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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.

Background and Purpose: Little is known regarding changes in the temporal lobe associated with traumatic brain injury (TBI) in early-to-mid adulthood. We report on two quantitative MR studies: study 1 addressed age-related changes of the temporal lobe in subjects aged 16-72 years; information obtained in this study provided a normative database for comparison with findings in 118 patients with TBI who were included in study 2. We expected stable morphology in healthy subjects and trauma-related atrophy in patients with TBI., Methods: MR multispectral tissue segmentation was used to calculate bilateral temporal lobe gyrus and sulcus, sylvian fissure CSF, hippocampus, and temporal horn volumes and to measure the white matter (WM) temporal stem., Results: With normal aging, gyral volume remained stable, decreasing approximately 0.26% per year (total, approximately 11%). Sulcal CSF volume doubled. Hippocampal volume decreased (minimally, significantly); temporal horn volume increased (not significantly) and was minimally related to hippocampal volume. WM measurements were constant. Trauma changed morphology; WM measures decreased. Gyral volumes were not different between the groups. In TBI, CSF volume increased significantly, was most related to reduced WM measurements, and was relatively independent of gyral volume. Temporal horn dilatation was related more to WM atrophy than to hippocampal atrophy. In TBI, subarachnoid sulcal and temporal horn CSF volumes were most related to WM atrophy, which was relatively independent of gyral volume; gyral and hippocampal volumes and WM measures were related to memory performance., Conclusion: Age-related changes cause minimal temporal lobe gyral, hippocampal, temporal horn, and WM atrophy. Only subarachnoid sulcal CSF volume changed robustly. Trauma produced disproportionate WM loss associated with increased temporal horn and sulcal CSF volumes; it caused substantial hippocampal atrophy, which was related to memory impairment. Gyral volume did not decrease, although it was related to memory performance.