The medial surface areas of the cingulate gyrus (CG) and other midline structures (corpus callosum, thalamus, lateral ventricle) were examined in 27 traumatically brain injured (TBI) and 12 age- and gender-matched control subjects from an established TBI data base. Significant atrophy, primarily in the posterior CG, was found in TBI patients. Degree of atrophy was related to severity of injury. TBI subjects also had significantly reduced corpus callosum and thalamic cross-sectional surface areas with associated increased lateral ventricular volume, as well as reduced brain volume and increased ventricle-to-brain ratio. Despite significant atrophy of the posterior CG, neuropsychological performance was not related to changes in CG cross-sectional surface area in the TBI subjects. This apparent discrepancy is discussed.

Prior or concurrent alcohol use at the time of traumatic brain injury (TBI) was examined in terms of post-injury atrophic changes measured by quantitative analysis of magnetic resonance imaging (MRI) and neuropsychological outcome. Two groups of TBI subjects were examined: those with a clinically significant blood alcohol level (BAL) present at the time of injury (TBI + BAL) and those without a significant BAL (TBI-only). To explore the potential impact of both acute and chronic alcohol use, subjects in both groups were further clustered into one of four subgroups (NONE, MILD, MODERATE or HEAVY) based upon available information regarding their pre-injury alcohol use. One-way analysis of covariance (ANCOVA) and multiple analysis of covariance (MANCOVA) were used with subject grouping as the main factor. Age, injury severity as measured by Glasgow Coma Scale (GCS) score, years of education, total intracranial volume (TICV), and the number of days post-injury were included as covariates where appropriate. Increased general atrophy was observed in patients with (a) a positive BAL and/or (b) a history of moderate to heavy pre-injury alcohol use. In addition, performance on neuropsychological outcome variables (WAIS-R and WMS-R Index scores) was generally worse in the subgroups of patients with positive BAL and a history of preinjury alcohol use, as compared to the other TBI groups though not statistically significant. Implications of alcohol use, at the time of brain injury, are discussed.

Other than brainstem injury, DOI CT findings relate poorly to rehabilitation outcome. Presence of DOI CT abnormalities were associated with the development of cerebral atrophy, which was associated with poorer rehabilitation discharge DRS and FIM scores.