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Hadi Z, Mahmud M, Seemungal BM. Brain Mechanisms Explaining Postural Imbalance in Traumatic Brain Injury: A Systematic Review. Brain Connect 2024; 14:144-177. [PMID: 38343363 DOI: 10.1089/brain.2023.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Introduction: Persisting imbalance and falls in community-dwelling traumatic brain injury (TBI) survivors are linked to reduced long-term survival. However, a detailed understanding of the impact of TBI upon the brain mechanisms mediating imbalance is lacking. To understand the state of the art concerning the brain mechanisms mediating imbalance in TBI, we performed a systematic review of the literature. Methods: PubMed, Web of Science, and Scopus were searched and peer-reviewed research articles in humans, with any severity of TBI (mild, moderate, severe, or concussion), which linked a postural balance assessment (objective or subjective) with brain imaging (through computed tomography, T1-weighted imaging, functional magnetic resonance imaging [fMRI], resting-state fMRI, diffusion tensor imaging, magnetic resonance spectroscopy, single-photon emission computed tomography, electroencephalography, magnetoencephalography, near-infrared spectroscopy, and evoked potentials) were included. Out of 1940 articles, 60 were retrieved and screened, and 25 articles fulfilling inclusion criteria were included. Results: The most consistent finding was the link between imbalance and the cerebellum; however, the regions within the cerebellum were inconsistent. Discussion: The lack of consistent findings could reflect that imbalance in TBI is due to a widespread brain network dysfunction, as opposed to focal cortical damage. The inconsistency in the reported findings may also be attributed to heterogeneity of methodology, including data analytical techniques, small sample sizes, and choice of control groups. Future studies should include a detailed clinical phenotyping of vestibular function in TBI patients to account for the confounding effect of peripheral vestibular disorders on imbalance and brain imaging.
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Affiliation(s)
- Zaeem Hadi
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Mohammad Mahmud
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Barry M Seemungal
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, United Kingdom
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Newsome MR, Martindale SL, Davenport N, Dennis EL, Diaz M, Esopenko C, Hodges C, Jackson GR, Liu Q, Kenney K, Mayer AR, Rowland JA, Scheibel RS, Steinberg JL, Taylor BA, Tate DF, Werner JK, Walker WC, Wilde EA. Subcortical functional connectivity and its association with walking performance following deployment related mild TBI. Front Neurol 2023; 14:1276437. [PMID: 38156092 PMCID: PMC10752967 DOI: 10.3389/fneur.2023.1276437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/18/2023] [Indexed: 12/30/2023] Open
Abstract
Introduction The relation between traumatic brain injury (TBI), its acute and chronic symptoms, and the potential for remote neurodegenerative disease is a priority for military research. Structural and functional connectivity (FC) of the basal ganglia, involved in motor tasks such as walking, are altered in some samples of Service Members and Veterans with TBI, but any behavioral implications are unclear and could further depend on the context in which the TBI occurred. Methods In this study, FC from caudate and pallidum seeds was measured in Service Members and Veterans with a history of mild TBI that occurred during combat deployment, Service Members and Veterans whose mild TBI occurred outside of deployment, and Service Members and Veterans who had no lifetime history of TBI. Results FC patterns differed for the two contextual types of mild TBI. Service Members and Veterans with deployment-related mild TBI demonstrated increased FC between the right caudate and lateral occipital regions relative to both the non-deployment mild TBI and TBI-negative groups. When evaluating the association between FC from the caudate and gait, the non-deployment mild TBI group showed a significant positive relationship between walking time and FC with the frontal pole, implicated in navigational planning, whereas the deployment-related mild TBI group trended towards a greater negative association between walking time and FC within the occipital lobes, associated with visuo-spatial processing during navigation. Discussion These findings have implications for elucidating subtle motor disruption in Service Members and Veterans with deployment-related mild TBI. Possible implications for future walking performance are discussed.
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Affiliation(s)
- Mary R. Newsome
- Research Service Line, George E. Wahlen VA Medical Center, Salt Lake City, UT, United States
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, United States
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States
| | - Sarah L. Martindale
- Research and Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, United States
- Veterans Integrated Service Networks (VISN)-6 Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, NC, United States
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Nicholas Davenport
- Research Service Line, Minneapolis VA Health Care System, Minneapolis, MN, United States
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States
| | - Emily L. Dennis
- Research Service Line, George E. Wahlen VA Medical Center, Salt Lake City, UT, United States
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Marlene Diaz
- Research Service Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - Carrie Esopenko
- Department of Rehabilitation and Human Performance, Icahn School of Medicine, New York, NY, United States
| | - Cooper Hodges
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - George R. Jackson
- Parkinson's Disease Research, Education and Clinical Center (PADRECC), Michael E. DeBakey VA Medical Center, Houston, TX, United States
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Qisheng Liu
- Research Service Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
- Center for Translational Research on Inflammatory Diseases (CTRID), Baylor College of Medicine, Houston, TX, United States
| | - Kimbra Kenney
- Department of Neurology, Uniform Services University, Bethesda, MD, United States
| | - Andrew R. Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, United States
- Departments of Psychiatry and Behavioral Sciences, Psychology and Neurology, University of New Mexico, Albuquerque, NM, United States
| | - Jared A. Rowland
- Research and Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, United States
- Veterans Integrated Service Networks (VISN)-6 Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, NC, United States
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Randall S. Scheibel
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States
- Research Service Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - Joel L. Steinberg
- Department of Psychiatry, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, United States
| | - Brian A. Taylor
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - David F. Tate
- Research Service Line, George E. Wahlen VA Medical Center, Salt Lake City, UT, United States
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - J. Kent Werner
- Department of Neurology, Uniform Services University, Bethesda, MD, United States
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - William C. Walker
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | - Elisabeth A. Wilde
- Research Service Line, George E. Wahlen VA Medical Center, Salt Lake City, UT, United States
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, United States
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States
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Zimmerman KA, Cournoyer J, Lai H, Snider SB, Fischer D, Kemp S, Karton C, Hoshizaki TB, Ghajari M, Sharp DJ. The biomechanical signature of loss of consciousness: computational modelling of elite athlete head injuries. Brain 2023; 146:3063-3078. [PMID: 36546554 PMCID: PMC10316777 DOI: 10.1093/brain/awac485] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/17/2022] [Accepted: 12/02/2022] [Indexed: 08/27/2023] Open
Abstract
Sports related head injuries can cause transient neurological events including loss of consciousness and dystonic posturing. However, it is unknown why head impacts that appear similar produce distinct neurological effects. The biomechanical effect of impacts can be estimated using computational models of strain within the brain. Here, we investigate the strain and strain rates produced by professional American football impacts that led to loss of consciousness, posturing or no neurological signs. We reviewed 1280 National Football League American football games and selected cases where the team's medical personnel made a diagnosis of concussion. Videos were then analysed for signs of neurological events. We identified 20 head impacts that showed clear video signs of loss of consciousness and 21 showing clear abnormal posturing. Forty-one control impacts were selected where there was no observable evidence of neurological signs, resulting in 82 videos of impacts for analysis. Video analysis was used to guide physical reconstructions of these impacts, allowing us to estimate the impact kinematics. These were then used as input to a detailed 3D high-fidelity finite element model of brain injury biomechanics to estimate strain and strain rate within the brain. We tested the hypotheses that impacts producing loss of consciousness would be associated with the highest biomechanical forces, that loss of consciousness would be associated with high forces in brainstem nuclei involved in arousal and that dystonic posturing would be associated with high forces in motor regions. Impacts leading to loss of consciousness compared to controls produced higher head acceleration (linear acceleration; 81.5 g ± 39.8 versus 47.9 ± 21.4; P = 0.004, rotational acceleration; 5.9 krad/s2 ± 2.4 versus 3.5 ± 1.6; P < 0.001) and in voxel-wise analysis produced larger brain deformation in many brain regions, including parts of the brainstem and cerebellum. Dystonic posturing was also associated with higher deformation compared to controls, with brain deformation observed in cortical regions that included the motor cortex. Loss of consciousness was specifically associated with higher strain rates in brainstem regions implicated in maintenance of consciousness, including following correction for the overall severity of impact. These included brainstem nuclei including the locus coeruleus, dorsal raphé and parabrachial complex. The results show that in head impacts producing loss of consciousness, brain deformation is disproportionately seen in brainstem regions containing nuclei involved in arousal, suggesting that head impacts produce loss of consciousness through a biomechanical effect on key brainstem nuclei involved in the maintenance of consciousness.
