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Yu F, Shukla DK, Armstrong RC, Marion CM, Radomski KL, Selwyn RG, Dardzinski BJ. Repetitive Model of Mild Traumatic Brain Injury Produces Cortical Abnormalities Detectable by Magnetic Resonance Diffusion Imaging, Histopathology, and Behavior. J Neurotrauma 2016; 34:1364-1381. [PMID: 27784203 PMCID: PMC5385606 DOI: 10.1089/neu.2016.4569] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Noninvasive detection of mild traumatic brain injury (mTBI) is important for evaluating acute through chronic effects of head injuries, particularly after repetitive impacts. To better detect abnormalities from mTBI, we performed longitudinal studies (baseline, 3, 6, and 42 days) using magnetic resonance diffusion tensor imaging (DTI) and diffusion kurtosis imaging (DKI) in adult mice after repetitive mTBI (r-mTBI; daily × 5) or sham procedure. This r-mTBI produced righting reflex delay and was first characterized in the corpus callosum to demonstrate low levels of axon damage, astrogliosis, and microglial activation, without microhemorrhages. High-resolution DTI-DKI was then combined with post-imaging pathological validation along with behavioral assessments targeted for the impact regions. In the corpus callosum, only DTI fractional anisotropy at 42 days showed significant change post-injury. Conversely, cortical regions under the impact site (M1–M2, anterior cingulate) had reduced axial diffusivity (AD) at all time points with a corresponding increase in axial kurtosis (Ka) at 6 days. Post-imaging neuropathology showed microglial activation in both the corpus callosum and cortex at 42 days after r-mTBI. Increased cortical microglial activation correlated with decreased cortical AD after r-mTBI (r = −0.853; n = 5). Using Thy1-YFP-16 mice to fluorescently label neuronal cell bodies and processes revealed low levels of axon damage in the cortex after r-mTBI. Finally, r-mTBI produced social deficits consistent with the function of this anterior cingulate region of cortex. Overall, vulnerability of cortical regions is demonstrated after mild repetitive injury, with underlying differences of DTI and DKI, microglial activation, and behavioral deficits.
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Affiliation(s)
- Fengshan Yu
- 1 Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences , Bethesda, Maryland.,2 Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Dinesh K Shukla
- 1 Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences , Bethesda, Maryland.,5 Department of Psychiatry, University of Maryland School of Medicine , Baltimore, Maryland
| | - Regina C Armstrong
- 1 Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences , Bethesda, Maryland.,2 Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences , Bethesda, Maryland.,3 Program in Neuroscience, Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Christina M Marion
- 1 Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences , Bethesda, Maryland.,3 Program in Neuroscience, Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Kryslaine L Radomski
- 1 Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences , Bethesda, Maryland.,2 Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Reed G Selwyn
- 1 Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences , Bethesda, Maryland.,6 Department of Radiology, University of New Mexico , Albuquerque, New Mexico
| | - Bernard J Dardzinski
- 1 Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences , Bethesda, Maryland.,4 Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences , Bethesda, Maryland
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152
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Huang MX, Harrington DL, Robb Swan A, Angeles Quinto A, Nichols S, Drake A, Song T, Diwakar M, Huang CW, Risbrough VB, Dale A, Bartsch H, Matthews S, Huang JW, Lee RR, Baker DG. Resting-State Magnetoencephalography Reveals Different Patterns of Aberrant Functional Connectivity in Combat-Related Mild Traumatic Brain Injury. J Neurotrauma 2016; 34:1412-1426. [PMID: 27762653 DOI: 10.1089/neu.2016.4581] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Blast mild traumatic brain injury (mTBI) is a leading cause of sustained impairment in military service members and veterans. However, the mechanism of persistent disability is not fully understood. The present study investigated disturbances in brain functioning in mTBI participants using a source-imaging-based approach to analyze functional connectivity (FC) from resting-state magnetoencephalography (rs-MEG). Study participants included 26 active-duty service members or veterans who had blast mTBI with persistent post-concussive symptoms, and 22 healthy control active-duty service members or veterans. The source time courses from regions of interest (ROIs) were used to compute ROI to whole-brain (ROI-global) FC for different frequency bands using two different measures: 1) time-lagged cross-correlation and 2) phase-lock synchrony. Compared with the controls, blast mTBI participants showed increased ROI-global FC in beta, gamma, and low-frequency bands, but not in the alpha band. Sources of abnormally increased FC included the: 1) prefrontal cortex (right ventromedial prefrontal cortex [vmPFC], right rostral anterior cingulate cortex [rACC]), and left ventrolateral and dorsolateral prefrontal cortex; 2) medial temporal lobe (bilateral parahippocampus, hippocampus, and amygdala); and 3) right putamen and cerebellum. In contrast, the blast mTBI group also showed decreased FC of the right frontal pole. Group differences were highly consistent across the two different FC measures. FC of the left ventrolateral prefrontal cortex correlated with executive functioning and processing speed in mTBI participants. Altogether, our findings of increased and decreased regionalpatterns of FC suggest that disturbances in intrinsic brain connectivity may be the result of multiple mechanisms, and are associated with cognitive sequelae of the injury.
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Affiliation(s)
- Ming-Xiong Huang
- 1 Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System , San Diego, California.,2 Department of Radiology, University of California , San Diego, California
| | - Deborah L Harrington
- 1 Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System , San Diego, California.,2 Department of Radiology, University of California , San Diego, California
| | - Ashley Robb Swan
- 1 Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System , San Diego, California.,2 Department of Radiology, University of California , San Diego, California
| | - Annemarie Angeles Quinto
- 1 Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System , San Diego, California.,2 Department of Radiology, University of California , San Diego, California
| | - Sharon Nichols
- 3 Department of Neuroscience, University of California , San Diego, California
| | | | - Tao Song
- 2 Department of Radiology, University of California , San Diego, California
| | - Mithun Diwakar
- 2 Department of Radiology, University of California , San Diego, California
| | - Charles W Huang
- 5 Department of Bioengineering, University of California , San Diego, California
| | - Victoria B Risbrough
- 6 Department of Psychiatry, University of California , San Diego, California.,7 VA Center of Excellence for Stress and Mental Health , San Diego, California
| | - Anders Dale
- 2 Department of Radiology, University of California , San Diego, California
| | - Hauke Bartsch
- 2 Department of Radiology, University of California , San Diego, California
| | - Scott Matthews
- 1 Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System , San Diego, California.,6 Department of Psychiatry, University of California , San Diego, California.,8 Aspire Center , VASDHS Residential Rehabilitation Treatment Program, San Diego, California
| | | | - Roland R Lee
- 1 Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System , San Diego, California.,2 Department of Radiology, University of California , San Diego, California
| | - Dewleen G Baker
- 1 Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System , San Diego, California.,6 Department of Psychiatry, University of California , San Diego, California.,7 VA Center of Excellence for Stress and Mental Health , San Diego, California
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153
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Naeser MA, Martin PI, Ho MD, Krengel MH, Bogdanova Y, Knight JA, Yee MK, Zafonte R, Frazier J, Hamblin MR, Koo BB. Transcranial, Red/Near-Infrared Light-Emitting Diode Therapy to Improve Cognition in Chronic Traumatic Brain Injury. Photomed Laser Surg 2016; 34:610-626. [DOI: 10.1089/pho.2015.4037] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Margaret A. Naeser
- VA Boston Healthcare System (12-A), Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Paula I. Martin
- VA Boston Healthcare System (12-A), Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Michael D. Ho
- VA Boston Healthcare System (12-A), Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Maxine H. Krengel
- VA Boston Healthcare System (12-A), Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Yelena Bogdanova
- VA Boston Healthcare System (12-A), Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Jeffrey A. Knight
- VA Boston Healthcare System (12-A), Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
- Behavioral Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts
| | - Megan K. Yee
- VA Boston Healthcare System (12-A), Boston, Massachusetts
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
- Massachusetts General Hospital, Boston, Massachusetts
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Judith Frazier
- TBI Research Program, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | - Michael R. Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston Massachusetts
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts
| | - Bang-Bon Koo
- Boston University Center for Biomedical Imaging, Boston, Massachusetts
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154
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Strauss SB, Kim N, Branch CA, Kahn ME, Kim M, Lipton RB, Provataris JM, Scholl HF, Zimmerman ME, Lipton ML. Bidirectional Changes in Anisotropy Are Associated with Outcomes in Mild Traumatic Brain Injury. AJNR Am J Neuroradiol 2016; 37:1983-1991. [PMID: 27282864 DOI: 10.3174/ajnr.a4851] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 04/25/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE Mild traumatic brain injury results in a heterogeneous constellation of deficits and symptoms that persist in a subset of patients. This prospective longitudinal study identifies early diffusion tensor imaging biomarkers of mild traumatic brain injury that significantly relate to outcomes at 1 year following injury. MATERIALS AND METHODS DTI was performed on 39 subjects with mild traumatic brain injury within 16 days of injury and 40 controls; 26 subjects with mild traumatic brain injury returned for follow-up at 1 year. We identified subject-specific regions of abnormally high and low fractional anisotropy and calculated mean fractional anisotropy, axial diffusivity, radial diffusivity, and mean diffusivity across all white matter voxels brain-wide and each of several white matter regions. Assessment of cognitive performance and symptom burden was performed at 1 year. RESULTS Significant associations of brain-wide DTI measures and outcomes included the following: mean radial diffusivity and mean diffusivity with memory; and mean fractional anisotropy, radial diffusivity, and mean diffusivity with health-related quality of life. Significant differences in outcomes were found between subjects with and without abnormally high fractional anisotropy for the following white matter regions and outcome measures: left frontal lobe and left temporal lobe with attention at 1 year, left and right cerebelli with somatic postconcussion symptoms at 1 year, and right thalamus with emotional postconcussion symptoms at 1 year. CONCLUSIONS Individualized assessment of DTI abnormalities significantly relates to long-term outcomes in mild traumatic brain injury. Abnormally high fractional anisotropy is significantly associated with better outcomes and might represent an imaging correlate of postinjury compensatory processes.
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Affiliation(s)
- S B Strauss
- From the Department of Radiology (S.B.S., M.L.L.), Montefiore Medical Center, Bronx, New York
| | - N Kim
- Departments of Radiology (N.K., M.L.L.)
- The Gruss Magnetic Resonance Research Center (N.K., C.A.B., M.E.K., H.F.S., M.L.L.)
| | - C A Branch
- Physiology and Biophysics (C.A.B.)
- The Gruss Magnetic Resonance Research Center (N.K., C.A.B., M.E.K., H.F.S., M.L.L.)
| | - M E Kahn
- The Gruss Magnetic Resonance Research Center (N.K., C.A.B., M.E.K., H.F.S., M.L.L.)
| | - M Kim
- Epidemiology and Population Health (M.K., R.B.L.)
| | - R B Lipton
- Epidemiology and Population Health (M.K., R.B.L.)
- The Saul R. Korey Department of Neurology (R.B.L., M.E.Z.)
| | - J M Provataris
- Department of Emergency Medicine (J.M.P.), Jacobi Medical Center, Bronx, New York
| | - H F Scholl
- The Gruss Magnetic Resonance Research Center (N.K., C.A.B., M.E.K., H.F.S., M.L.L.)
| | - M E Zimmerman
- The Saul R. Korey Department of Neurology (R.B.L., M.E.Z.)
| | - M L Lipton
- From the Department of Radiology (S.B.S., M.L.L.), Montefiore Medical Center, Bronx, New York
- Departments of Radiology (N.K., M.L.L.)
- Psychiatry and Behavioral Sciences (M.L.L.)
- The Gruss Magnetic Resonance Research Center (N.K., C.A.B., M.E.K., H.F.S., M.L.L.)
- The Dominick P. Purpura Department of Neuroscience (M.L.L.), Albert Einstein College of Medicine, Bronx, New York
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155
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Bahrami N, Sharma D, Rosenthal S, Davenport EM, Urban JE, Wagner B, Jung Y, Vaughan CG, Gioia GA, Stitzel JD, Whitlow CT, Maldjian JA. Subconcussive Head Impact Exposure and White Matter Tract Changes over a Single Season of Youth Football. Radiology 2016; 281:919-926. [PMID: 27775478 DOI: 10.1148/radiol.2016160564] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Purpose To examine the effects of subconcussive impacts resulting from a single season of youth (age range, 8-13 years) football on changes in specific white matter (WM) tracts as detected with diffusion-tensor imaging in the absence of clinically diagnosed concussions. Materials and Methods Head impact data were recorded by using the Head Impact Telemetry system and quantified as the combined-probability risk-weighted cumulative exposure (RWECP). Twenty-five male participants were evaluated for seasonal fractional anisotropy (FA) changes in specific WM tracts: the inferior fronto-occipital fasciculus (IFOF), inferior longitudinal fasciculus, and superior longitudinal fasciculus (SLF). Fiber tracts were segmented into a central core and two fiber terminals. The relationship between seasonal FA change in the whole fiber, central core, and the fiber terminals with RWECP was also investigated. Linear regression analysis was conducted to determine the association between RWECP and change in fiber tract FA during the season. Results There were statistically significant linear relationships between RWEcp and decreased FA in the whole (R2 = 0.433; P = .003), core (R2 = 0.3649; P = .007), and terminals (R2 = 0.5666; P < .001) of left IFOF. A trend toward statistical significance (P = .08) in right SLF was observed. A statistically significant correlation between decrease in FA of the right SLF terminal and RWECP was also observed (R2 = 0.2893; P = .028). Conclusion This study found a statistically significant relationship between head impact exposure and change of FA fractional anisotropy value of whole, core, and terminals of left IFOF and right SLF's terminals where WM and gray matter intersect, in the absence of a clinically diagnosed concussion. © RSNA, 2016.
