Experimental Brain Research

, Volume 235, Issue 9, pp 2777–2786 | Cite as

Subcortical brain atrophy in Gulf War Illness

  • Peka Christova
  • Lisa M. James
  • Brian E. Engdahl
  • Scott M. Lewis
  • Adam F. Carpenter
  • Apostolos P. Georgopoulos
Research Article


Gulf War Illness (GWI) is a multisystem disorder that has affected a substantial number of veterans who served in the 1990–1991 Gulf War. The brain is prominently affected, as manifested by the presence of neurological, cognitive and mood symptoms. Although brain dysfunction in GWI has been well documented (EBioMedicine 12:127–32, 2016), abnormalities in brain structure have been debated. Here we report a substantial (~10%) subcortical brain atrophy in GWI comprising mainly the brainstem, cerebellum and thalamus, and, to a lesser extent, basal ganglia, amygdala and diencephalon. The highest atrophy was observed in the brainstem, followed by left cerebellum and right thalamus, then by right cerebellum and left thalamus. These findings indicate graded atrophy of regions anatomically connected through the brainstem via the crossed superior cerebellar peduncle (left cerebellum → right thalamus, right cerebellum → left thalamus). This distribution of atrophy, together with the observed systematic reduction in volume of other subcortical areas (basal ganglia, amygdala and diencephalon), resemble the distribution of atrophy seen in toxic encephalopathy (Am J Neuroradiol 13:747–760, 1992) caused by a variety of substances, including organic solvents. Given the potential exposure of Gulf War veterans to “a wide range of biological and chemical agents including sand, smoke from oil-well fires, paints, solvents, insecticides, petroleum fuels and their combustion products, organophosphate nerve agents, pyridostigmine bromide, …” (Institute of Medicine National Research Council. Gulf War and Health: Volume 1. Depleted uranium, pyridostigmine bromide, sarin, and vaccines. National Academies Press, Washington DC, 2000), it is reasonable to suppose that such exposures, alone or in combination, could underlie the subcortical atrophy observed.


Gulf War Illness Brain atrophy Brainstem Cerebellum Thalamus Toxic encephalopathy 



We thank Dr. Effie-Photini Tsilibari for bringing to our attention the potentially crucial role of the blood brain barrier in cerebellar dysfunction. This study was supported in part by the US Department of Veterans Affairs and the University of Minnesota. The contents of this paper do not represent the views of the US Department of Veterans Affairs or the United States Government.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.


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Copyright information

© Springer-Verlag GmbH Germany (outside the USA) 2017

Authors and Affiliations

  • Peka Christova
    • 1
    • 2
  • Lisa M. James
    • 1
    • 2
    • 3
  • Brian E. Engdahl
    • 1
    • 2
    • 4
  • Scott M. Lewis
    • 1
    • 5
  • Adam F. Carpenter
    • 1
    • 5
  • Apostolos P. Georgopoulos
    • 1
    • 2
    • 3
    • 5
  1. 1.Brain Sciences Center, Department of Veterans Affairs Health Care SystemMinneapolis VAHCSMinneapolisUSA
  2. 2.Department of NeuroscienceUniversity of Minnesota Medical SchoolMinneapolisUSA
  3. 3.Department of PsychiatryUniversity of Minnesota Medical SchoolMinneapolisUSA
  4. 4.Department of PsychologyUniversity of MinnesotaMinneapolisUSA
  5. 5.Department of NeurologyUniversity of Minnesota Medical SchoolMinneapolisUSA

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