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Affiliation(s)
- Karl A Zimmerman
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London, London, UK
- Department of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
- HEAD Lab, Dyson School of Design Engineering, Imperial College London, London, UK
| | - Janie Cournoyer
- Neurotrauma Impact Science Laboratory, University of Ottawa, Ottawa, ON, Canada
| | - Helen Lai
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London, London, UK
- Department of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - Samuel B Snider
- Division of Neurocritical care, Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - David Fischer
- Division of Neurocritical Care, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Simon Kemp
- Rugby Football Union, Twickenham, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Clara Karton
- Neurotrauma Impact Science Laboratory, University of Ottawa, Ottawa, ON, Canada
| | - Thomas B Hoshizaki
- Neurotrauma Impact Science Laboratory, University of Ottawa, Ottawa, ON, Canada
| | - Mazdak Ghajari
- HEAD Lab, Dyson School of Design Engineering, Imperial College London, London, UK
| | - David J Sharp
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London, London, UK
- Department of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
- The Royal British Legion Centre for Blast Injury Studies and the Department of Bioengineering, Imperial College London, London, UK
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Mohamed AZ, Lagopoulos J, Nasrallah FA, Shan Z. Self-reported Fatigue was Associated with Increased White-matter Alterations in Long-term Traumatic Brain Injury and Posttraumatic Stress Disorder Patients. Neuroscience 2023; 520:46-57. [PMID: 37080447 PMCID: PMC10357124 DOI: 10.1016/j.neuroscience.2023.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/12/2023] [Accepted: 03/28/2023] [Indexed: 04/22/2023]
Abstract
Fatigue is a long-lasting problem in traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD), with limited research that investigated the fatigue-related white-matter changes within TBI and/or PTSD cohorts. This exploratory cross-sectional study used diffusion tensor imaging (DTI) and neuropsychological data collected from 153 male Vietnam War veterans, as part of the Alzheimer's Disease Neuroimaging Initiative - Department of Defense, and were divided clinically into control veterans, PTSD, TBI, and with both TBI and PTSD (TBI + PTSD). The existence of fatigue was defined by the question "Do you often feel tired, fatigued, or sleepy during the daytime?". DTI data were compared between fatigue and non-fatigue subgroups in each clinical group using tract-based spatial statistics voxel-based differences. Fatigue was reported in controls (29.55%), slightly higher in TBI (52.17%, PBenf = 0.06), and significantly higher in both TBI + PTSD (66.67%, PBenf = 0.001) and PTSD groups (79.25%, PBenf < 0.001). Compared to non-fatigued subgroups, no white-matter differences were observed in the fatigued subgroups of control or TBI, while the fatigued PTSD subgroup only showed increased diffusivity measures (i.e., radial and axial), and the fatigued TBI + PTSD subgroup showed decreased fractional anisotropy and increased diffusivity measures (PFWE ≤ 0.05). The results act as preliminary findings suggesting fatigue to be significantly reported in TBI + PTSD and PTSD decades post-trauma with a possible link to white-matter microstructural differences in both PTSD and TBI + PTSD. Future studies with larger cohorts and detailed fatigue assessments would be required to identify the white-matter changes associated with fatigue in these cohorts.
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Affiliation(s)
- Abdalla Z Mohamed
- Thompson Institute, University of the Sunshine Coast, Sunshine Coast, QLD 4575, Australia.
| | - Jim Lagopoulos
- Thompson Institute, University of the Sunshine Coast, Sunshine Coast, QLD 4575, Australia
| | - Fatima A Nasrallah
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Zack Shan
- Thompson Institute, University of the Sunshine Coast, Sunshine Coast, QLD 4575, Australia
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Volumetric MRI Findings in Mild Traumatic Brain Injury (mTBI) and Neuropsychological Outcome. Neuropsychol Rev 2023; 33:5-41. [PMID: 33656702 DOI: 10.1007/s11065-020-09474-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
Region of interest (ROI) volumetric assessment has become a standard technique in quantitative neuroimaging. ROI volume is thought to represent a coarse proxy for making inferences about the structural integrity of a brain region when compared to normative values representative of a healthy sample, adjusted for age and various demographic factors. This review focuses on structural volumetric analyses that have been performed in the study of neuropathological effects from mild traumatic brain injury (mTBI) in relation to neuropsychological outcome. From a ROI perspective, the probable candidate structures that are most likely affected in mTBI represent the target regions covered in this review. These include the corpus callosum, cingulate, thalamus, pituitary-hypothalamic area, basal ganglia, amygdala, and hippocampus and associated structures including the fornix and mammillary bodies, as well as whole brain and cerebral cortex along with the cerebellum. Ventricular volumetrics are also reviewed as an indirect assessment of parenchymal change in response to injury. This review demonstrates the potential role and limitations of examining structural changes in the ROIs mentioned above in relation to neuropsychological outcome. There is also discussion and review of the role that post-traumatic stress disorder (PTSD) may play in structural outcome in mTBI. As emphasized in the conclusions, structural volumetric findings in mTBI are likely just a single facet of what should be a multimodality approach to image analysis in mTBI, with an emphasis on how the injury damages or disrupts neural network integrity. The review provides an historical context to quantitative neuroimaging in neuropsychology along with commentary about future directions for volumetric neuroimaging research in mTBI.
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White matter connectometry in patients with disorders of consciousness revealed by 7-Tesla magnetic resonance imaging. Brain Imaging Behav 2022; 16:1983-1991. [DOI: 10.1007/s11682-022-00668-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 03/01/2022] [Accepted: 03/21/2022] [Indexed: 11/02/2022]
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García-Gomar MG, Singh K, Cauzzo S, Bianciardi M. In vivo structural connectome of arousal and motor brainstem nuclei by 7 Tesla and 3 Tesla MRI. Hum Brain Mapp 2022; 43:4397-4421. [PMID: 35633277 PMCID: PMC9435015 DOI: 10.1002/hbm.25962] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 05/08/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Brainstem nuclei are key participants in the generation and maintenance of arousal, which is a basic function that modulates wakefulness/sleep, autonomic responses, affect, attention, and consciousness. Their mechanism is based on diffuse pathways ascending from the brainstem to the thalamus, hypothalamus, basal forebrain and cortex. Several arousal brainstem nuclei also participate in motor functions that allow humans to respond and interact with the surrounding through a multipathway motor network. Yet, little is known about the structural connectivity of arousal and motor brainstem nuclei in living humans. This is due to the lack of appropriate tools able to accurately visualize brainstem nuclei in conventional imaging. Using a recently developed in vivo probabilistic brainstem nuclei atlas and 7 Tesla diffusion‐weighted images (DWI), we built the structural connectome of 18 arousal and motor brainstem nuclei in living humans (n = 19). Furthermore, to investigate the translatability of our findings to standard clinical MRI, we acquired 3 Tesla DWI on the same subjects, and measured the association of the connectome across scanners. For both arousal and motor circuits, our results showed high connectivity within brainstem nuclei, and with expected subcortical and cortical structures based on animal studies. The association between 3 Tesla and 7 Tesla connectivity values was good, especially within the brainstem. The resulting structural connectome might be used as a baseline to better understand arousal and motor functions in health and disease in humans.