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Affiliation(s)
- Naeim Bahrami
- From the Advanced Neuroscience Imaging Research (ANSIR) Laboratory (N.B., D.S., E.M.D., Y.J., C.T.W., J.A.M.), Wake Forest School of Medicine (S.R.), Department of Radiology-Neuroradiology (Y.J., C.T.W.), Department of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Department of Family and Community Medicine (C.T.W.), Department of Neurosurgery (C.T.W.), Virginia Tech-Wake Forest School of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Division of Pediatric Neuropsychology (C.G.V., G.A.G.), Children's National Health System, George Washington University School of Medicine, Rockville, Md; Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC (J.D.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (E.M.D., B.W., J.A.M.)
| | - Dev Sharma
- From the Advanced Neuroscience Imaging Research (ANSIR) Laboratory (N.B., D.S., E.M.D., Y.J., C.T.W., J.A.M.), Wake Forest School of Medicine (S.R.), Department of Radiology-Neuroradiology (Y.J., C.T.W.), Department of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Department of Family and Community Medicine (C.T.W.), Department of Neurosurgery (C.T.W.), Virginia Tech-Wake Forest School of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Division of Pediatric Neuropsychology (C.G.V., G.A.G.), Children's National Health System, George Washington University School of Medicine, Rockville, Md; Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC (J.D.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (E.M.D., B.W., J.A.M.)
| | - Scott Rosenthal
- From the Advanced Neuroscience Imaging Research (ANSIR) Laboratory (N.B., D.S., E.M.D., Y.J., C.T.W., J.A.M.), Wake Forest School of Medicine (S.R.), Department of Radiology-Neuroradiology (Y.J., C.T.W.), Department of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Department of Family and Community Medicine (C.T.W.), Department of Neurosurgery (C.T.W.), Virginia Tech-Wake Forest School of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Division of Pediatric Neuropsychology (C.G.V., G.A.G.), Children's National Health System, George Washington University School of Medicine, Rockville, Md; Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC (J.D.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (E.M.D., B.W., J.A.M.)
| | - Elizabeth M Davenport
- From the Advanced Neuroscience Imaging Research (ANSIR) Laboratory (N.B., D.S., E.M.D., Y.J., C.T.W., J.A.M.), Wake Forest School of Medicine (S.R.), Department of Radiology-Neuroradiology (Y.J., C.T.W.), Department of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Department of Family and Community Medicine (C.T.W.), Department of Neurosurgery (C.T.W.), Virginia Tech-Wake Forest School of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Division of Pediatric Neuropsychology (C.G.V., G.A.G.), Children's National Health System, George Washington University School of Medicine, Rockville, Md; Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC (J.D.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (E.M.D., B.W., J.A.M.)
| | - Jillian E Urban
- From the Advanced Neuroscience Imaging Research (ANSIR) Laboratory (N.B., D.S., E.M.D., Y.J., C.T.W., J.A.M.), Wake Forest School of Medicine (S.R.), Department of Radiology-Neuroradiology (Y.J., C.T.W.), Department of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Department of Family and Community Medicine (C.T.W.), Department of Neurosurgery (C.T.W.), Virginia Tech-Wake Forest School of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Division of Pediatric Neuropsychology (C.G.V., G.A.G.), Children's National Health System, George Washington University School of Medicine, Rockville, Md; Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC (J.D.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (E.M.D., B.W., J.A.M.)
| | - Benjamin Wagner
- From the Advanced Neuroscience Imaging Research (ANSIR) Laboratory (N.B., D.S., E.M.D., Y.J., C.T.W., J.A.M.), Wake Forest School of Medicine (S.R.), Department of Radiology-Neuroradiology (Y.J., C.T.W.), Department of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Department of Family and Community Medicine (C.T.W.), Department of Neurosurgery (C.T.W.), Virginia Tech-Wake Forest School of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Division of Pediatric Neuropsychology (C.G.V., G.A.G.), Children's National Health System, George Washington University School of Medicine, Rockville, Md; Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC (J.D.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (E.M.D., B.W., J.A.M.)
| | - Youngkyoo Jung
- From the Advanced Neuroscience Imaging Research (ANSIR) Laboratory (N.B., D.S., E.M.D., Y.J., C.T.W., J.A.M.), Wake Forest School of Medicine (S.R.), Department of Radiology-Neuroradiology (Y.J., C.T.W.), Department of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Department of Family and Community Medicine (C.T.W.), Department of Neurosurgery (C.T.W.), Virginia Tech-Wake Forest School of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Division of Pediatric Neuropsychology (C.G.V., G.A.G.), Children's National Health System, George Washington University School of Medicine, Rockville, Md; Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC (J.D.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (E.M.D., B.W., J.A.M.)
| | - Christopher G Vaughan
- From the Advanced Neuroscience Imaging Research (ANSIR) Laboratory (N.B., D.S., E.M.D., Y.J., C.T.W., J.A.M.), Wake Forest School of Medicine (S.R.), Department of Radiology-Neuroradiology (Y.J., C.T.W.), Department of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Department of Family and Community Medicine (C.T.W.), Department of Neurosurgery (C.T.W.), Virginia Tech-Wake Forest School of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Division of Pediatric Neuropsychology (C.G.V., G.A.G.), Children's National Health System, George Washington University School of Medicine, Rockville, Md; Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC (J.D.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (E.M.D., B.W., J.A.M.)
| | - Gerard A Gioia
- From the Advanced Neuroscience Imaging Research (ANSIR) Laboratory (N.B., D.S., E.M.D., Y.J., C.T.W., J.A.M.), Wake Forest School of Medicine (S.R.), Department of Radiology-Neuroradiology (Y.J., C.T.W.), Department of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Department of Family and Community Medicine (C.T.W.), Department of Neurosurgery (C.T.W.), Virginia Tech-Wake Forest School of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Division of Pediatric Neuropsychology (C.G.V., G.A.G.), Children's National Health System, George Washington University School of Medicine, Rockville, Md; Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC (J.D.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (E.M.D., B.W., J.A.M.)
| | - Joel D Stitzel
- From the Advanced Neuroscience Imaging Research (ANSIR) Laboratory (N.B., D.S., E.M.D., Y.J., C.T.W., J.A.M.), Wake Forest School of Medicine (S.R.), Department of Radiology-Neuroradiology (Y.J., C.T.W.), Department of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Department of Family and Community Medicine (C.T.W.), Department of Neurosurgery (C.T.W.), Virginia Tech-Wake Forest School of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Division of Pediatric Neuropsychology (C.G.V., G.A.G.), Children's National Health System, George Washington University School of Medicine, Rockville, Md; Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC (J.D.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (E.M.D., B.W., J.A.M.)
| | - Christopher T Whitlow
- From the Advanced Neuroscience Imaging Research (ANSIR) Laboratory (N.B., D.S., E.M.D., Y.J., C.T.W., J.A.M.), Wake Forest School of Medicine (S.R.), Department of Radiology-Neuroradiology (Y.J., C.T.W.), Department of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Department of Family and Community Medicine (C.T.W.), Department of Neurosurgery (C.T.W.), Virginia Tech-Wake Forest School of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Division of Pediatric Neuropsychology (C.G.V., G.A.G.), Children's National Health System, George Washington University School of Medicine, Rockville, Md; Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC (J.D.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (E.M.D., B.W., J.A.M.)
| | - Joseph A Maldjian
- From the Advanced Neuroscience Imaging Research (ANSIR) Laboratory (N.B., D.S., E.M.D., Y.J., C.T.W., J.A.M.), Wake Forest School of Medicine (S.R.), Department of Radiology-Neuroradiology (Y.J., C.T.W.), Department of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Department of Family and Community Medicine (C.T.W.), Department of Neurosurgery (C.T.W.), Virginia Tech-Wake Forest School of Biomedical Engineering (N.B., J.E.U., Y.J., J.D.S., C.T.W.), Division of Pediatric Neuropsychology (C.G.V., G.A.G.), Children's National Health System, George Washington University School of Medicine, Rockville, Md; Childress Institute for Pediatric Trauma, Wake Forest School of Medicine, Winston-Salem, NC (J.D.S.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (E.M.D., B.W., J.A.M.)
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McAllister TW. Mild Traumatic Brain Injury. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2016; 14:410-421. [PMID: 31975821 DOI: 10.1176/appi.focus.20160025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Mild traumatic brain injury (MTBI) is a significant public health problem worldwide. Injured individuals have an increased relative risk of developing a variety of neuropsychiatric conditions associated with the profile of brain regions typically affected in TBI. Within a neurobiopsychosocial framework, this article reviews what is known about the neuropsychiatric sequelae of MTBI, with an emphasis on recent advances.
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Affiliation(s)
- Thomas W McAllister
- Dr. McAllister is with the Department of Psychiatry, Indiana University School of Medicine, Indianapolis (e-mail: )
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157
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Spitz G, Alway Y, Gould KR, Ponsford JL. Disrupted White Matter Microstructure and Mood Disorders after Traumatic Brain Injury. J Neurotrauma 2016; 34:807-815. [PMID: 27550509 DOI: 10.1089/neu.2016.4527] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Traumatic brain injury (TBI) is associated with an elevated frequency of mood disorders that may, in part, be explained by changes in white-matter microstructure. This study is the first to examine the relationship between mood disorders and white-matter pathology in a sample of patients with mild to severe TBI using a standardized psychiatric interview. This study reports on a sub-sample of 29 individuals recruited from a large prospective study that examined the evolution of psychiatric disorders following complicated, mild to severe TBI. Individuals with TBI were also compared with 23 healthy control participants. Individuals were invited to complete the Structured Clinical Interview for DSM-IV Disorders (SCID) to diagnose psychiatric disorders. Participants who developed a mood disorder within the first 3 years were categorized into a TBI-Mood group. Diffusion tensor tractography assessed white matter microstructure using atlas-based tract-averaged and along-tract approaches. Fractional anisotropy (FA) was used as the measure of white-matter microstructure. TBI participants with and without a mood disorder did not differ in regard to injury severity and other background factors. Nevertheless, TBI participants diagnosed with a mood disorder displayed significantly lower tract-averaged FA values for the right arcuate fasciculus (p = 0.011), right inferior longitudinal fasciculus (p = 0.009), and anterior segments I (p = 0.0004) and II (p = 0.007) of the corpus callosum, as well as the left (p = 0.014) and right (p = 0.015) fronto-occipital longitudinal fasciculi. The pattern of white matter disruption identified in the current study provides further support for a neurobiological basis of post-TBI mood disorders. Greater understanding of individuals' underlying neuropathology may enable better characterization and prediction of mood disorders. Integration of neuropathology may also inform the potential efficacy of pharmacological and psychological interventions.
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Affiliation(s)
- Gershon Spitz
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University , Clayton, Australia .,Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
| | - Yvette Alway
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University , Clayton, Australia .,Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
| | - Kate Rachel Gould
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University , Clayton, Australia .,Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
| | - Jennie L Ponsford
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University , Clayton, Australia .,Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia
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158
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159
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Cui J, Ng LJ, Volman V. Callosal dysfunction explains injury sequelae in a computational network model of axonal injury. J Neurophysiol 2016; 116:2892-2908. [PMID: 27683891 DOI: 10.1152/jn.00603.2016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 09/22/2016] [Indexed: 12/28/2022] Open
Abstract
Mild traumatic brain injury (mTBI) often results in neurobehavioral aberrations such as impaired attention and increased reaction time. Diffusion imaging and postmortem analysis studies suggest that mTBI primarily affects myelinated axons in white matter tracts. In particular, corpus callosum, mediating interhemispheric information exchange, has been shown to be affected in mTBI. Yet little is known about the mechanisms linking the injury of myelinated callosal axons to the neurobehavioral sequelae of mTBI. To address this issue, we devised and studied a large, biologically plausible neuronal network model of cortical tissue. Importantly, the model architecture incorporated intra- and interhemispheric organization, including myelinated callosal axons and distance-dependent axonal conduction delays. In the resting state, the intact model network exhibited several salient features, including alpha-band (8-12 Hz) collective activity with low-frequency irregular spiking of individual neurons. The network model of callosal injury captured several clinical observations, including 1) "slowing down" of the network rhythms, manifested as an increased resting-state theta-to-alpha power ratio, 2) reduced response to attention-like network stimulation, manifested as a reduced spectral power of collective activity, and 3) increased population response time in response to stimulation. Importantly, these changes were positively correlated with injury severity, supporting proposals to use neurobehavioral indices as biomarkers for determining the severity of injury. Our modeling effort helps to understand the role played by the injury of callosal myelinated axons in defining the neurobehavioral sequelae of mTBI.
