Investigating Connectivity of Orbitomedial Prefrontal Region in a Patient with Traumatic Brain Injury

Abstract

The majority of the research studying the prefrontal region has focused on gray matter injury. However, recent studies show that damage to white matter also contributes to the development of cognitive impairment after traumatic brain injury (TBI). Through the use of diffusion tensor imaging (DTI), it is now possible to assess the white matter fiber pathways between brain regions. With Diffusion Tensor Tractography (DTT), fibers of interest can be three dimensionally reconstructed and associated measurements can be performed. In this paper, we present the case of an individual that suffered from panic attacks, behavioral changes, auditory hallucinations and disturbing bodily sensations after traumatic brain injury. The patient was evaluated with a detailed clinical and neuropsychological assessment, magnetic resonance imaging (MRI) and DTI. MRI revealed cystic encephalomalasia with a diameter of 3.4 cm in the left orbitomedial frontal region. With DTT, major white matter tracts of the traumatized area were compared with symmetrical tracts in the contralateral side. Streamline count for the right inferior fronto-occipital fasciculus (iFOF) was 54 while no streamlines could be found for the left iFOF. For the left uncinate fasciculus and the left cingulum, streamline counts were significantly lower compared with the right side (62% and 34% lower; respectively). White matter damage in TBI can cause dysfunction of different brain regions through disruption of connections with the traumatized area. In this case report, we emphasized that symptoms were not limited with dysfunction of the traumatized region and the regular functions of other brain regions were also affected via the disturbance of connection pathways.