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Affiliation(s)
- María Guadalupe García-Gomar
- Brainstem Imaging Laboratory, Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Escuela Nacional de Estudios Superiores, Juriquilla, Universidad Nacional Autónoma de México, Querétaro, Mexico
| | - Kavita Singh
- Brainstem Imaging Laboratory, Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Simone Cauzzo
- Brainstem Imaging Laboratory, Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Life Sciences Institute, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Marta Bianciardi
- Brainstem Imaging Laboratory, Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Division of Sleep Medicine, Harvard University, Boston, Massachusetts, USA
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Harch PG. Systematic Review and Dosage Analysis: Hyperbaric Oxygen Therapy Efficacy in Mild Traumatic Brain Injury Persistent Postconcussion Syndrome. Front Neurol 2022; 13:815056. [PMID: 35370898 PMCID: PMC8968958 DOI: 10.3389/fneur.2022.815056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background Mild traumatic brain injury results in over 15% of patients progressing to Persistent Postconcussion Syndrome, a condition with significant consequences and limited treatment options. Hyperbaric oxygen therapy has been applied to Persistent Postconcussion Syndrome with conflicting results based on its historical understanding/definition as a disease-specific therapy. This is a systematic review of the evidence for hyperbaric oxygen therapy (HBOT) in Persistent Postconcussion Syndrome using a dose-analysis that is based on the scientific definition of hyperbaric oxygen therapy as a dual-component drug composed of increased barometric pressure and hyperoxia. Methods In this review, PubMed, CINAHL, and the Cochrane Systematic Review Database were searched from August 8–22, 2021 for all adult clinical studies published in English on hyperbaric oxygen therapy in mild traumatic brain injury Persistent Postconcussion Syndrome (symptoms present at least 3 months). Randomized trials and studies with symptomatic and/or cognitive outcomes were selected for final analysis. Randomized trials included those with no-treatment control groups or control groups defined by either the historical or scientific definition. Studies were analyzed according to the dose of oxygen and barometric pressure and classified as Levels 1–5 based on significant immediate post-treatment symptoms or cognitive outcomes compared to control groups. Levels of evidence classifications were made according to the Centre for Evidence-Based Medicine and a practice recommendation according to the American Society of Plastic Surgeons. Methodologic quality and bias were assessed according to the PEDro Scale. Results Eleven studies were included: six randomized trials, one case-controlled study, one case series, and three case reports. Whether analyzed by oxygen, pressure, or composite oxygen and pressure dose of hyperbaric therapy statistically significant symptomatic and cognitive improvements or cognitive improvements alone were achieved for patients treated with 40 HBOTS at 1.5 atmospheres absolute (ATA) (four randomized trials). Symptoms were also improved with 30 treatments at 1.3 ATA air (one study), positive and negative results were obtained at 1.2 ATA air (one positive and one negative study), and negative results in one study at 2.4 ATA oxygen. All studies involved <75 subjects/study. Minimal bias was present in four randomized trials and greater bias in 2. Conclusion In multiple randomized and randomized controlled studies HBOT at 1.5 ATA oxygen demonstrated statistically significant symptomatic and cognitive or cognitive improvements alone in patients with mild traumatic brain injury Persistent Postconcussion Syndrome. Positive and negative results occurred at lower and higher doses of oxygen and pressure. Increased pressure within a narrow range appears to be the more important effect than increased oxygen which is effective over a broad range. Improvements were greater when patients had comorbid Post Traumatic Stress Disorder. Despite small sample sizes, the 1.5 ATA HBOT studies meet the Centre for Evidence-Based Medicine Level 1 criteria and an American Society of Plastic Surgeons Class A Recommendation for HBOT treatment of mild traumatic brain injury persistent postconcussion syndrome.
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Ozturk ED, Chanfreau-Coffinier C, Sakamoto MS, Delano-Wood L, Merritt VC. Characterization of Million Veteran Program (MVP) enrollees with Comprehensive Traumatic Brain Injury Evaluation (CTBIE) data: An analysis of neurobehavioral symptoms. J Psychiatr Res 2021; 145:230-242. [PMID: 34942434 PMCID: PMC9401093 DOI: 10.1016/j.jpsychires.2021.12.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/19/2021] [Accepted: 12/11/2021] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to examine neurobehavioral symptom reporting in a large sample of military veterans (N = 12,144) who completed the Comprehensive Traumatic Brain Injury Evaluation (CTBIE) and enrolled in the VA's Million Veteran Program (MVP). The CTBIE is a clinician-administered interview that assesses for historical, deployment-related traumatic brain injury (TBI) and evaluates symptoms using the Neurobehavioral Symptom Inventory (NSI). Clinicians completing the CTBIE made clinical determinations about participants' (1) TBI diagnostic status (i.e., CTBIE+ or CTBIE-) and (2) current symptom etiology (i.e., Symptom Resolution, TBI, Behavioral Health, Comorbid TBI + Behavioral Health [Comorbid], or Other). We evaluated the association of TBI diagnostic status and symptom etiology group with neurobehavioral symptoms. Results showed a significant association between TBI diagnostic status and all NSI variables, with CTBIE+ veterans endorsing greater symptoms than CTBIE- veterans. There was also a significant association between symptom etiology group and all NSI variables; specifically, the Comorbid and Behavioral Health groups generally endorsed significantly greater symptoms compared to the other groups. Follow-up analyses showed that relative to the Symptom Resolution group, the Comorbid and Behavioral Health groups had increased odds of severe/very severe cognitive and affective symptoms, whereas the TBI and Other groups did not. Finally, presence of psychiatric symptoms, pain, post-traumatic amnesia, loss of consciousness, and blast exposure significantly predicted Comorbid symptom etiology group membership. Findings from this large epidemiologic MVP study have relevant clinical implications and further highlight the importance of prioritizing integrated behavioral health interventions for this vulnerable population.
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Affiliation(s)
- Erin D Ozturk
- San Diego State University/University of California, San Diego Joint Doctoral Program, San Diego, CA, United States
| | - Catherine Chanfreau-Coffinier
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - McKenna S Sakamoto
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States
| | - Lisa Delano-Wood
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States; Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States; Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, United States
| | - Victoria C Merritt
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States; Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States; Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, United States.
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Potential Mechanisms of Acute Standing Balance Deficits After Concussions and Subconcussive Head Impacts: A Review. Ann Biomed Eng 2021; 49:2693-2715. [PMID: 34258718 DOI: 10.1007/s10439-021-02831-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/29/2021] [Indexed: 01/04/2023]
Abstract
Standing balance deficits are prevalent after concussions and have also been reported after subconcussive head impacts. However, the mechanisms underlying such deficits are not fully understood. The objective of this review is to consolidate evidence linking head impact biomechanics to standing balance deficits. Mechanical energy transferred to the head during impacts may deform neural and sensory components involved in the control of standing balance. From our review of acute balance-related changes, concussions frequently resulted in increased magnitude but reduced complexity of postural sway, while subconcussive studies showed inconsistent outcomes. Although vestibular and visual symptoms are common, potential injury to these sensors and their neural pathways are often neglected in biomechanics analyses. While current evidence implies a link between tissue deformations in deep brain regions including the brainstem and common post-concussion balance-related deficits, this link has not been adequately investigated. Key limitations in current studies include inadequate balance sampling duration, varying test time points, and lack of head impact biomechanics measurements. Future investigations should also employ targeted quantitative methods to probe the sensorimotor and neural components underlying balance control. A deeper understanding of the specific injury mechanisms will inform diagnosis and management of balance deficits after concussions and subconcussive head impact exposure.
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Mortaheb S, Filippini MM, Kaux JF, Annen J, Lejeune N, Martens G, Calderón MAF, Laureys S, Thibaut A. Neurophysiological Biomarkers of Persistent Post-concussive Symptoms: A Scoping Review. Front Neurol 2021; 12:687197. [PMID: 34566837 PMCID: PMC8459021 DOI: 10.3389/fneur.2021.687197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: Persistent post-concussive symptoms (PCS) consist of neurologic and psychological complaints persisting after a mild traumatic brain injury (mTBI). It affects up to 50% of mTBI patients, may cause long-term disability, and reduce patients' quality of life. The aim of this review was to examine the possible use of different neuroimaging modalities in PCS. Methods: Articles from Pubmed database were screened to extract studies that investigated the relationship between any neuroimaging features and symptoms of PCS. Descriptive statistics were applied to report the results. Results: A total of 80 out of 939 papers were included in the final review. Ten examined conventional MRI (30% positive finding), 24 examined diffusion weighted imaging (54.17% positive finding), 23 examined functional MRI (82.61% positive finding), nine examined electro(magneto)encephalography (77.78% positive finding), and 14 examined other techniques (71% positive finding). Conclusion: MRI was the most widely used technique, while functional techniques seem to be the most sensitive tools to evaluate PCS. The common functional patterns associated with symptoms of PCS were a decreased anti-correlation between the default mode network and the task positive network and reduced brain activity in specific areas (most often in the prefrontal cortex). Significance: Our findings highlight the importance to use functional approaches which demonstrated a functional alteration in brain connectivity and activity in most studies assessing PCS.