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Affiliation(s)
- Jianxia Cui
- L-3 Applied Technologies, Inc., San Diego, California
| | - Laurel J Ng
- L-3 Applied Technologies, Inc., San Diego, California
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160
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Erdodi LA, Pelletier CL, Roth RM. Elevations on select Conners’ CPT-II scales indicate noncredible responding in adults with traumatic brain injury. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 25:19-28. [DOI: 10.1080/23279095.2016.1232262] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Laszlo A. Erdodi
- Department of Psychology, Neuropsychology Track, University of Windsor, Windsor, Ontario, Canada
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Chantalle L. Pelletier
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Robert M. Roth
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
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161
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Strauss S, Hulkower M, Gulko E, Zampolin RL, Gutman D, Chitkara M, Zughaft M, Lipton ML. Current Clinical Applications and Future Potential of Diffusion Tensor Imaging in Traumatic Brain Injury. Top Magn Reson Imaging 2016; 24:353-62. [PMID: 26636640 DOI: 10.1097/rmr.0000000000000071] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the setting of acute central nervous system (CNS) emergencies, computed tomography (CT) and conventional magnetic resonance imaging (MRI) play an important role in the identification of life-threatening intracranial injury. However, the full extent or even presence of brain damage frequently escapes detection by conventional CT and MRI. Advanced MRI techniques such as diffusion tensor imaging (DTI) are emerging as important adjuncts in the diagnosis of microstructural white matter injury in the acute and postacute brain-injured patient. Although DTI aids in detection of brain injury pathology, which has been repeatedly associated with typical adverse clinical outcomes, the evolution of acute changes and their long-term prognostic implications are less clear and the subject of much active research. A major aim of current research is to identify imaging-based biomarkers that can identify the subset of TBI patients who are at risk for adverse outcome and can therefore most benefit from ongoing care and rehabilitation as well as future therapeutic interventions.The aim of this study is to introduce the current methods used to obtain DTI in the clinical setting, describe a set of common interpretation strategies with their associated advantages and pitfalls, as well as illustrate the clinical utility of DTI through a set of specific patient scenarios. We conclude with a discussion of future potential for the management of TBI.
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Affiliation(s)
- Sara Strauss
- *Department of Radiology of Montefiore Medical Center, Bronx, NY †Radiology Ltd., Tuscon, AZ ‡The Gruss Magnetic Resonance Research Center of Albert Einstein College of Medicine, Bronx, NY §Department of Radiology of Albert Einstein College of Medicine, Bronx, NY
- Department of Psychiatry and Behavioral Sciences of Albert Einstein College of Medicine, Bronx, NY ¶Dominick P. Purpura Department of Neuroscience of Albert Einstein College of Medicine, Bronx, NY
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162
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Sorg SF, Schiehser DM, Bondi MW, Luc N, Clark AL, Jacobson MW, Frank LR, Delano-Wood L. White Matter Microstructural Compromise Is Associated With Cognition But Not Posttraumatic Stress Disorder Symptoms in Military Veterans With Traumatic Brain Injury. J Head Trauma Rehabil 2016; 31:297-308. [PMID: 26360008 PMCID: PMC5997182 DOI: 10.1097/htr.0000000000000189] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate white matter microstructure compromise in Veterans with a history of traumatic brain injury (TBI) and its possible contribution to posttraumatic stress disorder (PTSD) symptomatology and neuropsychological functioning via diffusion tensor imaging. PARTICIPANTS AND METHODS Thirty-eight Veterans with mild (n = 33) and moderate (n = 5) TBI and 17 military control participants without TBI completed neuropsychological testing and psychiatric screening and underwent magnetic resonance imaging an average of 4 years following their TBI event(s). Fractional anisotropy (FA) and diffusivity measures were extracted from 9 white matter tracts. RESULTS Compared with military control participants, TBI participants reported higher levels of PTSD symptoms and performed worse on measures of memory and psychomotor-processing speed. Traumatic brain injury was associated with lower FA in the genu of the corpus callosum and left cingulum bundle. Fractional anisotropy negatively correlated with processing speed and/or executive functions in 7 of the 8 tracts. Regional FA did not correlate with memory or PTSD symptom ratings. CONCLUSION Results suggest that current PTSD symptoms are independent of TBI-related white matter alterations, as measured by diffusion tensor imaging. In addition, white matter microstructural compromise may contribute to reduced processing speed in our sample of participants with history of neurotrauma. Findings of the current study add insight into the factors associated with complicated recovery from mild to moderate TBI.
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Affiliation(s)
- Scott F. Sorg
- Veterans Affairs San Diego Healthcare System, San Diego, CA, 92161, USA
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Dawn M. Schiehser
- Veterans Affairs San Diego Healthcare System, San Diego, CA, 92161, USA
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Mark W. Bondi
- Veterans Affairs San Diego Healthcare System, San Diego, CA, 92161, USA
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Norman Luc
- Veterans Affairs San Diego Healthcare System, San Diego, CA, 92161, USA
| | - Alexandra L. Clark
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego CA, 92120
| | - Mark W. Jacobson
- Veterans Affairs San Diego Healthcare System, San Diego, CA, 92161, USA
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Lawrence R. Frank
- Dept. of Radiology, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Lisa Delano-Wood
- Veterans Affairs San Diego Healthcare System, San Diego, CA, 92161, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA 92161, USA
- Dept. of Psychiatry, University of California, San Diego, La Jolla, CA, 92093, USA
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163
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Brain Magnetic Resonance Imaging for Traumatic Brain Injury: Why, When, and How? Top Magn Reson Imaging 2016; 24:225-39. [PMID: 26502305 DOI: 10.1097/rmr.0000000000000061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Conventional magnetic resonance imaging (MRI) and angiography (MRA) provide invaluable information in the evaluation of patients with all stages and grades of traumatic brain injury (TBI). The information obtained with MRI provides a more complete assessment of the patient's brain injury and possible long-term sequelae.
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164
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Strain JF, Didehbani N, Spence J, Conover H, Bartz EK, Mansinghani S, Jeroudi MK, Rao NK, Fields LM, Kraut MA, Cullum CM, Hart J, Womack KB. White Matter Changes and Confrontation Naming in Retired Aging National Football League Athletes. J Neurotrauma 2016; 34:372-379. [PMID: 27297660 DOI: 10.1089/neu.2016.4446] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Using diffusion tensor imaging (DTI), we assessed the relationship of white matter integrity and performance on the Boston Naming Test (BNT) in a group of retired professional football players and a control group. We examined correlations between fractional anisotropy (FA) and mean diffusivity (MD) with BNT T-scores in an unbiased voxelwise analysis processed with tract-based spatial statistics (TBSS). We also analyzed the DTI data by grouping voxels together as white matter tracts and testing each tract's association with BNT T-scores. Significant voxelwise correlations between FA and BNT performance were only seen in the retired football players (p < 0.02). Two tracts had mean FA values that significantly correlated with BNT performance: forceps minor and forceps major. White matter integrity is important for distributed cognitive processes, and disruption correlates with diminished performance in athletes exposed to concussive and subconcussive brain injuries, but not in controls without such exposure.
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Affiliation(s)
- Jeremy F Strain
- 1 Department of Neurology, Washington University School of Medicine , St. Louis, Missouri
| | - Nyaz Didehbani
- 2 Center for BrainHealth®, The University of Texas at Dallas , School of Behavioral and Brain Sciences, Dallas, Texas.,3 Department of Neurology and Neurotherapeutics and Department of Psychiatry, University of Texas Southwestern Medical Center , Dallas, Texas
| | - Jeffrey Spence
- 2 Center for BrainHealth®, The University of Texas at Dallas , School of Behavioral and Brain Sciences, Dallas, Texas
| | - Heather Conover
- 2 Center for BrainHealth®, The University of Texas at Dallas , School of Behavioral and Brain Sciences, Dallas, Texas
| | - Elizabeth K Bartz
- 2 Center for BrainHealth®, The University of Texas at Dallas , School of Behavioral and Brain Sciences, Dallas, Texas
| | - Sethesh Mansinghani
- 2 Center for BrainHealth®, The University of Texas at Dallas , School of Behavioral and Brain Sciences, Dallas, Texas
| | - Myrtle K Jeroudi
- 3 Department of Neurology and Neurotherapeutics and Department of Psychiatry, University of Texas Southwestern Medical Center , Dallas, Texas
| | - Neena K Rao
- 2 Center for BrainHealth®, The University of Texas at Dallas , School of Behavioral and Brain Sciences, Dallas, Texas
| | - Lindy M Fields
- 2 Center for BrainHealth®, The University of Texas at Dallas , School of Behavioral and Brain Sciences, Dallas, Texas
| | - Michael A Kraut
- 2 Center for BrainHealth®, The University of Texas at Dallas , School of Behavioral and Brain Sciences, Dallas, Texas.,4 Department of Radiology, The Johns Hopkins School of Medicine , Baltimore, Maryland
| | - C Munro Cullum
- 3 Department of Neurology and Neurotherapeutics and Department of Psychiatry, University of Texas Southwestern Medical Center , Dallas, Texas
| | - John Hart
- 2 Center for BrainHealth®, The University of Texas at Dallas , School of Behavioral and Brain Sciences, Dallas, Texas.,3 Department of Neurology and Neurotherapeutics and Department of Psychiatry, University of Texas Southwestern Medical Center , Dallas, Texas
| | - Kyle B Womack
- 3 Department of Neurology and Neurotherapeutics and Department of Psychiatry, University of Texas Southwestern Medical Center , Dallas, Texas
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165
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Wright DK, Trezise J, Kamnaksh A, Bekdash R, Johnston LA, Ordidge R, Semple BD, Gardner AJ, Stanwell P, O'Brien TJ, Agoston DV, Shultz SR. Behavioral, blood, and magnetic resonance imaging biomarkers of experimental mild traumatic brain injury. Sci Rep 2016; 6:28713. [PMID: 27349514 PMCID: PMC4923906 DOI: 10.1038/srep28713] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/07/2016] [Indexed: 12/14/2022] Open
Abstract
Repeated mild traumatic brain injuries (mTBI) may lead to serious neurological consequences, especially if re-injury occurs within the period of increased cerebral vulnerability (ICV) triggered by the initial insult. MRI and blood proteomics might provide objective measures of pathophysiological changes in mTBI, and indicate when the brain is no longer in a state of ICV. This study assessed behavioral, MRI, and blood-based markers in a rat model of mTBI. Rats were given a sham or mild fluid percussion injury (mFPI), and behavioral testing, MRI, and blood collections were conducted up to 30 days post-injury. There were cognitive impairments for three days post-mFPI, before normalizing by day 5 post-injury. In contrast, advanced MRI (i.e., tractography) and blood proteomics (i.e., vascular endothelial growth factor) detected a number of abnormalities, some of which were still present 30 days post-mFPI. These findings suggest that MRI and blood proteomics are sensitive measures of the molecular and subtle structural changes following mTBI. Of particular significance, this study identified novel tractography measures that are able to detect mTBI and may be more sensitive than traditional diffusion-tensor measures. Furthermore, the blood and MRI findings may have important implications in understanding ICV and are translatable to the clinical setting.
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Affiliation(s)
- David K Wright
- Anatomy and Neuroscience, The University of Melbourne, Parkville, VIC, 3010, Australia.,The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, 3052, Australia
| | - Jack Trezise
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, 3050, Australia
| | - Alaa Kamnaksh
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Ramsey Bekdash
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Leigh A Johnston
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, 3052, Australia.,Department of Electrical and Electronic Engineering, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Roger Ordidge
- Anatomy and Neuroscience, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Bridgette D Semple
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, 3050, Australia
| | - Andrew J Gardner
- Centre for Stroke and Brain Injury, School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Peter Stanwell
- School of Health Sciences, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Terence J O'Brien
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, 3050, Australia
| | - Denes V Agoston
- Department of Anatomy, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Sandy R Shultz
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, 3050, Australia
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166
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Wang X, Xie H, Cotton AS, Brickman KR, Lewis TJ, Wall JT, Tamburrino MB, Bauer WR, Law K, McLean SA, Liberzon I. Early Changes in Cortical Emotion Processing Circuits after Mild Traumatic Brain Injury from Motor Vehicle Collision. J Neurotrauma 2016; 34:273-280. [PMID: 27169480 DOI: 10.1089/neu.2015.4392] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Mild traumatic brain injury (mTBI) patients frequently experience emotion dysregulation symptoms, including post-traumatic stress. Although mTBI likely affects cortical activation and structure, resulting in cognitive symptoms after mTBI, early effects of mTBI on cortical emotion processing circuits have rarely been examined. To assess early mTBI effects on cortical functional and structural components of emotion processing, we assessed cortical activation to fearful faces within the first 2 weeks after motor vehicle collision (MVC) in survivors who did and did not experience mTBI. We also examined the thicknesses of cortical regions with altered activation. MVC survivors with mTBI (n = 21) had significantly less activation in left superior parietal gyrus (SPG) (-5.9, -81.8, 33.8; p = 10-3.623), left medial orbitofrontal gyrus (mOFG) (-4.7, 36.1, -19.3; p = 10-3.231), and left and right lateral orbitofrontal gyri (lOFG) (left: -16.0, 41.4, -16.6; p = 10-2.573; right: 18.7, 22.7, -17.7; p = 10-2.764) than MVC survivors without mTBI (n = 23). SPG activation in mTBI survivors within 2 weeks after MVC was negatively correlated with subsequent post-traumatic stress symptom severity at 3 months (r = -0.68, p = 0.03). Finally, the SPG region was thinner in the mTBI survivors than in the non-mTBI survivors (F = 11.07, p = 0.002). These results suggest that early differences in activation and structure in cortical emotion processing circuits in trauma survivors who sustain mTBI may contribute to the development of emotion-related symptoms.
