 22 TBI children (13 boys; mean age at insult = 11.6 years; 72.7% in chronic condition) and 31 age-matched healthy children. Patients were tested with outcome rating scales and the Wechsler Intelligence Scale for Children (WISC). DT MRI indices were obtained from several supra- and infra-tentorial WM tracts. Cortical lobar and deep GM volumes were derived. Comparisons between patients and controls, and between patients in acute (<6 months from the event) vs. chronic (≥6 months) condition were performed. Results: Patients showed a widespread pattern of decreased WM FA and GM atrophy. Compared to acute, chronic patients showed severer atrophy in the right frontal lobe and reduced FA in the left inferior longitudinal fasciculus and corpus callosum (CC). Decreased axial diffusivity was observed in acute patients versus controls in the inferior fronto-occipital fasciculus and CC. Chronic patients showed increased axial diffusivity in the same structures. Uncinate fasciculus DT MRI abnormalities correlated with atrophy in the frontal and temporal lobes. Hippocampal atrophy correlated with reduced WISC scores, whereas putamen atrophy correlated with lower functional independence measure scores. Conclusions: The study isolated a distributed fronto-temporal network of structures particularly vulnerable to axonal damage and atrophy that may contribute to cognitive deficits following TBI.

Original languageEnglish
JournalEuropean Journal of Neurology
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Atrophy
Pediatrics
Wechsler Scales
Corpus Callosum
Frontal Lobe
Intelligence
Diffusion Magnetic Resonance Imaging
Traumatic Brain Injury
Putamen
Temporal Lobe
Magnetic Resonance Imaging
Gray Matter
White Matter

Keywords

  • diffusion tensor imaging
  • FIM scale
  • neurobehavioral sequelae
  • paediatric brain injury
  • traumatic brain injury

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

@article{b5de5ce9f9d446318fb31a2a224558c5,
title = "Fronto-temporal vulnerability to disconnection in paediatric moderate and severe traumatic brain injury",
abstract = "Background: In patients with moderate and severe paediatric traumatic brain injury (TBI), we investigated the presence and severity of white matter (WM) tract damage, cortical lobar and deep grey matter (GM) atrophies, their interplay and their correlation with outcome rating scales. Methods: Diffusion tensor (DT) and 3D T1-weighted MRI scans were obtained from 22 TBI children (13 boys; mean age at insult = 11.6 years; 72.7{\%} in chronic condition) and 31 age-matched healthy children. Patients were tested with outcome rating scales and the Wechsler Intelligence Scale for Children (WISC). DT MRI indices were obtained from several supra- and infra-tentorial WM tracts. Cortical lobar and deep GM volumes were derived. Comparisons between patients and controls, and between patients in acute (<6 months from the event) vs. chronic (≥6 months) condition were performed. Results: Patients showed a widespread pattern of decreased WM FA and GM atrophy. Compared to acute, chronic patients showed severer atrophy in the right frontal lobe and reduced FA in the left inferior longitudinal fasciculus and corpus callosum (CC). Decreased axial diffusivity was observed in acute patients versus controls in the inferior fronto-occipital fasciculus and CC. Chronic patients showed increased axial diffusivity in the same structures. Uncinate fasciculus DT MRI abnormalities correlated with atrophy in the frontal and temporal lobes. Hippocampal atrophy correlated with reduced WISC scores, whereas putamen atrophy correlated with lower functional independence measure scores. Conclusions: The study isolated a distributed fronto-temporal network of structures particularly vulnerable to axonal damage and atrophy that may contribute to cognitive deficits following TBI.",
keywords = "diffusion tensor imaging, FIM scale, neurobehavioral sequelae, paediatric brain injury, traumatic brain injury",
author = "E. Molteni and E. Pagani and S. Strazzer and F. Arrigoni and E. Beretta and G. Boffa and S. Galbiati and M. Filippi and Rocca, {M. A.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/ene.13963",
language = "English",
journal = "European Journal of Neurology",
issn = "1351-5101",
publisher = "Wiley-Blackwell Publishing Ltd",

}

TY - JOUR

T1 - Fronto-temporal vulnerability to disconnection in paediatric moderate and severe traumatic brain injury

AU - Molteni, E.