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Affiliation(s)
- Sepehr Mortaheb
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Brain Clinic, University Hospital of Liège, Liège, Belgium.,Physiology of Cognition Lab., GIGA-Consciousness, University of Liège, Liège, Belgium
| | - Maria Maddalena Filippini
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Brain Clinic, University Hospital of Liège, Liège, Belgium.,Neuromotor and Rehabilitation Department, Azienda Unita Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico (USL-IRCSS) di Reggio Emilia, Reggio Emilia, Italy
| | - Jean-François Kaux
- Physical Medicine and Sport Traumatology Department, Sports, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athletes Health, FIMS Collaborative Centre of Sport Medicine, University and University Hospital of Liège, Liège, Belgium
| | - Jitka Annen
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Brain Clinic, University Hospital of Liège, Liège, Belgium
| | - Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Brain Clinic, University Hospital of Liège, Liège, Belgium.,Institute of NeuroScience, University of Louvain, Brussels, Belgium
| | - Géraldine Martens
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Physical Medicine and Sport Traumatology Department, Sports, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athletes Health, FIMS Collaborative Centre of Sport Medicine, University and University Hospital of Liège, Liège, Belgium
| | | | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Brain Clinic, University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Brain Clinic, University Hospital of Liège, Liège, Belgium
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12
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Brooks JS, Allison W, Harriss A, Bian K, Mao H, Dickey JP. Purposeful Heading Performed by Female Youth Soccer Players Leads to Strain Development in Deep Brain Structures. Neurotrauma Rep 2021; 2:354-362. [PMID: 34901935 PMCID: PMC8655815 DOI: 10.1089/neur.2021.0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Head impacts in soccer have been associated with both short- and long-term neurological consequences. Youth players' brains are especially vulnerable given that their brains are still developing, and females are at an increased risk of traumatic brain injury (TBI) compared to males. Approximately 90% of head impacts in soccer occur from purposeful heading. Accordingly, this study assessed the relationship between kinematic variables and brain strain during purposeful headers in female youth soccer players. A convenience sample of 36 youth female soccer players (13.4 [0.9] years of age) from three elite youth soccer teams wore wireless sensors to quantify head impact magnitudes during games. Purposeful heading events were categorized by game scenario (e.g., throw-in, goal kick) for 60 regular season games (20 games per team). A total of 434 purposeful headers were identified. Finite element model simulations were performed to calculate average peak maximum principal strain (APMPS) in the corpus callosum, thalamus, and brainstem on a subset of 110 representative head impacts. Rotational velocity was strongly associated with APMPS in these three regions of the brain (r = 0.83-0.87). Linear acceleration was weakly associated with APMPS (r = 0.13-0.31). Game scenario did not predict APMPS during soccer games (p > 0.05). Results demonstrated considerable APMPS in the corpus callosum (mean = 0.102) and thalamus (mean = 0.083). In addition, the results support the notion that rotational velocity is a better predictor of brain strain than linear acceleration and may be a potential indicator of changes to the brain.
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Affiliation(s)
- Jeffrey S. Brooks
- School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Wayne Allison
- School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Alexandra Harriss
- Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Kewei Bian
- Department of Mechanical and Materials Engineering, Faculty of Engineering, Western University, London, Ontario, Canada
| | - Haojie Mao
- Department of Mechanical and Materials Engineering, Faculty of Engineering, Western University, London, Ontario, Canada
- School of Biomedical Engineering, Western University, London, Ontario, Canada
| | - James P. Dickey
- School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
- School of Biomedical Engineering, Western University, London, Ontario, Canada
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13
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Gonzalez AC, Kim M, Keser Z, Ibrahim L, Singh SK, Ahmad MJ, Hasan O, Kamali A, Hasan KM, Schulz PE. Diffusion Tensor Imaging Correlates of Concussion Related Cognitive Impairment. Front Neurol 2021; 12:639179. [PMID: 34108926 PMCID: PMC8180854 DOI: 10.3389/fneur.2021.639179] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/20/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Cognitive impairment after concussion has been widely reported, but there is no reliable imaging biomarker that predicts the severity of cognitive decline post-concussion. This study tests the hypothesis that patients with a history of concussion and persistent cognitive impairment have fractional anisotropy (FA) and mean diffusivity (MD) values from diffusion tensor imaging (DTI) that are specifically associated with poor performance on the Montreal Cognitive Assessment (MoCA). Methods: Fifty-three subjects (19 females) with concussions and persistent cognitive symptoms had MR imaging and the MoCA. Imaging was analyzed by atlas-based, whole-brain DTI segmentation and FLAIR lesion segmentation. Then, we conducted a random forest-based recursive feature elimination (RFE) with 10-fold cross-validation on the entire dataset, and with partial correlation adjustment for age and lesion load. Results: RFE showed that 11 DTI variables were found to be important predictors of MoCA scores. Partial correlation analyses, corrected for age and lesion load, showed significant correlations between MoCA scores and right fronto-temporal regions: inferior temporal gyrus MD (r = -0.62, p = 0.00001), middle temporal gyrus MD (r = -0.54, p = 0.0001), angular gyrus MD (r = -0.48, p = 0.0008), and inferior frontal gyrus FA (r = 0.44, p = 0.002). Discussion: This is the first study to demonstrate a correlation between MoCA scores and DTI variables in patients with a history of concussion and persistent cognitive impairment. This kind of research will significantly increase our understanding of why certain persons have persistent cognitive changes after concussion which, in turn, may allow us to predict persistent impairment after concussion and suggest new interventions.
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Affiliation(s)
- Angelica C. Gonzalez
- Department of Neurology, University of Texas McGovern Medical School, Houston, TX, United States
| | - Minseon Kim
- Department of Neurology, University of Texas McGovern Medical School, Houston, TX, United States
| | - Zafer Keser
- Department of Neurology, University of Texas McGovern Medical School, Houston, TX, United States
| | - Lamya Ibrahim
- Department of Neurology, University of Texas McGovern Medical School, Houston, TX, United States
| | - Sonia K. Singh
- Department of Neurology, University of Texas McGovern Medical School, Houston, TX, United States
| | - Mohammed J. Ahmad
- Department of Neurology, University of Texas McGovern Medical School, Houston, TX, United States
| | - Omar Hasan
- Department of Neurology, University of Texas McGovern Medical School, Houston, TX, United States
| | - Arash Kamali
- Department of Diagnostic and Interventional Radiology, University of Texas McGovern Medical School, Houston, TX, United States
| | - Khader M. Hasan
- Department of Diagnostic and Interventional Radiology, University of Texas McGovern Medical School, Houston, TX, United States
| | - Paul E. Schulz
- Department of Neurology, University of Texas McGovern Medical School, Houston, TX, United States
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Ruzinak R, Bittsansky M, Martinikova M, Nosal V, Kantorova E, Ballova J, Turcanova Koprusakova M, Hnilicova P, Grendar M, Dusenka R, Kolarovszki B, Zelenak K, Kurca E, Sivak S. Proton magnetic resonance spectroscopy changes in the brainstem in patients after mild traumatic brain injury with loss of consciousness. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 166:84-90. [PMID: 33976431 DOI: 10.5507/bp.2021.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/26/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Loss of consciousness (LOC) is used as a diagnostic feature of mild traumatic brain injury (MTBI). However, only 10% of concussions result in LOC. There are only a limited number of in-vivo studies dealing with unconsciousness and structural and functional integrity of the brainstem in patients with MTBI. The aim of our pilot study was to assess the sensitivity of proton magnetic resonance spectroscopy (1H-MRS) to detect metabolic changes in the brainstem in patients after MTBI with unconscioussness. METHODS Twenty-four patients (12 with LOC, and 12 without LOC) within 3 days of MTBI and 19 healthy controls were examined. All subjects underwent single-voxel 1H-MRS examination of the upper brainstem. Spectra were evaluated using LCModel software. Ratios of total N-acetylaspartate (tNAA), total choline-containing compounds (tCho) and glutamate plus glutamine (Glx) to total creatine (tCre) were used for calculations. RESULTS We found a significant decrease in tNAA/tCre and tCho/tCre ratios in the patient group with LOC when compared with the control group of healthy volunteers (P=0.002 and P=0.041, respectively), and a significant decrease in the tNAA/tCre ratio in the LOC group when compared with patients without LOC (P=0.04). Other metabolite ratios in the brainstem did not show any significant group differences. CONCLUSION Our findings indicate that decrease of tNAA/tCre ratio in the upper brainstem using single-voxel 1H-MRS may provide a potential biomarker for MTBI associated with LOC.