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Affiliation(s)
- Xin Wang
- 1 Department of Psychiatry, University of Toledo , Toledo, Ohio.,2 Department of Neurosciences, University of Toledo , Toledo, Ohio.,3 Department of Radiology, University of Toledo , Toledo, Ohio
| | - Hong Xie
- 2 Department of Neurosciences, University of Toledo , Toledo, Ohio
| | - Andrew S Cotton
- 1 Department of Psychiatry, University of Toledo , Toledo, Ohio
| | | | | | - John T Wall
- 2 Department of Neurosciences, University of Toledo , Toledo, Ohio
| | | | - William R Bauer
- 2 Department of Neurosciences, University of Toledo , Toledo, Ohio
| | - Kenny Law
- 1 Department of Psychiatry, University of Toledo , Toledo, Ohio
| | - Samuel A McLean
- 5 Department of Anesthesiology, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Israel Liberzon
- 6 Department of Psychiatry, University of Michigan , Ann Arbor, Michigan
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167
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Sener S, Van Hecke W, Feyen BF, Van der Steen G, Pullens P, Van de Hauwe L, Menovsky T, Parizel PM, Jorens PG, Maas AI. Diffusion Tensor Imaging. Neurosurgery 2016; 79:786-793. [DOI: 10.1227/neu.0000000000001325] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
A great need exists in traumatic brain injury (TBI) and aneurysmal subarachnoid hemorrhage (aSAH) for objective biomarkers to better characterize the disease process and to serve as early endpoints in clinical studies. Diffusion tensor imaging (DTI) has shown promise in TBI, but much less is known about aSAH.
OBJECTIVE:
To explore the use of whole-brain DTI tractography in TBI and aSAH as a biomarker and early endpoint.
METHODS:
Of a cohort of 43 patients with severe TBI (n = 20) or aSAH (n = 23) enrolled in a prospective, observational, multimodality monitoring study, DTI data were acquired at approximately day 12 (median, 12 days; interquartile range, 12-14 days) after injury in 22 patients (TBI, n = 12; aSAH, n = 10). Whole-brain DTI tractography was performed, and the following parameters quantified: average fractional anisotropy, mean diffusivity, tract length, and the total number of reconstructed fiber tracts. These were compared between TBI and aSAH patients and correlated with mortality and functional outcome assessed at 6 months by the Glasgow Outcome Scale Extended.
RESULTS:
Significant differences were found for fractional anisotropy values (P = .01), total number of tracts (P = .03), and average tract length (P = .002) between survivors and nonsurvivors. A sensitivity analysis showed consistency of results between the TBI and aSAH patients for the various DTI measures.
CONCLUSION:
DTI parameters, assessed at approximately day 12 after injury, correlated with mortality at 6 months in patients with severe TBI or aSAH. Similar patterns were found for both TBI and aSAH patients. This supports a potential role of DTI as early endpoint for clinical studies and a predictor of late mortality.
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Affiliation(s)
- Süleyman Sener
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium
- University of Antwerp, Edegem, Belgium
| | - Wim Van Hecke
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
| | - Bart F.E. Feyen
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium
- University of Antwerp, Edegem, Belgium
| | | | - Pim Pullens
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
| | - Luc Van de Hauwe
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
| | - Tomas Menovsky
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium
- University of Antwerp, Edegem, Belgium
| | - Paul M. Parizel
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
- University of Antwerp, Edegem, Belgium
| | - Philippe G. Jorens
- Department of Intensive Care, Antwerp University Hospital, Edegem, Belgium
- University of Antwerp, Edegem, Belgium
| | - Andrew I.R. Maas
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium
- University of Antwerp, Edegem, Belgium
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168
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Connectome-scale assessment of structural and functional connectivity in mild traumatic brain injury at the acute stage. NEUROIMAGE-CLINICAL 2016; 12:100-115. [PMID: 27408795 PMCID: PMC4932612 DOI: 10.1016/j.nicl.2016.06.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 06/08/2016] [Accepted: 06/14/2016] [Indexed: 01/16/2023]
Abstract
Mild traumatic brain injury (mTBI) accounts for over one million emergency visits each year in the United States. The large-scale structural and functional network connectivity changes of mTBI are still unknown. This study was designed to determine the connectome-scale brain network connectivity changes in mTBI at both structural and functional levels. 40 mTBI patients at the acute stage and 50 healthy controls were recruited. A novel approach called Dense Individualized and Common Connectivity-based Cortical Landmarks (DICCCOLs) was applied for connectome-scale analysis of both diffusion tensor imaging and resting state functional MRI data. Among 358 networks identified on DICCCOL analysis, 41 networks were identified as structurally discrepant between patient and control groups. The involved major white matter tracts include the corpus callosum, and superior and inferior longitudinal fasciculi. Functional connectivity analysis identified 60 connectomic signatures that differentiate patients from controls with 93.75% sensitivity and 100% specificity. Analysis of functional domains showed decreased intra-network connectivity within the emotion network and among emotion-cognition interactions, and increased interactions among action-emotion and action-cognition as well as within perception networks. This work suggests that mTBI may result in changes of structural and functional connectivity on a connectome scale at the acute stage.
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169
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Wolf JA, Koch PF. Disruption of Network Synchrony and Cognitive Dysfunction After Traumatic Brain Injury. Front Syst Neurosci 2016; 10:43. [PMID: 27242454 PMCID: PMC4868948 DOI: 10.3389/fnsys.2016.00043] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/26/2016] [Indexed: 11/13/2022] Open
Abstract
Traumatic brain injury (TBI) is a heterogeneous disorder with many factors contributing to a spectrum of severity, leading to cognitive dysfunction that may last for many years after injury. Injury to axons in the white matter, which are preferentially vulnerable to biomechanical forces, is prevalent in many TBIs. Unlike focal injury to a discrete brain region, axonal injury is fundamentally an injury to the substrate by which networks of the brain communicate with one another. The brain is envisioned as a series of dynamic, interconnected networks that communicate via long axonal conduits termed the "connectome". Ensembles of neurons communicate via these pathways and encode information within and between brain regions in ways that are timing dependent. Our central hypothesis is that traumatic injury to axons may disrupt the exquisite timing of neuronal communication within and between brain networks, and that this may underlie aspects of post-TBI cognitive dysfunction. With a better understanding of how highly interconnected networks of neurons communicate with one another in important cognitive regions such as the limbic system, and how disruption of this communication occurs during injury, we can identify new therapeutic targets to restore lost function. This requires the tools of systems neuroscience, including electrophysiological analysis of ensemble neuronal activity and circuitry changes in awake animals after TBI, as well as computational modeling of the effects of TBI on these networks. As more is revealed about how inter-regional neuronal interactions are disrupted, treatments directly targeting these dysfunctional pathways using neuromodulation can be developed.
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Affiliation(s)
- John A Wolf
- Center for Brain Injury and Repair, Department of Neurosurgery, University of PennsylvaniaPhiladelphia, PA, USA; Corporal Michael J. Crescenz VA Medical CenterPhiladelphia, PA, USA
| | - Paul F Koch
- Center for Brain Injury and Repair, Department of Neurosurgery, University of Pennsylvania Philadelphia, PA, USA
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170
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Shim SS, Stutzmann GE. Inhibition of Glycogen Synthase Kinase-3: An Emerging Target in the Treatment of Traumatic Brain Injury. J Neurotrauma 2016; 33:2065-2076. [PMID: 26979735 DOI: 10.1089/neu.2015.4177] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Although traumatic brain injury (TBI) has been a major public health concern for decades, the pathophysiological mechanism of TBI is not clearly understood, and an effective medical treatment of TBI is not available at present. Of particular concern is sustained TBI, which has a strong tendency to take a deteriorating neurodegenerative course into chronic traumatic encephalopathy (CTE) and dementia, including Alzheimer's disease. Tauopathy and beta amyloid (Aβ) plaques are known to be the key pathological markers of TBI, which contribute to the progressive deterioration associated with TBI such as CTE and Alzheimer's disease. The multiple lines of evidence strongly suggest that the inhibition of glycogen synthase kinase-3 (GSK-3) is a potential target in the treatment of TBI. GSK-3 constitutively inhibits neuroprotective processes and promotes apoptosis. After TBI, GSK-3 is inhibited through the receptor tyrosine kinase (RTK) and canonical Wnt signaling pathways as an innate neuroprotective mechanism against TBI. GSK-3 inhibition via GSK-3 inhibitors and drugs activating RTK or Wnt signaling is likely to reinforce the innate neuroprotective mechanism. GSK-3 inhibition studies using rodent TBI models demonstrate that GSK-3 inhibition produces diverse neuroprotective actions such as reducing the size of the traumatic injury, tauopathy, Aβ accumulation, and neuronal death, by releasing and activating neuroprotective substrates from GSK-3 inhibition. These effects are correlated with reduced TBI-induced behavioral and cognitive symptoms. Here, we review studies on the therapeutic effects of GSK-3 inhibition in TBI rodent models, and critically discuss the issues that these studies address.
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Affiliation(s)
- Seong S Shim
- 1 Atlanta VA Medical Center, Mental Health Service Line , Decatur, Georgia
| | - Grace E Stutzmann
- 2 Department of Neuroscience, Rosalind Franklin University/The Chicago Medical School , North Chicago, Illinois
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Hilz MJ, Liu M, Koehn J, Wang R, Ammon F, Flanagan SR, Hösl KM. Valsalva maneuver unveils central baroreflex dysfunction with altered blood pressure control in persons with a history of mild traumatic brain injury. BMC Neurol 2016; 16:61. [PMID: 27146718 PMCID: PMC4857428 DOI: 10.1186/s12883-016-0584-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 04/29/2016] [Indexed: 02/04/2023] Open
Abstract
Background Patients with a history of mild TBI (post-mTBI-patients) have an unexplained increase in long-term mortality which might be related to central autonomic dysregulation (CAD). We investigated whether standardized baroreflex-loading, induced by a Valsalva maneuver (VM), unveils CAD in otherwise healthy post-mTBI-patients. Methods In 29 healthy persons (31.3 ± 12.2 years; 9 women) and 25 post-mTBI-patients (35.0 ± 13.2 years, 7 women, 4–98 months post-injury), we monitored respiration (RESP), RR-intervals (RRI) and systolic blood pressure (BP) at rest and during three VMs. At rest, we calculated parameters of total autonomic modulation [RRI-coefficient-of-variation (CV), RRI-standard-deviation (RRI-SD), RRI-total-powers], of sympathetic [RRI-low-frequency-powers (LF), BP-LF-powers] and parasympathetic modulation [square-root-of-mean-squared-differences-of-successive-RRIs (RMSSD), RRI-high-frequency-powers (HF)], the index of sympatho-vagal balance (RRI LF/HF-ratios), and baroreflex sensitivity (BRS). We calculated Valsalva-ratios (VR) and times from lowest to highest RRIs after strain (VR-time) as indices of parasympathetic activation, intervals from highest systolic BP-values after strain-release to the time when systolic BP had fallen by 90 % of the differences between peak-phase-IV-BP and baseline-BP (90 %-BP-normalization-times), and velocities of BP-normalization (90 %-BP-normalization-velocities) as indices of sympathetic withdrawal. We compared patient- and control-parameters before and during VM (Mann-Whitney-U-tests or t-tests; significance: P < 0.05). Results At rest, RRI-CVs, RRI-SDs, RRI-total-powers, RRI-LF-powers, BP-LF-powers, RRI-RMSSDs, RRI-HF-powers, and BRS were lower in patients than controls. During VMs, 90 %-BP-normalization-times were longer, and 90 %-BP-normalization-velocities were lower in patients than controls (P < 0.05). Conclusions Reduced autonomic modulation at rest and delayed BP-decrease after VM-induced baroreflex-loading indicate subtle CAD with altered baroreflex adjustment to challenge. More severe autonomic challenge might trigger more prominent cardiovascular dysregulation and thus contribute to increased mortality risk in post-mTBI-patients.
