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Imaging Explores 19th-Century Brain Injury

May 17, 2012
Written by: , Filed in: Neuroradiology
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A strange but fascinating new study uses brain and skull imaging to take a new look at the strange but fascinating case of Phineas Gage, the man who, in 1848, survived the blasting of an iron rod through the left frontal lobe of his brain.

Gage was a railroad worker. The accident took place during construction of a roadbed in Vermont. He not only survived but also went on to work at several jobs and travel widely (always carrying the rod with him) before dying 12 years later in San Francisco, apparently as a result of epileptic seizures related to his injury.

For more than a century and a half, scientists have argued about the precise location of the injury, the degree of brain damage, and the exact cause of the behavioral changes seen in Gage after the accident. (The physician who treated him said that the formerly hard-working, responsible man became fitful, impatient, and profane.)

To settle the disputes, UCLA researchers obtained modern brain images of men who matched Gage’s age at the time of the injury (25) and right-handedness. They used software to position a composite of 110 such images onto Gage’s virtual skull, constructed from CT scans taken in 2001 of the actual skull, which is displayed in the Warren Anatomical Museum in Boston.

The study determined that the accident damaged 4 percent of Gage’s cerebral cortex but nearly 11 percent of his brain’s white matter. Jack Van Horn, PhD, lead author of the study, summarized the findings:

Our work illustrates that while cortical damage was restricted to the left frontal lobe, the passage of the tamping iron resulted in the widespread interruption of white matter connectivity throughout his brain, so it likely was a major contributor to the behavioral changes he experienced.

Dr. Van Horn is an assistant professor of neurology and a member of UCLA’s Laboratory of Neuro Imaging. He was quoted in a UCLA news release. The study was published Wednesday in PLoS ONE.

“Connections were lost between the left frontal, left temporal, and right frontal cortices and the left limbic structures of the brain, which likely had considerable impact on his executive as well as his emotional functions,” Dr. Van Horn said.

The behavioral changes might have been familiar to doctors today. “The extensive loss of white matter connectivity, affecting both hemispheres, plus the direct damage by the rod, which was limited to the left cerebral hemisphere, is not unlike modern patients who have suffered a traumatic brain injury,” Dr. Van Horn said.

“And it is analogous to certain forms of degenerative diseases, such as Alzheimer’s disease or frontal temporal dementia, in which neural pathways in the frontal lobes are degraded, which is known to result in profound behavioral changes.”

Related seminar: Neuro & Musculoskeletal Imaging


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