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Affiliation(s)
- Robert Ruzinak
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic
| | - Michal Bittsansky
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratilava, Slovak Republic
| | - Martina Martinikova
- Department of Neurology, F.D. Roosevelt Hospital, Banska Bystrica, Slovak Republic
| | - Vladimir Nosal
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic
| | - Ema Kantorova
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic
| | - Jana Ballova
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic
| | - Monika Turcanova Koprusakova
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic
| | - Petra Hnilicova
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratilava, Slovak Republic
| | - Marian Grendar
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratilava, Slovak Republic
| | | | - Branislav Kolarovszki
- Clinic of Neurosurgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic
| | - Kamil Zelenak
- Clinic of Radiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic
| | - Egon Kurca
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic
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15
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Abstract
Supplemental digital content is available in the text. Objective The aims of this study were to investigate changes in regional brain volume after concussion (mild traumatic brain injury) and to examine the relationship between change in brain volume and cognitive deficits. Design Twenty-eight patients with mild traumatic brain injury and 27 age-matched controls were included in this study. Magnetic resonance imaging (3 T) data were obtained from the participants. Structural brain volume changes were examined using tensor-based morphometry, which identifies regional structural differences in the whole brain, including cerebrospinal fluid, gray matter, and white matter. Volume contraction and expansion were compared between groups using a two-sample t test. The association between time post-injury or neurocognitive function and volumetric changes was examined using regression analysis. Results Individuals with mild traumatic brain injury exhibited volume reduction in the brainstem, including the pontine reticular formation. Regional cerebral volume changes were not associated with time post-injury but were significantly associated with neurocognitive function, especially with executive card sorting test, forward digit span test, and performance on verbal learning test. The greater regional cerebral volume was associated with better cognitive performance after mild traumatic brain injury. Conclusion Decreased brainstem volume may indicate its vulnerability to traumatic injury, and cerebral volume in specific regions was positively associated with patients’ cognitive function after injury.
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16
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Cui Y, Li M, Biswal B, Jing W, Zhou C, Liu H, Guo D, Xia Y, Yao D. Dynamic Configuration of Coactive Micropatterns in the Default Mode Network During Wakefulness and Sleep. Brain Connect 2021; 11:471-482. [PMID: 33403904 DOI: 10.1089/brain.2020.0827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: The default mode network (DMN) is a prominent intrinsic network that is observable in many mammalian brains. However, a few studies have investigated the temporal dynamics of this network based on direct physiological recordings. Methods: Herein, we addressed this issue by characterizing the dynamics of local field potentials from the rat DMN during wakefulness and sleep with an exploratory analysis. We constructed a novel coactive micropattern (CAMP) algorithm to evaluate the configurations of rat DMN dynamics, and further revealed the relationship between DMN dynamics with different wakefulness and alertness levels. Results: From the gamma activity (40-80 Hz) in the DMN across wakefulness and sleep, three spatially stable CAMPs were detected: a common low-activity level micropattern (cDMN), an anterior high-activity level micropattern (aDMN), and a posterior high-activity level micropattern (pDMN). A dynamic balance across CAMPs emerged during wakefulness and was disrupted in sleep stages. In the slow-wave sleep (SWS) stage, cDMN became the primary activity pattern, whereas aDMN and pDMN were the major activity patterns in the rapid eye movement sleep stage. In addition, further investigation revealed phasic relationships between CAMPs and the up-down states of the slow DMN activity in the SWS stage. Conclusion: Our study revealed that the dynamic configurations of CAMPs were highly associated with different stages of wakefulness, and provided a potential three-state model to describe the DMN dynamics for wakefulness and alertness. Impact statement In the current study, a novel coactive micropattern (CAMP) method was developed to elucidate fast default mode network (DMN) dynamics during wakefulness and sleep. Our findings demonstrated that the dynamic configurations of DMN activity are specific to different wakefulness stages and provided a three-state DMN CAMP model to depict wakefulness levels, thus revealing a potentially new neurophysiological representation of alertness levels. This work could elucidate the DMN dynamics underlying different stages of wakefulness and have important implications for the theoretical understanding of the neural mechanism of wakefulness and alertness.
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Affiliation(s)
- Yan Cui
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for NeuroInformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Min Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for NeuroInformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Bharat Biswal
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for NeuroInformation, University of Electronic Science and Technology of China, Chengdu, China.,Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey, USA
| | - Wei Jing
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for NeuroInformation, University of Electronic Science and Technology of China, Chengdu, China.,Department of Physiology, School of Basic Medicine and Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Changsong Zhou
- Department of Physics, Centre for Nonlinear Studies and Beijing-Hong Kong-Singapore Joint Centre for Nonlinear and Complex Systems (Hong Kong), Institute of Computational and Theoretical Studies, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Huixiao Liu
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for NeuroInformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Daqing Guo
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for NeuroInformation, University of Electronic Science and Technology of China, Chengdu, China.,Sichuan Institute for Brain Science and Brain-Inspired Intelligence, Chengdu, China
| | - Yang Xia
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for NeuroInformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Dezhong Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for NeuroInformation, University of Electronic Science and Technology of China, Chengdu, China.,Sichuan Institute for Brain Science and Brain-Inspired Intelligence, Chengdu, China.,School of Electrical Engineering, Zhengzhou University, Zhengzhou, China
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17
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Elevated Intraindividual Variability in Executive Functions and Associations with White Matter Microstructure in Veterans with Mild Traumatic Brain Injury. J Int Neuropsychol Soc 2021; 27:305-314. [PMID: 32967755 PMCID: PMC8462939 DOI: 10.1017/s1355617720000879] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We examined whether intraindividual variability (IIV) across tests of executive functions (EF-IIV) is elevated in Veterans with a history of mild traumatic brain injury (mTBI) relative to military controls (MCs) without a history of mTBI. We also explored relationships among EF-IIV, white matter microstructure, and posttraumatic stress disorder (PTSD) symptoms. METHOD A total of 77 Veterans (mTBI = 43, MCs = 34) completed neuropsychological testing, diffusion tensor imaging (DTI), and PTSD symptom ratings. EF-IIV was calculated as the standard deviation across six tests of EF, along with an EF-Mean composite. DSI Studio connectometry analysis identified white matter tracts significantly associated with EF-IIV according to generalized fractional anisotropy (GFA). RESULTS After adjusting for EF-Mean and PTSD symptoms, the mTBI group showed significantly higher EF-IIV than MCs. Groups did not differ on EF-Mean after adjusting for PTSD symptoms. Across groups, PTSD symptoms significantly negatively correlated with EF-Mean, but not with EF-IIV. EF-IIV significantly negatively correlated with GFA in multiple white matter pathways connecting frontal and more posterior regions. CONCLUSIONS Veterans with mTBI demonstrated significantly greater IIV across EF tests compared to MCs, even after adjusting for mean group differences on those measures as well as PTSD severity. Findings suggest that, in contrast to analyses that explore effects of mean performance across tests, discrepancy analyses may capture unique variance in neuropsychological performance and more sensitively capture cognitive disruption in Veterans with mTBI histories. Importantly, findings show that EF-IIV is negatively associated with the microstructure of white matter pathways interconnecting cortical regions that mediate executive function and attentional processes.