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Affiliation(s)
- Max J Hilz
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054, Erlangen, Germany.
| | - Mao Liu
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054, Erlangen, Germany
| | - Julia Koehn
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054, Erlangen, Germany
| | - Ruihao Wang
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054, Erlangen, Germany
| | - Fabian Ammon
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054, Erlangen, Germany
| | - Steven R Flanagan
- Department of Rehabilitation Medicine, New York University School of Medicine, 240 East 38th Street, New York, NY, 10016, USA
| | - Katharina M Hösl
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Prof.-Ernst-Nathan-Strasse 1, 90419, Nuremberg, Germany
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Multani N, Goswami R, Khodadadi M, Ebraheem A, Davis KD, Tator CH, Wennberg R, Mikulis DJ, Ezerins L, Tartaglia MC. The association between white-matter tract abnormalities, and neuropsychiatric and cognitive symptoms in retired professional football players with multiple concussions. J Neurol 2016; 263:1332-41. [PMID: 27142715 DOI: 10.1007/s00415-016-8141-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/20/2016] [Accepted: 04/22/2016] [Indexed: 02/02/2023]
Abstract
Retired professional athletes, who have suffered repetitive concussions, report symptoms of depression, anxiety, and memory impairment over time. Moreover, recent imaging data suggest chronic white-matter tract deterioration in sport-related concussion. The aim of this study is to evaluate the impact of repetitive concussions in retired professional football players on white-matter tracts, and relate these changes to neuropsychological function. All subjects (18 retired professional football players and 17 healthy controls) underwent imaging, neuropsychological assessment, and reported on concussion-related symptoms. Whole brain tract-based spatial statistics analysis revealed increased axial diffusivity in the right hemisphere of retired players in the (1) superior longitudinal fasciculus (SLF), (2) corticospinal tract, and (3) anterior thalamic radiations, suggesting chronic axonal degeneration in these tracts. Moreover, retired players report significantly higher neuropsychiatric and cognitive symptoms than healthy controls, and worsening of these symptoms since their last concussion. Loss of integrity in the right SLF significantly correlated with participants' visual learning ability. In sum, these results suggest that repetitive concussions in retired professional football players are associated with focal white-matter tract abnormalities that could explain some of the neuropsychiatric symptoms and cognitive deficits experienced by these retired athletes.
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Affiliation(s)
- Namita Multani
- Canadian Sports Concussion Project, Memory Clinic, Toronto Western Hospital, Tanz Centre for Research in Neurodegenerative Disease, 399 Bathurst St., West Wing 5-449, Toronto, ON, M5T 2S8, Canada.,Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada.,Division of Neurology, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada
| | - Ruma Goswami
- Canadian Sports Concussion Project, Memory Clinic, Toronto Western Hospital, Tanz Centre for Research in Neurodegenerative Disease, 399 Bathurst St., West Wing 5-449, Toronto, ON, M5T 2S8, Canada.,Division of Brain, Imaging and Behaviour-Systems Neuroscience, Toronto Western Hospital, Toronto Western Research Institute, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada
| | - Mozhgan Khodadadi
- Canadian Sports Concussion Project, Memory Clinic, Toronto Western Hospital, Tanz Centre for Research in Neurodegenerative Disease, 399 Bathurst St., West Wing 5-449, Toronto, ON, M5T 2S8, Canada
| | - Ahmed Ebraheem
- Canadian Sports Concussion Project, Memory Clinic, Toronto Western Hospital, Tanz Centre for Research in Neurodegenerative Disease, 399 Bathurst St., West Wing 5-449, Toronto, ON, M5T 2S8, Canada
| | - Karen D Davis
- Canadian Sports Concussion Project, Memory Clinic, Toronto Western Hospital, Tanz Centre for Research in Neurodegenerative Disease, 399 Bathurst St., West Wing 5-449, Toronto, ON, M5T 2S8, Canada.,Division of Brain, Imaging and Behaviour-Systems Neuroscience, Toronto Western Hospital, Toronto Western Research Institute, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada.,Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Department of Surgery, University of Toronto, 149 College Street, Toronto, ON, M5T 1P5, Canada
| | - Charles H Tator
- Canadian Sports Concussion Project, Memory Clinic, Toronto Western Hospital, Tanz Centre for Research in Neurodegenerative Disease, 399 Bathurst St., West Wing 5-449, Toronto, ON, M5T 2S8, Canada.,Division of Brain, Imaging and Behaviour-Systems Neuroscience, Toronto Western Hospital, Toronto Western Research Institute, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada.,Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Department of Surgery, University of Toronto, 149 College Street, Toronto, ON, M5T 1P5, Canada.,Division of Neurosurgery, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada
| | - Richard Wennberg
- Canadian Sports Concussion Project, Memory Clinic, Toronto Western Hospital, Tanz Centre for Research in Neurodegenerative Disease, 399 Bathurst St., West Wing 5-449, Toronto, ON, M5T 2S8, Canada.,Division of Neurology, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada
| | - David J Mikulis
- Canadian Sports Concussion Project, Memory Clinic, Toronto Western Hospital, Tanz Centre for Research in Neurodegenerative Disease, 399 Bathurst St., West Wing 5-449, Toronto, ON, M5T 2S8, Canada.,Division of Brain, Imaging and Behaviour-Systems Neuroscience, Toronto Western Hospital, Toronto Western Research Institute, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada.,Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Department of Medical Imaging, Toronto Western Hospital, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada
| | - Leo Ezerins
- Canadian Sports Concussion Project, Memory Clinic, Toronto Western Hospital, Tanz Centre for Research in Neurodegenerative Disease, 399 Bathurst St., West Wing 5-449, Toronto, ON, M5T 2S8, Canada
| | - Maria Carmela Tartaglia
- Canadian Sports Concussion Project, Memory Clinic, Toronto Western Hospital, Tanz Centre for Research in Neurodegenerative Disease, 399 Bathurst St., West Wing 5-449, Toronto, ON, M5T 2S8, Canada. .,Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, 60 Leonard Avenue, Toronto, ON, M5T 2S8, Canada. .,Division of Neurology, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada.
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Clark AL, Sorg SF, Schiehser DM, Luc N, Bondi MW, Sanderson M, Werhane ML, Delano-Wood L. Deep white matter hyperintensities affect verbal memory independent of PTSD symptoms in veterans with mild traumatic brain injury. Brain Inj 2016; 30:864-71. [DOI: 10.3109/02699052.2016.1144894] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Alexandra L. Clark
- San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Scott F. Sorg
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, UCSD School of Medicine, San Diego, CA, USA
| | - Dawn M. Schiehser
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, UCSD School of Medicine, San Diego, CA, USA
| | - Norman Luc
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Mark W. Bondi
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, UCSD School of Medicine, San Diego, CA, USA
| | - Mark Sanderson
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Madeleine L. Werhane
- San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Lisa Delano-Wood
- VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, UCSD School of Medicine, San Diego, CA, USA
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
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176
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Li J, Gao L, Xie K, Zhan J, Luo X, Wang H, Zhang H, Zhao J, Zhou F, Zeng X, He L, He Y, Gong H. Detection of Functional Homotopy in Traumatic Axonal Injury. Eur Radiol 2016; 27:325-335. [PMID: 27048533 DOI: 10.1007/s00330-016-4302-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 02/01/2016] [Accepted: 02/23/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study aimed to explore the interhemispheric intrinsic connectivity in traumatic axonal injury (TAI) patients. METHODS Twenty-one patients with TAI (14 males, seven females; mean age, 38.71 ± 15.25 years) and 22 well-matched healthy controls (16 males, six females; mean age, 38.50 ± 13.82 years) were recruited, and from them we obtained resting-state fMRI data. Interhemispheric coordination was examined using voxel-mirrored homotopic connectivity (VMHC) and seed-based functional connectivity analysis was performed. RESULTS We observed significantly decreased VMHC in a number of regions in TAI patients, including the prefrontal, temporal, occipital, parietal, and posterior cingulate cortices, thalami and cerebellar posterior lobes. Subsequent seed-based functional connectivity analysis revealed widely disrupted functional connectivity between the regions of local homotopic connectivity deficits and other areas of the brain, particularly the areas subserving the default, salience, integrative, and executive systems. The lower VMHC of the inferior frontal gyrus and basal ganglia, thalamus, and caudate were significant correlated with the Beck Depression Inventory score, Clinical Dementia Rating score, and Mini-Mental State Examination score, respectively. CONCLUSION TAI is associated with regionally decreased interhemispheric interactions and extensively disrupted seed-based functional connectivity, generating further evidence of diffuse disconnection being associated with clinical symptoms in TAI patients. KEY POINTS • Traumatic axonal injury is associated with decreased interhemispheric connectivity • Traumatic axonal injury couples with widely disrupted functional connectivity • These alterations support the default, salience, integrative, and executive functions.
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Affiliation(s)
- Jian Li
- Department of Radiology, The First Affiliated Hospital, Nanchang University, 17 Yongwai Zheng Street, Donghu District, Nanchang City, Jiangxi, 330006, China
| | - Lei Gao
- Department of Radiology, The First Affiliated Hospital, Nanchang University, 17 Yongwai Zheng Street, Donghu District, Nanchang City, Jiangxi, 330006, China.
| | - Kai Xie
- Department of Radiology, The First Affiliated Hospital, Nanchang University, 17 Yongwai Zheng Street, Donghu District, Nanchang City, Jiangxi, 330006, China
| | - Jie Zhan
- Department of Radiology, The First Affiliated Hospital, Nanchang University, 17 Yongwai Zheng Street, Donghu District, Nanchang City, Jiangxi, 330006, China
| | - Xiaoping Luo
- Department of Radiology, The First Affiliated Hospital, Nanchang University, 17 Yongwai Zheng Street, Donghu District, Nanchang City, Jiangxi, 330006, China
| | - Huifang Wang
- Department of Radiology, The First Affiliated Hospital, Nanchang University, 17 Yongwai Zheng Street, Donghu District, Nanchang City, Jiangxi, 330006, China
| | - Huifang Zhang
- Department of Radiology, The First Affiliated Hospital, Nanchang University, 17 Yongwai Zheng Street, Donghu District, Nanchang City, Jiangxi, 330006, China
| | - Jing Zhao
- Department of Radiology, The First Affiliated Hospital, Nanchang University, 17 Yongwai Zheng Street, Donghu District, Nanchang City, Jiangxi, 330006, China
| | - Fuqing Zhou
- Department of Radiology, The First Affiliated Hospital, Nanchang University, 17 Yongwai Zheng Street, Donghu District, Nanchang City, Jiangxi, 330006, China
| | - Xianjun Zeng
- Department of Radiology, The First Affiliated Hospital, Nanchang University, 17 Yongwai Zheng Street, Donghu District, Nanchang City, Jiangxi, 330006, China
| | - Laichang He
- Department of Radiology, The First Affiliated Hospital, Nanchang University, 17 Yongwai Zheng Street, Donghu District, Nanchang City, Jiangxi, 330006, China
| | - Yulin He
- Department of Radiology, The First Affiliated Hospital, Nanchang University, 17 Yongwai Zheng Street, Donghu District, Nanchang City, Jiangxi, 330006, China
| | - Honghan Gong
- Department of Radiology, The First Affiliated Hospital, Nanchang University, 17 Yongwai Zheng Street, Donghu District, Nanchang City, Jiangxi, 330006, China
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Dall'Acqua P, Johannes S, Mica L, Simmen HP, Glaab R, Fandino J, Schwendinger M, Meier C, Ulbrich EJ, Müller A, Jäncke L, Hänggi J. Connectomic and Surface-Based Morphometric Correlates of Acute Mild Traumatic Brain Injury. Front Hum Neurosci 2016; 10:127. [PMID: 27065831 PMCID: PMC4809899 DOI: 10.3389/fnhum.2016.00127] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/09/2016] [Indexed: 02/01/2023] Open
Abstract
Reduced integrity of white matter (WM) pathways and subtle anomalies in gray matter (GM) morphology have been hypothesized as mechanisms in mild traumatic brain injury (mTBI). However, findings on structural brain changes in early stages after mTBI are inconsistent and findings related to early symptoms severity are rare. Fifty-one patients were assessed with multimodal neuroimaging and clinical methods exclusively within 7 days following mTBI and compared to 53 controls. Whole-brain connectivity based on diffusion tensor imaging was subjected to network-based statistics, whereas cortical surface area, thickness, and volume based on T1-weighted MRI scans were investigated using surface-based morphometric analysis. Reduced connectivity strength within a subnetwork of 59 edges located predominantly in bilateral frontal lobes was significantly associated with higher levels of self-reported symptoms. In addition, cortical surface area decreases were associated with stronger complaints in five clusters located in bilateral frontal and postcentral cortices, and in the right inferior temporal region. Alterations in WM and GM were localized in similar brain regions and moderately-to-strongly related to each other. Furthermore, the reduction of cortical surface area in the frontal regions was correlated with poorer attentive-executive performance in the mTBI group. Finally, group differences were detected in both the WM and GM, especially when focusing on a subgroup of patients with greater complaints, indicating the importance of classifying mTBI patients according to severity of symptoms. This study provides evidence that mTBI affects not only the integrity of WM networks by means of axonal damage but also the morphology of the cortex during the initial post-injury period. These anomalies might be greater in the acute period than previously believed and the involvement of frontal brain regions was consistently pronounced in both findings. The dysconnected subnetwork suggests that mTBI can be conceptualized as a dysconnection syndrome. It remains unclear whether reduced WM integrity is the trigger for changes in cortical surface area or whether tissue deformations are the direct result of mechanical forces acting on the brain. The findings suggest that rapid identification of high-risk patients with the use of clinical scales should be assessed acutely as part of the mTBI protocol.