AU - Pagani, E.

AU - Strazzer, S.

AU - Arrigoni, F.

AU - Beretta, E.

AU - Boffa, G.

AU - Galbiati, S.

AU - Filippi, M.

AU - Rocca, M. A.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: In patients with moderate and severe paediatric traumatic brain injury (TBI), we investigated the presence and severity of white matter (WM) tract damage, cortical lobar and deep grey matter (GM) atrophies, their interplay and their correlation with outcome rating scales. Methods: Diffusion tensor (DT) and 3D T1-weighted MRI scans were obtained from 22 TBI children (13 boys; mean age at insult = 11.6 years; 72.7% in chronic condition) and 31 age-matched healthy children. Patients were tested with outcome rating scales and the Wechsler Intelligence Scale for Children (WISC). DT MRI indices were obtained from several supra- and infra-tentorial WM tracts. Cortical lobar and deep GM volumes were derived. Comparisons between patients and controls, and between patients in acute (<6 months from the event) vs. chronic (≥6 months) condition were performed. Results: Patients showed a widespread pattern of decreased WM FA and GM atrophy. Compared to acute, chronic patients showed severer atrophy in the right frontal lobe and reduced FA in the left inferior longitudinal fasciculus and corpus callosum (CC). Decreased axial diffusivity was observed in acute patients versus controls in the inferior fronto-occipital fasciculus and CC. Chronic patients showed increased axial diffusivity in the same structures. Uncinate fasciculus DT MRI abnormalities correlated with atrophy in the frontal and temporal lobes. Hippocampal atrophy correlated with reduced WISC scores, whereas putamen atrophy correlated with lower functional independence measure scores. Conclusions: The study isolated a distributed fronto-temporal network of structures particularly vulnerable to axonal damage and atrophy that may contribute to cognitive deficits following TBI.

AB - Background: In patients with moderate and severe paediatric traumatic brain injury (TBI), we investigated the presence and severity of white matter (WM) tract damage, cortical lobar and deep grey matter (GM) atrophies, their interplay and their correlation with outcome rating scales. Methods: Diffusion tensor (DT) and 3D T1-weighted MRI scans were obtained from 22 TBI children (13 boys; mean age at insult = 11.6 years; 72.7% in chronic condition) and 31 age-matched healthy children. Patients were tested with outcome rating scales and the Wechsler Intelligence Scale for Children (WISC). DT MRI indices were obtained from several supra- and infra-tentorial WM tracts. Cortical lobar and deep GM volumes were derived. Comparisons between patients and controls, and between patients in acute (<6 months from the event) vs. chronic (≥6 months) condition were performed. Results: Patients showed a widespread pattern of decreased WM FA and GM atrophy. Compared to acute, chronic patients showed severer atrophy in the right frontal lobe and reduced FA in the left inferior longitudinal fasciculus and corpus callosum (CC). Decreased axial diffusivity was observed in acute patients versus controls in the inferior fronto-occipital fasciculus and CC. Chronic patients showed increased axial diffusivity in the same structures. Uncinate fasciculus DT MRI abnormalities correlated with atrophy in the frontal and temporal lobes. Hippocampal atrophy correlated with reduced WISC scores, whereas putamen atrophy correlated with lower functional independence measure scores. Conclusions: The study isolated a distributed fronto-temporal network of structures particularly vulnerable to axonal damage and atrophy that may contribute to cognitive deficits following TBI.

KW - diffusion tensor imaging

KW - FIM scale

KW - neurobehavioral sequelae

KW - paediatric brain injury

KW - traumatic brain injury

UR - http://www.scopus.com/inward/record.url?scp=85065403162&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065403162&partnerID=8YFLogxK

U2 - 10.1111/ene.13963

DO - 10.1111/ene.13963

M3 - Article

JO - European Journal of Neurology

JF - European Journal of Neurology

SN - 1351-5101

ER -