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Apolipoprotein ɛ4 Status and Brain Structure 12 Months after Mild Traumatic Injury: Brain Age Prediction Using Brain Morphometry and Diffusion Tensor Imaging. J Clin Med 2021; 10:jcm10030418. [PMID: 33499167 PMCID: PMC7865561 DOI: 10.3390/jcm10030418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Apolipoprotein E (APOE) ɛ4 is associated with poor outcome following moderate to severe traumatic brain injury (TBI). There is a lack of studies investigating the influence of APOE ɛ4 on intracranial pathology following mild traumatic brain injury (MTBI). This study explores the association between APOE ɛ4 and MRI measures of brain age prediction, brain morphometry, and diffusion tensor imaging (DTI). Methods: Patients aged 16 to 65 with acute MTBI admitted to the trauma center were included. Multimodal MRI was performed 12 months after injury and associated with APOE ɛ4 status. Corrections for multiple comparisons were done using false discovery rate (FDR). Results: Of included patients, 123 patients had available APOE, volumetric, and DTI data of sufficient quality. There were no differences between APOE ɛ4 carriers (39%) and non-carriers in demographic and clinical data. Age prediction revealed high accuracy both for the DTI-based and the brain morphometry based model. Group comparisons revealed no significant differences in brain-age gap between ɛ4 carriers and non-carriers, and no significant differences in conventional measures of brain morphometry and volumes. Compared to non-carriers, APOE ɛ4 carriers showed lower fractional anisotropy (FA) in the hippocampal part of the cingulum bundle, which did not remain significant after FDR adjustment. Conclusion: APOE ɛ4 carriers might be vulnerable to reduced neuronal integrity in the cingulum. Larger cohort studies are warranted to replicate this finding.
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Atsumi N, Iwamoto M, Nakahira Y, Asano Y, Shinoda J. Investigation of dynamic deformation of the midbrain in rear-end collision using human brain FE model. Comput Methods Biomech Biomed Engin 2020; 23:1236-1246. [PMID: 32687404 DOI: 10.1080/10255842.2020.1795142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Mild traumatic brain injury (TBI), including concussions, can cause symptoms affecting physical or cognitive domains in the acute and chronic phases. In this study, we investigated the dynamic deformation of the brain stem, which might be important for these symptoms, using a human brain finite element model through reconstruction simulations of rear-end collisions in three different velocities. In all simulations, high maximum principal strain values were observed at the midbrain that were higher than those in the corpus callosum. These findings could provide some mechanical insights into brain disorders associated with mild TBI.
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Affiliation(s)
- Noritoshi Atsumi
- Human Science Special Assigned Lab., Toyota Central R&D Labs., Inc, Aichi, Japan
| | - Masami Iwamoto
- Human Science Special Assigned Lab., Toyota Central R&D Labs., Inc, Aichi, Japan
| | - Yuko Nakahira
- Human Science Special Assigned Lab., Toyota Central R&D Labs., Inc, Aichi, Japan
| | - Yoshitaka Asano
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo, Japan.,Department of Clinical Brain Sciences, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Jun Shinoda
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo, Japan.,Department of Clinical Brain Sciences, Graduate School of Medicine, Gifu University, Gifu, Japan
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20
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Orlando A, Rubin B, Panchal R, Tanner A, Hudson J, Harken K, Madayag R, Berg G, Bar-Or D. In Patients Over 50 Years, Increased Age Is Associated With Decreased Odds of Documented Loss of Consciousness After a Concussion. Front Neurol 2020; 11:39. [PMID: 32082248 PMCID: PMC7005230 DOI: 10.3389/fneur.2020.00039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 01/10/2020] [Indexed: 12/28/2022] Open
Abstract
Background: Advanced aged adults have the highest rate of traumatic brain injury (TBI) related hospital admissions, compared to younger age groups. Data were published in 2014 indicating differential injury and neurological responses to a TBI by age categories. In a recent article examining patients with mTBI and isolated subdural hematoma, it was found that older patients had a decreased risk of documented loss of consciousness (LOC). The primary objective was to determine the extent to which the odds of documented LOC changes with increasing age in a population of older adults suffering an isolated concussion and uncomplicated mTBI. Methods: This was a retrospective study utilizing 6 years (2010–2015) of National Trauma Data Bank data. This study included patients with (1) diagnosis of concussion; (2) positive or negative loss of consciousness; (3) loss of consciousness durations no longer than 59 min or undefined; (4) age ≥50 years; (5) had a “fall” mechanism of injury; and (6) a valid emergency department Glasgow coma scale 13–15. We excluded patients (1) with any intracranial hemorrhage or intracranial injury of other and unspecified nature; (2) skull fracture; (3) an injury severity scale score >17; (4) a concussion with “unspecified” LOC (ICD-9: 850.9). Results: There were 7,466 patients included in the study; the median (IQR) age was 70 (60–80) years. The risk of documented LOC was 71% (n = 5,319). An 80-year-old had 72% decreased odds of having a documented LOC, compared to a 50-year-old (OR = 0.28, 99.5%CI [0.23–0.34], P < 0.001). This association held when controlling for multiple demographic, comorbid, and clinical variables, and in sensitivity analyses. Conclusion: These nationwide data suggest that in patients aged ≥50 years, a significant inverse association exists between age and odds of documented LOC after sustaining a fall-related concussion. Additional studies are needed to validate these findings and to investigate the triad of age, documented LOC, and intracranial hemorrhage. Clinical diagnostic criteria relying on LOC might be at risk of being modified by the association between increasing age and decreasing odds of LOC.
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Affiliation(s)
- Alessandro Orlando
- Department of Trauma Research, Swedish Medical Center, Englewood, CO, United States.,Department of Trauma Research, Penrose Hospital, Colorado Springs, CO, United States.,Department of Trauma Research, Medical City Plano, Plano, TX, United States.,Department of Trauma Research, St. Anthony Hospital, Lakewood, CO, United States.,Department of Trauma Research, Research Medical Center, Kansas City, MO, United States.,Department of Trauma Research, Wesley Medical Center, Wichita, KS, United States
| | - Benjamin Rubin
- Department of Neurosurgery, Swedish Medical Center, Englewood, CO, United States
| | - Ripul Panchal
- Department of Neurosurgery, Medical City Plano, Plano, TX, United States
| | - Allen Tanner
- Department of Trauma Services, Penrose Hospital, Colorado Springs, CO, United States
| | - John Hudson
- Department of Neurosurgery, St. Anthony Hospital, Lakewood, CO, United States
| | - Kyle Harken
- Department of Trauma Services, Research Medical Center, Kansas City, MO, United States
| | - Robert Madayag
- Department of Trauma Services, St. Anthony Hospital, Lakewood, CO, United States
| | - Gina Berg
- Department of Trauma Research, Wesley Medical Center, Wichita, KS, United States
| | - David Bar-Or
- Department of Trauma Research, Swedish Medical Center, Englewood, CO, United States.,Department of Trauma Research, Penrose Hospital, Colorado Springs, CO, United States.,Department of Trauma Research, Medical City Plano, Plano, TX, United States.,Department of Trauma Research, St. Anthony Hospital, Lakewood, CO, United States.,Department of Trauma Research, Research Medical Center, Kansas City, MO, United States.,Department of Trauma Research, Wesley Medical Center, Wichita, KS, United States
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A Systematic Review and Meta-analysis on PTSD Following TBI Among Military/Veteran and Civilian Populations. J Head Trauma Rehabil 2020; 35:E21-E35. [DOI: 10.1097/htr.0000000000000514] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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FOD-based registration for susceptibility distortion correction in brainstem connectome imaging. Neuroimage 2019; 202:116164. [PMID: 31505273 DOI: 10.1016/j.neuroimage.2019.116164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 08/15/2019] [Accepted: 09/03/2019] [Indexed: 12/25/2022] Open
Abstract
The high resolution, multi-shell diffusion MRI (dMRI) data from the Human Connectome Project (HCP) provides a great opportunity to map fine-grained fiber pathways in human brainstem, but the severe susceptibility-induced distortion around the brainstem poses a significant challenge. While the correction tools used in the HCP Pipeline greatly reduce the distortion artifacts in the preprocessed data, significant residual distortions are still widely present, especially in the brainstem region. One fundamental reason is that the topup tool used in the HCP Pipeline only relies on the B0 images, which lack sufficient contrast about white matter pathways, to estimate the distortion displacement between opposite phase encodings (PEs). To fully utilize the rich information of HCP data that includes dMRI data from two opposite PEs, we compute the fiber orientation distributions (FODs) from the data of each PE and propose a novel method to estimate and correct the residual distortion using FOD-based registration. Using the dMRI data of 94 HCP subjects, we show quantitatively that our method can reduce the misalignment of main fiber direction in the brainstem by 21% as compared to the topup tool used in the HCP Pipeline. Our method is fully compatible with the HCP Pipeline and thus can be readily integrated with it to enhance distortion correction in connectome imaging research.