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Affiliation(s)
- Patrizia Dall'Acqua
- Bellikon Rehabilitation ClinicBellikon, Switzerland; Division Neuropsychology, Department of Psychology, University of ZurichZurich, Switzerland
| | | | - Ladislav Mica
- Division of Trauma Surgery, University Hospital Zurich Zurich, Switzerland
| | - Hans-Peter Simmen
- Division of Trauma Surgery, University Hospital Zurich Zurich, Switzerland
| | - Richard Glaab
- Department of Traumatology, Cantonal Hospital Aarau Aarau, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Cantonal Hospital Aarau Aarau, Switzerland
| | - Markus Schwendinger
- Interdisciplinary Emergency Centre, Baden Cantonal Hospital Baden, Switzerland
| | - Christoph Meier
- Department of Surgery, Waid Hospital Zurich Zurich, Switzerland
| | - Erika J Ulbrich
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich Zurich, Switzerland
| | | | - Lutz Jäncke
- Division Neuropsychology, Department of Psychology, University of ZurichZurich, Switzerland; International Normal Aging and Plasticity Imaging Center, University of ZurichZurich, Switzerland; Center for Integrative Human Physiology, University of ZurichZurich, Switzerland; University Research Priority Program, Dynamic of Healthy Aging, University of ZurichZurich, Switzerland
| | - Jürgen Hänggi
- Division Neuropsychology, Department of Psychology, University of Zurich Zurich, Switzerland
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Diffusion tensor imaging alterations in patients with postconcussion syndrome undergoing exercise treatment: a pilot longitudinal study. J Head Trauma Rehabil 2016; 30:E32-42. [PMID: 24721808 DOI: 10.1097/htr.0000000000000037] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate diffusion tensor imaging characteristics in patients with postconcussion syndrome (PCS) who received exercise (n = 4) and placebo stretching (n = 4) treatments compared with a group of healthy controls (n = 15). METHODS Subjects diagnosed with PCS obtained a diffusion tensor imaging magnetic resonance image at pretreatment (baseline) and approximately 8 weeks later (follow-up). Analyses included a groupwise comparison using tract-based spatial statistics and a z-score map that investigated localized regional anomalies compared with the healthy control group projected onto the tract-based spatial statistics skeleton. RESULTS The tract-based spatial statistics analysis detected groupwise differences in the genu of the corpus callosum at both time points with decreased fractional anisotropy and increased radial diffusivity and mean diffusivity values. In contrast, the z-score analysis was more sensitive to heterogeneous changes in fractional anisotropy, with both low- and high-localized areas across various white matter regions, the most prevalent being the corpus callosum, anterior and superior corona radiata, and internal and external capsules. The mean number of voxels different in patients with PCS versus healthy controls was greater in all cases (baseline lower: P < .03 and higher: P < .0001; follow-up lower: P < .0001 and higher: P < .0001). The volume and location of these abnormal regions changed between the 2 diffusion tensor imaging scans, but these did not correlate with the mitigation of symptoms in the patients with PCS. CONCLUSIONS Diffusion tensor imaging revealed spatially varying and heterogeneous localized irregularities in patients with PCS that persisted even as patient symptoms decreased and prognosis improved.
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Post-concussive syndrome after mild head trauma: epidemiological features in Tunisia. Eur J Trauma Emerg Surg 2016; 43:747-753. [DOI: 10.1007/s00068-016-0656-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 03/01/2016] [Indexed: 10/22/2022]
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Wright AD, Jarrett M, Vavasour I, Shahinfard E, Kolind S, van Donkelaar P, Taunton J, Li D, Rauscher A. Myelin Water Fraction Is Transiently Reduced after a Single Mild Traumatic Brain Injury--A Prospective Cohort Study in Collegiate Hockey Players. PLoS One 2016; 11:e0150215. [PMID: 26913900 PMCID: PMC4767387 DOI: 10.1371/journal.pone.0150215] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/10/2016] [Indexed: 12/12/2022] Open
Abstract
Impact-related mild traumatic brain injuries (mTBI) are a major public health concern, and remain as one of the most poorly understood injuries in the field of neuroscience. Currently, the diagnosis and management of such injuries are based largely on patient-reported symptoms. An improved understanding of the underlying pathophysiology of mTBI is urgently needed in order to develop better diagnostic and management protocols. Specifically, dynamic post-injury changes to the myelin sheath in the human brain have not been examined, despite ‘compromised white matter integrity’ often being described as a consequence of mTBI. In this preliminary cohort study, myelin water imaging was used to prospectively evaluate changes in myelin water fraction, derived from the T2 decay signal, in two varsity hockey teams (45 players) over one season of athletic competition. 11 players sustained a concussion during competition, and were scanned at 72 hours, 2 weeks, and 2 months post-injury. Results demonstrated a reduction in myelin water fraction at 2 weeks post-injury in several brain areas relative to preseason scans, including the splenium of the corpus callosum, right posterior thalamic radiation, left superior corona radiata, left superior longitudinal fasciculus, and left posterior limb of the internal capsule. Myelin water fraction recovered to pre-season values by 2 months post-injury. These results may indicate transient myelin disruption following a single mTBI, with subsequent remyelination of affected neurons. Myelin disruption was not apparent in the athletes who did not experience a concussion, despite exposure to repetitive subconcussive trauma over a season of collegiate hockey. These findings may help to explain many of the metabolic and neurological deficits observed clinically following mTBI.
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Affiliation(s)
- Alexander D. Wright
- MD/PhD Program, University of British Columbia, Vancouver, Canada
- Southern Medical Program, University of British Columbia Okanagan, Kelowna, Canada
- Department of Experimental Medicine, University of British Columbia, Vancouver, Canada
| | - Michael Jarrett
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
| | - Irene Vavasour
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
| | - Elham Shahinfard
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
| | - Shannon Kolind
- Faculty of Medicine, Division of Neurology, University of British Columbia, Vancouver, Canada
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada
| | - Jack Taunton
- Faculty of Medicine, Division of Sports Medicine, University of British Columbia, Vancouver, Canada
| | - David Li
- Faculty of Medicine, Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Alexander Rauscher
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
- Department of Pediatrics, Division of Neurology, University of British Columbia, Vancouver, Canada
- * E-mail:
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Yang T, Song J, Bu X, Wang C, Wu J, Cai J, Wan S, Fan C, Zhang C, Wang J. Elevated serum miR-93, miR-191, and miR-499 are noninvasive biomarkers for the presence and progression of traumatic brain injury. J Neurochem 2016; 137:122-9. [PMID: 26756543 DOI: 10.1111/jnc.13534] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/05/2016] [Accepted: 01/07/2016] [Indexed: 12/17/2022]
Abstract
The levels of miR-93, miR-191, and miR-499 have been reported to be up-regulated in the tissues of experimental traumatic brain injury (TBI) rat models. However, the clinical diagnostic and prognostic values of the serum signatures of these 3 miRNAs in TBI remain unclear. The purpose of this study was to determine the expression levels of these 3 microRNAs (miRNAs) in the sera of TBI patients and to evaluate their relationships with the severity and clinical outcome of TBI. The serum levels of these miRNAs were assessed in TBI patients (n = 76) and healthy controls (n = 38) by quantitative reverse-transcription PCR. The severities and clinical outcomes of the TBI patients were evaluated with the Glasgow coma scale and the Glasgow outcome scale. The serum miR-93, miR-191, and miR-499 levels were significantly increased in the TBI patients compared with the controls at all examined time points, and these levels were significantly higher in the patients with severe TBI than in those with moderate or mild TBI (p < 0.05). The serum miR-93, miR-191, and miR-499 levels were significantly higher in the patients with a poor outcome than in those with a good outcome (p < 0.05). The AUCs of miR-93, miR-191, and miR-499 for distinguishing the TBI patients from the healthy controls were 1.000 (p < 0.001), 0.727 (p < 0.001) and 0.801 (p < 0.001), respectively. Interestingly, the AUCs of miR-93, miR-191, and miR-499 for distinguishing the mild TBI patients from the healthy controls were 1.000 (p < 0.001), 0.742 (p < 0.001) and 0.819 (p < 0.001), respectively. Taken together, these results indicate that miR-93, miR-191, and miR-499 are potentially valuable indicators of the diagnosis, severity, and prognosis of TBI. Our study showed that the serum levels of miR-93, miR-191, and miR-499 are all increased in traumatic brain injury (TBI) patients. Their serum levels are associated with TBI severity and outcome, which suggest that these miRNAs play important roles in the pathogenesis and progression of TBI. We think these findings should provide a new strategy for the diagnostic, prognostic, and treatment of TBI.
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Affiliation(s)
- Ting Yang
- Department of Clinical Laboratory, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Jiaxi Song
- Department of Clinical Laboratory, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Xiaomin Bu
- Department of Clinical Laboratory, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Cheng Wang
- Department of Clinical Laboratory, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Jia Wu
- Department of Clinical Laboratory, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Jialu Cai
- Department of Clinical Laboratory, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Shujun Wan
- Department of Clinical Laboratory, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Chunli Fan
- Department of Clinical Laboratory, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Chunni Zhang
- Department of Clinical Laboratory, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Junjun Wang
- Department of Clinical Laboratory, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
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182
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Abstract
It is time to stop using the term concussion as it has no clear definition and no pathological meaning. This confusion is increasingly problematic as the management of ‘concussed’ individuals is a pressing concern. Historically, it has been used to describe patients briefly disabled following a head injury, with the assumption that this was due to a transient disorder of brain function without long-term sequelae. However, the symptoms of concussion are highly variable in duration, and can persist for many years with no reliable early predictors of outcome. Using vague terminology for post-traumatic problems leads to misconceptions and biases in the diagnostic process, producing uninterpretable science, poor clinical guidelines and confused policy. We propose that the term concussion should be avoided. Instead neurologists and other healthcare professionals should classify the severity of traumatic brain injury and then attempt to precisely diagnose the underlying cause of post-traumatic symptoms.
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Affiliation(s)
- David J Sharp
- Computational, Cognitive, and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Peter O Jenkins
- Computational, Cognitive, and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK
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183
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Disrupted Intrinsic Connectivity among Default, Dorsal Attention, and Frontoparietal Control Networks in Individuals with Chronic Traumatic Brain Injury. J Int Neuropsychol Soc 2016; 22:263-79. [PMID: 26888622 PMCID: PMC4763346 DOI: 10.1017/s1355617715001393] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Individuals with chronic traumatic brain injury (TBI) often show detrimental deficits in higher order cognitive functions requiring coordination of multiple brain networks. Although assessing TBI-related deficits in higher order cognition in the context of network dysfunction is promising, few studies have systematically investigated altered interactions among multiple networks in chronic TBI. METHOD We characterized disrupted resting-state functional connectivity of the default mode network (DMN), dorsal attention network (DAN), and frontoparietal control network (FPCN) whose interactions are required for internally and externally focused goal-directed cognition in chronic TBI. Specifically, we compared the network interactions of 40 chronic TBI individuals (8 years post-injury on average) with those of 17 healthy individuals matched for gender, age, and years of education. RESULTS The network-based statistic (NBS) on DMN-DAN-FPCN connectivity of these groups revealed statistically significant (p NBS2.58) reductions in within-DMN, within-FPCN, DMN-DAN, and DMN-FPCN connectivity of the TBI group over healthy controls. Importantly, such disruptions occurred prominently in between-network connectivity. Subsequent analyses further exhibited the disrupted connectivity patterns of the chronic TBI group occurring preferentially in long-range and inter-hemispheric connectivity of DMN-DAN-FPCN. Most importantly, graph-theoretic analysis demonstrated relative reductions in global, local and cost efficiency (p<.05) as a consequence of the network disruption patterns in the TBI group. CONCLUSION Our findings suggest that assessing multiple networks-of-interest simultaneously will allow us to better understand deficits in goal-directed cognition and other higher order cognitive phenomena in chronic TBI. Future research will be needed to better understand the behavioral consequences related to these network disruptions.
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184
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D'souza MM, Trivedi R, Singh K, Grover H, Choudhury A, Kaur P, Kumar P, Tripathi RP. Traumatic brain injury and the post-concussion syndrome: A diffusion tensor tractography study. Indian J Radiol Imaging 2016; 25:404-14. [PMID: 26751097 PMCID: PMC4693390 DOI: 10.4103/0971-3026.169445] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: The aim of the present study is to evaluate diffusion tensor tractography (DTT) as a tool for detecting diffuse axonal injury in patients of acute, mild, and moderate traumatic brain injury (TBI), using two diffusion variables: Fractional anisotropy (FA) and mean diffusivity (MD). The correlation of these indices with the severity of post-concussive symptoms was also assessed. Materials and Methods: Nineteen patients with acute, mild, or moderate TBI and twelve age- and sex-matched healthy controls were recruited. Following Magnetic Resonance Imaging (MRI) on a 3.0-T scanner, DTT was performed using the ‘fiber assignment by continuous tracking’ (FACT) algorithm for fiber reconstruction. Appropriate statistical tools were used to see the difference in FA and MD values between the control and patient groups. In the latter group, the severity of post-concussive symptoms was assessed six months following trauma, using the Rivermead Postconcussion Symptoms Questionnaire (RPSQ). Results: The patients displayed significant reduction in FA compared to the controls (P < 0.05) in several tracts, notably the corpus callosum, fornix, bilateral uncinate fasciculus, and bilateral superior thalamic radiations. Changes in MD were statistically significant in the left uncinate, inferior longitudinal fasciculus, and left posterior thalamic radiation. A strong correlation between these indices and the RPSQ scores was observed in several white matter tracts. Conclusion: Diffusion tensor imaging (DTI)-based quantitative analysis in acute, mild, and moderate TBI can identify axonal injury neuropathology, over and above that visualized on conventional MRI scans. Furthermore, the significant correlation observed between FA and MD indices and the severity of post-concussive symptoms could make it a useful predictor of the long-term outcome.
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Affiliation(s)
- Maria M D'souza
- Department of NMR and Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences (INMAS), New Delhi, India
| | - Richa Trivedi
- Department of NMR and Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences (INMAS), New Delhi, India
| | - Kavita Singh
- Department of NMR and Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences (INMAS), New Delhi, India
| | - Hemal Grover
- Department of Radiodiagnosis, Government Medical College, Patiala, Punjab, India
| | - Ajay Choudhury
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Ram Manohar Lohia Hospital, New Delhi, India
| | - Prabhjot Kaur
- Department of NMR and Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences (INMAS), New Delhi, India
| | - Pawan Kumar
- Department of NMR and Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences (INMAS), New Delhi, India
| | - Rajendra Prashad Tripathi
- Department of NMR and Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences (INMAS), New Delhi, India
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185
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Edlow BL, Copen WA, Izzy S, Bakhadirov K, van der Kouwe A, Glenn MB, Greenberg SM, Greer DM, Wu O. Diffusion tensor imaging in acute-to-subacute traumatic brain injury: a longitudinal analysis. BMC Neurol 2016; 16:2. [PMID: 26754948 PMCID: PMC4707723 DOI: 10.1186/s12883-015-0525-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 12/31/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Diffusion tensor imaging (DTI) may have prognostic utility in patients with traumatic brain injury (TBI), but the optimal timing of DTI data acquisition is unknown because of dynamic changes in white matter water diffusion during the acute and subacute stages of TBI. We aimed to characterize the direction and magnitude of early longitudinal changes in white matter fractional anisotropy (FA) and to determine whether acute or subacute FA values correlate more reliably with functional outcomes after TBI. METHODS From a prospective TBI outcomes database, 11 patients who underwent acute (≤7 days) and subacute (8 days to rehabilitation discharge) DTI were retrospectively analyzed. Longitudinal changes in FA were measured in 11 white matter regions susceptible to traumatic axonal injury. Correlations were assessed between acute FA, subacute FA and the disability rating scale (DRS) score, which was ascertained at discharge from inpatient rehabilitation. RESULTS FA declined from the acute-to-subacute period in the genu of the corpus callosum (0.70 ± 0.02 vs. 0.55 ± 0.11, p < 0.05) and inferior longitudinal fasciculus (0.54+/-0.07 vs. 0.49+/-0.07, p < 0.01). Acute correlations between FA and DRS score were variable: higher FA in the body (R = -0.78, p = 0.02) and splenium (R = -0.83, p = 0.003) of the corpus callosum was associated with better outcomes (i.e. lower DRS scores), whereas higher FA in the genu of the corpus callosum (R = 0.83, p = 0.02) corresponded with worse outcomes (i.e. higher DRS scores). In contrast, in the subacute period higher FA in the splenium correlated with better outcomes (R = -0.63, p < 0.05) and no inverse correlations were observed. CONCLUSIONS White matter FA declined during the acute-to-subacute stages of TBI. Variability in acute FA correlations with outcome suggests that the optimal timing of DTI for TBI prognostication may be in the subacute period.
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Affiliation(s)
- Brian L Edlow
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. .,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.
| | - William A Copen
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Saef Izzy
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Khamid Bakhadirov
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Andre van der Kouwe
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.
| | - Mel B Glenn
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - David M Greer
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. .,Department of Neurology, Yale-New Haven Hospital, Yale School of Medicine, New Haven, CT, USA.
| | - Ona Wu
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. .,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.
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186
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Astafiev SV, Zinn KL, Shulman GL, Corbetta M. Exploring the physiological correlates of chronic mild traumatic brain injury symptoms. NEUROIMAGE-CLINICAL 2016; 11:10-19. [PMID: 26909324 PMCID: PMC4732189 DOI: 10.1016/j.nicl.2016.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 12/31/2015] [Accepted: 01/04/2016] [Indexed: 12/14/2022]
Abstract
We report on the results of a multimodal imaging study involving behavioral assessments, evoked and resting-state BOLD fMRI, and DTI in chronic mTBI subjects. We found that larger task-evoked BOLD activity in the MT+/LO region in extra-striate visual cortex correlated with mTBI and PTSD symptoms, especially light sensitivity. Moreover, higher FA values near the left optic radiation (OR) were associated with both light sensitivity and higher BOLD activity in the MT+/LO region. The MT+/LO region was localized as a region of abnormal functional connectivity with central white matter regions previously found to have abnormal physiological signals during visual eye movement tracking (Astafiev et al., 2015). We conclude that mTBI symptoms and light sensitivity may be related to excessive responsiveness of visual cortex to sensory stimuli. This abnormal sensitivity may be related to chronic remodeling of white matter visual pathways acutely injured. We report a multimodal imaging study of symptoms in chronic mTBI. Higher BOLD activity in the MT +/LO region correlated with mTBI symptoms. Higher FA near the left optic radiation was associated with light sensitivity.
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Affiliation(s)
- Serguei V Astafiev
- Department of Neurology, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8225, St. Louis, MO 63110, USA.
| | - Kristina L Zinn
- Department of Neurology, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8225, St. Louis, MO 63110, USA.
| | - Gordon L Shulman
- Department of Neurology, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8225, St. Louis, MO 63110, USA.
| | - Maurizio Corbetta
- Department of Neurology, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8225, St. Louis, MO 63110, USA.
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187
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Lolli V, Pezzullo M, Delpierre I, Sadeghi N. MDCT imaging of traumatic brain injury. Br J Radiol 2016; 89:20150849. [PMID: 26607650 PMCID: PMC4985461 DOI: 10.1259/bjr.20150849] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/18/2015] [Accepted: 11/23/2015] [Indexed: 01/24/2023] Open
Abstract
The aim of emergency imaging is to detect treatable lesions before secondary neurological damage occurs. CT plays a primary role in the acute setting of head trauma, allowing accurate detection of lesions requiring immediate neurosurgical treatment. CT is also accurate in detecting secondary injuries and is therefore essential in follow-up. This review discusses the main characteristics of primary and secondary brain injuries.
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Affiliation(s)
- Valentina Lolli
- Radiology Department, Erasmus University Hospital, Brussels, Belgium
| | - Martina Pezzullo
- Radiology Department, Erasmus University Hospital, Brussels, Belgium
| | | | - Niloufar Sadeghi
- Radiology Department, Erasmus University Hospital, Brussels, Belgium
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188
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Delouche A, Attyé A, Heck O, Grand S, Kastler A, Lamalle L, Renard F, Krainik A. Diffusion MRI: Pitfalls, literature review and future directions of research in mild traumatic brain injury. Eur J Radiol 2016; 85:25-30. [PMID: 26724645 DOI: 10.1016/j.ejrad.2015.11.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/06/2015] [Accepted: 11/01/2015] [Indexed: 12/27/2022]
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189
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Jang SH. Diagnostic History of Traumatic Axonal Injury in Patients with Cerebral Concussion and Mild Traumatic Brain Injury. BRAIN & NEUROREHABILITATION 2016. [DOI: 10.12786/bn.2016.9.e1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
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190
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SNTF immunostaining reveals previously undetected axonal pathology in traumatic brain injury. Acta Neuropathol 2016; 131:115-35. [PMID: 26589592 DOI: 10.1007/s00401-015-1506-0] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 10/27/2015] [Accepted: 10/31/2015] [Indexed: 11/27/2022]
Abstract
Diffuse axonal injury (DAI) is a common feature of severe traumatic brain injury (TBI) and may also be a predominant pathology in mild TBI or "concussion". The rapid deformation of white matter at the instant of trauma can lead to mechanical failure and calcium-dependent proteolysis of the axonal cytoskeleton in association with axonal transport interruption. Recently, a proteolytic fragment of alpha-II spectrin, "SNTF", was detected in serum acutely following mild TBI in patients and was prognostic for poor clinical outcome. However, direct evidence that this fragment is a marker of DAI has yet to be demonstrated in either humans following TBI or in models of mild TBI. Here, we used immunohistochemistry (IHC) to examine for SNTF in brain tissue following both severe and mild TBI. Human severe TBI cases (survival <7d; n = 18) were compared to age-matched controls (n = 16) from the Glasgow TBI archive. We also examined brains from an established model of mild TBI at 6, 48 and 72 h post-injury versus shams. IHC specific for SNTF was compared to that of amyloid precursor protein (APP), the current standard for DAI diagnosis, and other known markers of axonal pathology including non-phosphorylated neurofilament-H (SMI-32), neurofilament-68 (NF-68) and compacted neurofilament-medium (RMO-14) using double and triple immunofluorescent labeling. Supporting its use as a biomarker of DAI, SNTF immunoreactive axons were observed at all time points following both human severe TBI and in the model of mild TBI. Interestingly, SNTF revealed a subpopulation of degenerating axons, undetected by the gold-standard marker of transport interruption, APP. While there was greater axonal co-localization between SNTF and APP after severe TBI in humans, a subset of SNTF positive axons displayed no APP accumulation. Notably, some co-localization was observed between SNTF and the less abundant neurofilament subtype markers. Other SNTF positive axons, however, did not co-localize with any other markers. Similarly, RMO-14 and NF-68 positive axonal pathology existed independent of SNTF and APP. These data demonstrate that multiple pathological axonal phenotypes exist post-TBI and provide insight into a more comprehensive approach to the neuropathological assessment of DAI.
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191
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Newcombe VFJ, Correia MM, Ledig C, Abate MG, Outtrim JG, Chatfield D, Geeraerts T, Manktelow AE, Garyfallidis E, Pickard JD, Sahakian BJ, Hutchinson PJA, Rueckert D, Coles JP, Williams GB, Menon DK. Dynamic Changes in White Matter Abnormalities Correlate With Late Improvement and Deterioration Following TBI: A Diffusion Tensor Imaging Study. Neurorehabil Neural Repair 2016; 30:49-62. [PMID: 25921349 DOI: 10.1177/1545968315584004] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Traumatic brain injury (TBI) is not a single insult with monophasic resolution, but a chronic disease, with dynamic processes that remain active for years. We aimed to assess patient trajectories over the entire disease narrative, from ictus to late outcome. METHODS Twelve patients with moderate-to-severe TBI underwent magnetic resonance imaging in the acute phase (within 1 week of injury) and twice in the chronic phase of injury (median 7 and 21 months), with some undergoing imaging at up to 2 additional time points. Longitudinal imaging changes were assessed using structural volumetry, deterministic tractography, voxel-based diffusion tensor analysis, and region of interest analyses (including corpus callosum, parasagittal white matter, and thalamus). Imaging changes were related to behavior. RESULTS Changes in structural volumes, fractional anisotropy, and mean diffusivity continued for months to years postictus. Changes in diffusion tensor imaging were driven by increases in both axial and radial diffusivity except for the earliest time point, and were associated with changes in reaction time and performance in a visual memory and learning task (paired associates learning). Dynamic structural changes after TBI can be detected using diffusion tensor imaging and could explain changes in behavior. CONCLUSIONS These data can provide further insight into early and late pathophysiology, and begin to provide a framework that allows magnetic resonance imaging to be used as an imaging biomarker of therapy response. Knowledge of the temporal pattern of changes in TBI patient populations also provides a contextual framework for assessing imaging changes in individuals at any given time point.
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Affiliation(s)
| | | | | | - Maria G Abate
- University of Cambridge, Cambridge, UK Gerardo Hospital, Monza, Milan, Italy
| | | | | | - Thomas Geeraerts
- University of Cambridge, Cambridge, UK University Hospital of Toulouse, Toulouse, France
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192
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Abstract
Traumatic brain injury (TBI) represents a significant public health problem in modern societies. It is primarily a consequence of traffic-related accidents and falls. Other recently recognized causes include sports injuries and indirect forces such as shock waves from battlefield explosions. TBI is an important cause of death and lifelong disability and represents the most well-established environmental risk factor for dementia. With the growing recognition that even mild head injury can lead to neurocognitive deficits, imaging of brain injury has assumed greater importance. However, there is no single imaging modality capable of characterizing TBI. Current advances, particularly in MR imaging, enable visualization and quantification of structural and functional brain changes not hitherto possible. In this review, we summarize data linking TBI with dementia, emphasizing the imaging techniques currently available in clinical practice along with some advances in medical knowledge.