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23
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The Influence of Shear Anisotropy in mTBI: A White Matter Constitutive Model. Ann Biomed Eng 2019; 47:1960-1970. [PMID: 31309368 DOI: 10.1007/s10439-019-02321-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 07/09/2019] [Indexed: 10/26/2022]
Abstract
We examine the influence of shear anisotropy of brain tissue on the potential for mild traumatic brain injury. First we develop a new constitutive description for the white matter in the brain that can capture the anisotropic behavior of the white matter in both tension and shear. The material parameters for the models are determined using a set of three experiments already published in the literature. The calibrated and parameterized model is then implemented in a computational (finite element) model of the head. This computational model is two-dimensional and is used to simulate a previously published injury-causing event in the National Hockey League, using axonal strain as criterion to assess the level of diffuse axonal injury. It is demonstrated that the inclusion of shear anisotropy affects both the nature and the extent of predicted injury. Further, the locations of the predicted injury are more consistent with observations in the literature.
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24
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Lange RT, Yeh PH, Brickell TA, Lippa SM, French LM. Postconcussion symptom reporting is not associated with diffusion tensor imaging findings in the subacute to chronic phase of recovery in military service members following mild traumatic brain injury. J Clin Exp Neuropsychol 2019; 41:497-511. [PMID: 30871410 DOI: 10.1080/13803395.2019.1585518] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The purpose of this study was to examine the relation between white matter integrity of the brain and postconcussion symptom reporting following mild traumatic brain injury (MTBI). METHOD Participants were 109 U.S. military service members (91.7% male) who had sustained a MTBI (n = 88) or orthopedic injury without TBI (trauma controls, TC, n = 21), enrolled from the Walter Reed National Military Medical Center, Bethesda, Maryland. Participants completed a battery of neurobehavioral symptom measures and underwent diffusion tensor imaging (DTI; General Electric 3T) of the whole brain, on average 44.9 months post injury (SD = 42.3). Measures of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were generated for 18 regions of interest (ROIs). Participants in the MTBI group were divided into two subgroups based on International Classification of Diseases-10th Revision (ICD-10) Category C criteria for postconcussion syndrome (PCS): PCS-present (n = 41) and PCS-absent (n = 47). RESULTS The PCS-present group had significantly worse scores on all 13 neurobehavioral measures than the PCS-absent group (p < .001, d = 0.87-2.50) and TC group (p < .003, d = 0.84-2.06). For all ROIs, there were no significant main effects across the three groups for FA, MD, AD, and RD (all ps >.03). Pairwise comparisons revealed no significant differences for all ROIs when using FA and RD, and only two significant pairwise differences were found between PCS-present and PCS-absent groups when using MD and AD [i.e., anterior thalamic radiation and cingulate gyrus (supracallosal) bundle]. CONCLUSIONS Consistent with past research, but not all studies, postconcussion symptom reporting was not associated with white matter integrity in the subacute to chronic phase of recovery following MTBI.
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Affiliation(s)
- Rael T Lange
- a Defense and Veterans Brain Injury Center , Walter Reed National Military Medical Center , Bethesda , MD , USA.,b National Intrepid Center of Excellence , Walter Reed National Military Medical Center , Bethesda , MD , USA.,c Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada
| | - Ping-Hong Yeh
- b National Intrepid Center of Excellence , Walter Reed National Military Medical Center , Bethesda , MD , USA
| | - Tracey A Brickell
- a Defense and Veterans Brain Injury Center , Walter Reed National Military Medical Center , Bethesda , MD , USA.,b National Intrepid Center of Excellence , Walter Reed National Military Medical Center , Bethesda , MD , USA.,d Department of Psychiatry , Uniformed Services University of the Health Sciences , Bethesda , MD , USA
| | - Sara M Lippa
- a Defense and Veterans Brain Injury Center , Walter Reed National Military Medical Center , Bethesda , MD , USA.,b National Intrepid Center of Excellence , Walter Reed National Military Medical Center , Bethesda , MD , USA
| | - Louis M French
- a Defense and Veterans Brain Injury Center , Walter Reed National Military Medical Center , Bethesda , MD , USA.,b National Intrepid Center of Excellence , Walter Reed National Military Medical Center , Bethesda , MD , USA.,d Department of Psychiatry , Uniformed Services University of the Health Sciences , Bethesda , MD , USA
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25
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Hunter LE, Lubin N, Glassman NR, Xue X, Spira M, Lipton ML. Comparing Region of Interest versus Voxel-Wise Diffusion Tensor Imaging Analytic Methods in Mild and Moderate Traumatic Brain Injury: A Systematic Review and Meta-Analysis. J Neurotrauma 2018; 36:1222-1230. [PMID: 30375271 DOI: 10.1089/neu.2018.5838] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Diffusion tensor imaging is a magnetic resonance imaging technique that is uniquely capable of detecting microstructural tissue damage in mild and moderate traumatic brain injuries (TBIs). To date, it remains unknown if two common analytic techniques, region of interest (ROI) versus voxel-wise (VW) analyses, detect injury in similar locations. The purpose of this systematic review and meta-analysis was to directly compare the regions of abnormality elucidated by each method. Twenty-seven ROI and 11 VW studies met our inclusion criteria. Our ROI meta-analysis identified 11 regions, including the splenium of the corpus callosum, where fractional anisotropy (FA) was significantly decreased in TBI patients, compared with controls. Likewise, we identified higher mean diffusivity/apparent diffusivity constant in the genu, body, and splenium of the corpus callosum. Alternatively, our VW analysis identified one region of high FA in the right superior longitudinal fasciculus and seven regions of low FA, with the two largest located in the corpus callosum. High mean diffusivity and high radial diffusivity, both in the right inferior longitudinal fasciculus, also was revealed by our VW analysis. Moreover, we have shown that the magnitude of damage in the corpus callosum revealed by ROI analysis (z = -3.15) is greater than that demonstrated by VW analysis (z = -1.41). Overall, this study indicates that both ROI and VW analytic methods are sensitive to low FA in the corpus callosum; however, the ROI method has more power to detect the full extent of tissue abnormality in the corpus callosum. More research utilizing standardized methods and reporting is essential to fully characterize the extent to which ROI and VW analyses can concordantly detect other locations of pathology in mild and moderate TBI patients.