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Affiliation(s)
- Joana Ramalho
- Centro Hospitalar de Lisboa Central, Lisboa, Portugal; University of North Carolina at Chapel Hill, Chapel Hill, NC, US
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193
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Hilz MJ, Aurnhammer F, Flanagan SR, Intravooth T, Wang R, Hösl KM, Pauli E, Koehn J. Eyeball Pressure Stimulation Unveils Subtle Autonomic Cardiovascular Dysfunction in Persons with a History of Mild Traumatic Brain Injury. J Neurotrauma 2015; 32:1796-804. [DOI: 10.1089/neu.2014.3842] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Max J. Hilz
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Felix Aurnhammer
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Steven R. Flanagan
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, New York
| | - Tassanai Intravooth
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ruihao Wang
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Katharina M. Hösl
- Department of Psychiatry, Addiction Psychiatry, Psychotherapy, and Psychosomatic Medicine, Klinikum am Europakanal Erlangen, Erlangen, Germany
| | - Elisabeth Pauli
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Julia Koehn
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
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194
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Wang Y, Nelson LD, LaRoche AA, Pfaller AY, Nencka AS, Koch KM, McCrea MA. Cerebral Blood Flow Alterations in Acute Sport-Related Concussion. J Neurotrauma 2015; 33:1227-36. [PMID: 26414315 DOI: 10.1089/neu.2015.4072] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Sport-related concussion (SRC) is a major health problem, affecting millions of athletes each year. While the clinical effects of SRC (e.g., symptoms and functional impairments) typically resolve within several days, increasing evidence suggests persistent neurophysiological abnormalities beyond the point of clinical recovery after injury. This study aimed to evaluate cerebral blood flow (CBF) changes in acute SRC, as measured using advanced arterial spin labeling (ASL) magnetic resonance imaging (MRI). We compared CBF maps assessed in 18 concussed football players (age, 17.8 ± 1.5 years) obtained within 24 h and at 8 days after injury with a control group of 19 matched non-concussed football players. While the control group did not show any changes in CBF between the two time-points, concussed athletes demonstrated a significant decrease in CBF at 8 days relative to within 24 h. Scores on the clinical symptom (Sport Concussion Assessment Tool 3, SCAT3) and cognitive measures (Standardized Assessment of Concussion [SAC]) demonstrated significant impairment (vs. pre-season baseline levels) at 24 h (SCAT, p < 0.0001; SAC, p < 0.01) but returned to baseline levels at 8 days. Two additional computerized neurocognitive tests, the Automated Neuropsychological Assessment Metrics and Immediate Post-Concussion and Cognitive Testing, showed a similar pattern of changes. These data support the hypothesis that physiological changes persist beyond the point of clinical recovery after SRC. Our results also indicate that advanced ASL MRI methods might be useful for detecting and tracking the longitudinal course of underlying neurophysiological recovery from concussion.
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Affiliation(s)
- Yang Wang
- 1 Department of Radiology, Medical College of Wisconsin , Milwaukee, Wisconsin.,2 Department of Biophysics, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Lindsay D Nelson
- 3 Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, Wisconsin.,4 Department of Neurology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Ashley A LaRoche
- 3 Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Adam Y Pfaller
- 3 Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Andrew S Nencka
- 1 Department of Radiology, Medical College of Wisconsin , Milwaukee, Wisconsin.,2 Department of Biophysics, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Kevin M Koch
- 1 Department of Radiology, Medical College of Wisconsin , Milwaukee, Wisconsin.,2 Department of Biophysics, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Michael A McCrea
- 3 Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, Wisconsin.,4 Department of Neurology, Medical College of Wisconsin , Milwaukee, Wisconsin
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195
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Johnson CP, Juranek J, Swank PR, Kramer L, Cox CS, Ewing-Cobbs L. White matter and reading deficits after pediatric traumatic brain injury: A diffusion tensor imaging study. NEUROIMAGE-CLINICAL 2015; 9:668-77. [PMID: 26740920 PMCID: PMC4660156 DOI: 10.1016/j.nicl.2015.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 10/16/2015] [Accepted: 10/16/2015] [Indexed: 01/18/2023]
Abstract
Pediatric traumatic brain injury often results in significant long-term deficits in mastery of reading ability. This study aimed to identify white matter pathways that, when damaged, predicted reading deficits in children. Based on the dual-route model of word reading, we predicted that integrity of the inferior fronto-occipital fasciculus would be related to performance in sight word identification while integrity of the superior longitudinal fasciculus would be related to performance in phonemic decoding. Reading fluency and comprehension were hypothesized to relate to the superior longitudinal fasciculus, inferior fronto-occipital fasciculus, and cingulum bundle. The connectivity of white matter pathways was used to predict reading deficits in children aged 6 to 16 years with traumatic brain injury (n = 29) and those with orthopedic injury (n = 27) using tract-based spatial statistics. Results showed that children with traumatic brain injury and reduced microstructural integrity of the superior longitudinal fasciculus demonstrated reduced word-reading ability on sight word and phonemic decoding tasks. Additionally, children with traumatic brain injury and microstructural changes involving the cingulum bundle demonstrated reduced reading fluency. Results support the association of a dorsal pathway via the superior longitudinal fasciculus with both sight word reading and phonemic decoding. No association was identified between the inferior fronto-occipital fasciculus and sight word reading or phonemic decoding. Reading fluency was associated with the integrity of the cingulum bundle. These findings support dissociable pathways predicting word reading and fluency using Diffusion Tensor Imaging and provide additional information for developing models of acquired reading deficits by specifying areas of brain damage which may predict reading deficits following recovery from the acute phase of TBI. We apply models of white matter and reading ability to pediatric brain trauma. We report dissociable effects for integrity of specific white matter pathways and specific reading skills following injury. We report a relationship between the cingulum bundle and reading ability. The implications of these findings are discussed in terms of brain-based reading models as they relate to brain injury.
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Affiliation(s)
- Chad Parker Johnson
- University of Hawaii at Hilo, Department of Psychology, 200 W Kawili St., Hilo, HI 96720, United States
| | - Jenifer Juranek
- University of Texas Health Science Center, Pediatrics, 7000 Fannin Street, Houston, TX 77030, United States
| | - Paul R Swank
- University of Texas Health Science Center, Pediatrics, 7000 Fannin Street, Houston, TX 77030, United States
| | - Larry Kramer
- University of Texas Health Science Center, Pediatrics, 7000 Fannin Street, Houston, TX 77030, United States
| | - Charles S Cox
- University of Texas Health Science Center, Pediatrics, 7000 Fannin Street, Houston, TX 77030, United States
| | - Linda Ewing-Cobbs
- University of Texas Health Science Center, Pediatrics, 7000 Fannin Street, Houston, TX 77030, United States
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196
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Van Beek L, Ghesquière P, Lagae L, De Smedt B. Mathematical Difficulties and White Matter Abnormalities in Subacute Pediatric Mild Traumatic Brain Injury. J Neurotrauma 2015; 32:1567-78. [DOI: 10.1089/neu.2014.3809] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Leen Van Beek
- Parenting and Special Education Research Unit, University of Leuven, Belgium
| | - Pol Ghesquière
- Parenting and Special Education Research Unit, University of Leuven, Belgium
| | - Lieven Lagae
- Department of Development and Regeneration, University of Leuven, Belgium
| | - Bert De Smedt
- Parenting and Special Education Research Unit, University of Leuven, Belgium
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197
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Doulames VM, Vilcans M, Lee S, Shea TB. Social interaction attenuates the extent of secondary neuronal damage following closed head injury in mice. Front Behav Neurosci 2015; 9:275. [PMID: 26528156 PMCID: PMC4606018 DOI: 10.3389/fnbeh.2015.00275] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 09/28/2015] [Indexed: 11/13/2022] Open
Abstract
Recovery following Traumatic Brain Injury (TBI) can vary tremendously among individuals. Lifestyle following injury, including differential social interactions, may modulate the extent of secondary injury following TBI. To examine this possibility under controlled conditions, closed head injury (CHI) was induced in C57Bl6 mice using a standardized weight drop device after which mice were either housed in isolation or with their original cagemates (“socially-housed”) for 4 weeks. CHI transiently impaired novel object recognition (NOR) in both isolated and social mice, confirming physical and functional injury. By contrast, Y maze navigation was impaired in isolated but not social mice at 1–4 weeks post CHI. CHI increased excitotoxic signaling in hippocampal slices from all mice, which was transiently exacerbated by isolation at 2 weeks post CHI. CHI slightly increased reactive oxygen species and did not alter levels of amyloid beta (Abeta), total or phospho-tau, total or phosphorylated neurofilaments. CHI increased serum corticosterone in both groups, which was exacerbated by isolation. These findings support the hypothesis that socialization may attenuate secondary damage following TBI. In addition, a dominance hierarchy was noted among socially-housed mice, in which the most submissive mouse displayed indices of stress in the above analyses that were statistically identical to those observed for isolated mice. This latter finding underscores that the nature and extent of social interaction may need to vary among individuals to provide therapeutic benefit.
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Affiliation(s)
- Vanessa M Doulames
- Center for Neurobiology and Neurodegeneration Research, UMass Lowell Lowell, MA, USA ; Biomedical and Biotechnology Program, University of Massachusetts Lowell Lowell, MA, USA
| | - Meghan Vilcans
- Center for Neurobiology and Neurodegeneration Research, UMass Lowell Lowell, MA, USA ; Department of Biological Sciences, University of Massachusetts Lowell Lowell, MA, USA
| | - Sangmook Lee
- Center for Neurobiology and Neurodegeneration Research, UMass Lowell Lowell, MA, USA ; Department of Biological Sciences, University of Massachusetts Lowell Lowell, MA, USA
| | - Thomas B Shea
- Center for Neurobiology and Neurodegeneration Research, UMass Lowell Lowell, MA, USA ; Biomedical and Biotechnology Program, University of Massachusetts Lowell Lowell, MA, USA ; Department of Biological Sciences, University of Massachusetts Lowell Lowell, MA, USA
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198
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Hill-Jarrett TG, Gravano JT, Sozda CN, Perlstein WM. Visuospatial attention after traumatic brain injury: The role of hemispheric specialization. Brain Inj 2015; 29:1617-29. [PMID: 26451899 DOI: 10.3109/02699052.2015.1075155] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To evaluate the behavioural and neural effects of TBI on the hemispheric integrity of three components of visuospatial attention: alerting, orienting and executive control. METHOD Behavioural performance and high density event-related potentials (ERPs) were acquired while a sample of 12 patients with chronic moderate-to-severe TBI and 12 controls performed the Lateralized Attention Network Test (LANT). Neural indices of attention (posterior N1 amplitude to alerting and orienting cues, midline P3 amplitude during conflict resolution) were examined. RESULTS Patients with TBI exhibited smaller N1 amplitude to alerting cues, but comparable behavioural performance to controls. Participants with TBI also demonstrated poorer orienting performance to the left hemispace relative to the right. A corresponding reduction in right hemisphere N1 was found during left orienting to spatial cues in the TBI group. No group differences were observed on behavioural measures of executive control; however, patients with TBI exhibited reduced P3 amplitude overall. CONCLUSIONS TBI may have an enduring effect on the orienting system at both neural and behavioural levels. Assessment of attention in chronic TBI can be improved by the integration of hemispheric findings that suggest disproportionate vulnerability in leftward orienting. Results may enhance clinical sensitivity to detection of subtle signs of neglect.
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Affiliation(s)
- Tanisha G Hill-Jarrett
- a Department of Clinical and Health Psychology , University of Florida , Gainesville , FL , USA
| | - Jason T Gravano
- a Department of Clinical and Health Psychology , University of Florida , Gainesville , FL , USA
| | | | - William M Perlstein
- a Department of Clinical and Health Psychology , University of Florida , Gainesville , FL , USA .,c VA RR&D Brain Rehabilitation and Research Center of Excellence , Malcom Randall VA, Gainesville, FL , USA
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199
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Huang M, Lee RR. Magnetoencephalography (MEG) Slow-Wave Imaging for Diagnosing Non-acute Mild Traumatic Brain Injury. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0121-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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200
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Sundman M, Doraiswamy PM, Morey RA. Neuroimaging assessment of early and late neurobiological sequelae of traumatic brain injury: implications for CTE. Front Neurosci 2015; 9:334. [PMID: 26441507 PMCID: PMC4585087 DOI: 10.3389/fnins.2015.00334] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 09/04/2015] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) has been increasingly accepted as a major external risk factor for neurodegenerative morbidity and mortality. Recent evidence indicates that the resultant chronic neurobiological sequelae following head trauma may, at least in part, contribute to a pathologically distinct disease known as Chronic Traumatic Encephalopathy (CTE). The clinical manifestation of CTE is variable, but the symptoms of this progressive disease include impaired memory and cognition, affective disorders (i.e., impulsivity, aggression, depression, suicidality, etc.), and diminished motor control. Notably, mounting evidence suggests that the pathology contributing to CTE may be caused by repetitive exposure to subconcussive hits to the head, even in those with no history of a clinically evident head injury. Given the millions of athletes and military personnel with potential exposure to repetitive subconcussive insults and TBI, CTE represents an important public health issue. However, the incidence rates and pathological mechanisms are still largely unknown, primarily due to the fact that there is no in vivo diagnostic tool. The primary objective of this manuscript is to address this limitation and discuss potential neuroimaging modalities that may be capable of diagnosing CTE in vivo through the detection of tau and other known pathological features. Additionally, we will discuss the challenges of TBI research, outline the known pathology of CTE (with an emphasis on Tau), review current neuroimaging modalities to assess the potential routes for in vivo diagnosis, and discuss the future directions of CTE research.
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Affiliation(s)
- Mark Sundman
- Duke-UNC Brain Imaging and Analysis Center, Duke University Medical Center Durham, NC, USA
| | - P Murali Doraiswamy
- Department of Psychiatry, Duke University Medical Center Durham, NC, USA ; Duke Institute for Brain Sciences, Duke University Medical Center Durham, NC, USA
| | - Rajendra A Morey
- Duke-UNC Brain Imaging and Analysis Center, Duke University Medical Center Durham, NC, USA
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