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Affiliation(s)
- Liane E Hunter
- 1 Gruss Magnetic Resonance Imaging Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Naomi Lubin
- 1 Gruss Magnetic Resonance Imaging Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Nancy R Glassman
- 2 Samuel Gottesman Library, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Xiaonan Xue
- 3 Department of Epidemiology and Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Moshe Spira
- 1 Gruss Magnetic Resonance Imaging Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Michael L Lipton
- 1 Gruss Magnetic Resonance Imaging Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.,4 Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.,5 Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.,6 Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.,7 Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
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26
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Jurick SM, Hoffman SN, Sorg S, Keller AV, Evangelista ND, DeFord NE, Sanderson-Cimino M, Bangen KJ, Delano-Wood L, Deoni S, Jak AJ. Pilot investigation of a novel white matter imaging technique in Veterans with and without history of mild traumatic brain injury. Brain Inj 2018; 32:1256-1265. [DOI: 10.1080/02699052.2018.1493225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Sarah M. Jurick
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | | | - Scott Sorg
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Amber V. Keller
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | | | - Nicole E. DeFord
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Mark Sanderson-Cimino
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Katherine J. Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Lisa Delano-Wood
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Sean Deoni
- Department of Pediatrics, Brown University, Providence, RI, USA
| | - Amy J. Jak
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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27
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White Matter Deficits Underlying the Impaired Consciousness Level in Patients with Disorders of Consciousness. Neurosci Bull 2018; 34:668-678. [PMID: 29987517 DOI: 10.1007/s12264-018-0253-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/26/2018] [Indexed: 01/17/2023] Open
Abstract
In this study, we aimed to (1) identify white matter (WM) deficits underlying the consciousness level in patients with disorders of consciousness (DOCs) using diffusion tensor imaging (DTI), and (2) evaluate the relationship between DTI metrics and clinical measures of the consciousness level in DOC patients. With a cohort of 8 comatose, 8 unresponsive wakefulness syndrome/vegetative state, and 14 minimally conscious state patients and 25 patient controls, we performed group comparisons of the DTI metrics in 48 core WM regions of interest (ROIs), and examined the clinical relevance using correlation analysis. We identified multiple abnormal WM ROIs in DOC patients compared with normal controls, and the DTI metrics in these ROIs were significantly correlated with clinical measures of the consciousness level. Therefore, our findings suggested that multiple WM tracts are involved in the impaired consciousness levels in DOC patients and demonstrated the clinical relevance of DTI for DOC patients.
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28
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Tang Y, Sun W, Toga AW, Ringman JM, Shi Y. A probabilistic atlas of human brainstem pathways based on connectome imaging data. Neuroimage 2018; 169:227-239. [PMID: 29253653 PMCID: PMC5856609 DOI: 10.1016/j.neuroimage.2017.12.042] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/05/2017] [Accepted: 12/14/2017] [Indexed: 11/26/2022] Open
Abstract
The brainstem is a critical structure that regulates vital autonomic functions, houses the cranial nerves and their nuclei, relays motor and sensory information between the brain and spinal cord, and modulates cognition, mood, and emotions. As a primary relay center, the fiber pathways of the brainstem include efferent and afferent connections among the cerebral cortex, spinal cord, and cerebellum. While diffusion MRI has been successfully applied to map various brain pathways, its application for the in vivo imaging of the brainstem pathways has been limited due to inadequate resolution and large susceptibility-induced distortion artifacts. With the release of high-resolution data from the Human Connectome Project (HCP), there is increasing interest in mapping human brainstem pathways. Previous works relying on HCP data to study brainstem pathways, however, did not consider the prevalence (>80%) of large distortions in the brainstem even after the application of correction procedures from the HCP-Pipeline. They were also limited in the lack of adequate consideration of subject variability in either fiber pathways or region of interests (ROIs) used for bundle reconstruction. To overcome these limitations, we develop in this work a probabilistic atlas of 23 major brainstem bundles using high-quality HCP data passing rigorous quality control. For the large-scale data from the 500-Subject release of HCP, we conducted extensive quality controls to exclude subjects with severe distortions in the brainstem area. After that, we developed a systematic protocol to manually delineate 1300 ROIs on 20 HCP subjects (10 males; 10 females) for the reconstruction of fiber bundles using tractography techniques. Finally, we leveraged our novel connectome modeling techniques including high order fiber orientation distribution (FOD) reconstruction from multi-shell diffusion imaging and topography-preserving tract filtering algorithms to successfully reconstruct the 23 fiber bundles for each subject, which were then used to calculate the probabilistic atlases in the MNI152 space for public release. In our experimental results, we demonstrate that our method yielded anatomically faithful reconstruction of the brainstem pathways and achieved improved performance in comparison with an existing atlas of cerebellar peduncles based on HCP data. These atlases have been publicly released on NITRIC (https://www.nitrc.org/projects/brainstem_atlas/) and can be readily used by brain imaging researchers interested in studying brainstem pathways.
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Affiliation(s)
- Yuchun Tang
- Laboratory of Neuro Imaging (LONI), USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Research Center for Sectional and Imaging Anatomy, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
| | - Wei Sun
- Laboratory of Neuro Imaging (LONI), USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Arthur W Toga
- Laboratory of Neuro Imaging (LONI), USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - John M Ringman
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yonggang Shi
- Laboratory of Neuro Imaging (LONI), USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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29
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Post A, Kendall M, Cournoyer J, Karton C, Oeur RA, Dawson L, Hoshizaki TB. Brain tissue analysis of impacts to American football helmets. Comput Methods Biomech Biomed Engin 2018; 21:264-277. [PMID: 29502453 DOI: 10.1080/10255842.2018.1445229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Concussion in American football is a prevalent concern. Research has been conducted examining frequencies, location, and thresholds for concussion from impacts. Little work has been done examining how impact location may affect risk of concussive injury. The purpose of this research was to examine how impact site on the helmet and type of impact, affects the risk of concussive injury as quantified using finite element modelling of the human head and brain. A linear impactor was used to impact a helmeted Hybrid III headform in several locations and using centric and non-centric impact vectors. The resulting dynamic response was used as input for the Wayne State Brain Injury Model to determine the risk of concussive injury by utilizing maximum principal strain as the predictive variable. The results demonstrated that impacts that occur primarily to the side of the head resulted in higher magnitudes of strain in the grey and white matter, as well as the brain stem. Finally, commonly worn American football helmets were used in this research and significant risk of injury was incurred for all impacts. These results suggest that improvements in American football helmets are warranted, in particular for impacts to the side of the helmet.
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Affiliation(s)
- Andrew Post
- a Human Kinetics , University of Ottawa , Ottawa , Canada.,b Division of Neurosurgery , St. Michael's Hospital , Toronto , Canada
| | | | | | - Clara Karton
- a Human Kinetics , University of Ottawa , Ottawa , Canada
| | - R Anna Oeur
- a Human Kinetics , University of Ottawa , Ottawa , Canada
| | - Lauren Dawson
- a Human Kinetics , University of Ottawa , Ottawa , Canada
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30
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Raikes AC, Schaefer SY, Studenka BE. Concussion history is negatively associated with visual-motor force complexity: evidence for persistent effects on visual-motor integration. Brain Inj 2018; 32:747-754. [PMID: 29485290 DOI: 10.1080/02699052.2018.1444204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Long-term monitoring of concussion recovery requires time- and cost-effective methods. Physiologic complexity may be useful in evaluating visual-motor integration following concussion. The purpose of this study was to quantify the extent to which prior number of concussions influenced visual-motor tracking force complexity. METHODS Thirty-five individuals with a self-reported concussion history (age: 20.92 ± 1.98) and 15 without (age: 20.92 ± 2.21) performed an isometric visual-motor tracking task, using index finger force to trace a straight line across a computer screen. Finger force root mean square error (RMSE), multi-scale complexity, and average power from 0 to 12 Hertz (Hz) were calculated. Individual multiple regressions were fit to these outcomes. RESULTS Force complexity decreased linearly with an increasing number of concussions (R2 = 0.101). Males had more complex force overall (R2 = 0.219) and greater 4-8 Hz average power (R2 = 0.193). The 8-12 Hz average power decreased significantly for individuals with prior loss of consciousness (LOC) and increasing numbers of concussions (R2 = 0.143). CONCLUSION Individuals exhibited linear decreases in visual-motor tracking force complexity with increasing numbers of concussions, influenced by both gender and a history of LOC. These findings indicate cumulative changes in the ways in which previously concussed individuals process and integrate visual information to guide behaviour.
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Affiliation(s)
- Adam C Raikes
- a Social, Cognitive, and Affective Neuroscience Lab , The University of Arizona , Tucson , AZ , USA.,b Kinesiology and Health Science , Utah State University , Logan , UT , USA
| | - Sydney Y Schaefer
- c School of Biological and Health Engineering , Arizona State University , Tempe , AZ , USA
| | - Breanna E Studenka
- b Kinesiology and Health Science , Utah State University , Logan , UT , USA
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31
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Jurick SM, Bangen KJ, Evangelista ND, Sanderson-Cimino M, Delano-Wood L, Jak AJ. Advanced neuroimaging to quantify myelin in vivo: Application to mild TBI. Brain Inj 2018; 30:1452-1457. [PMID: 27834545 DOI: 10.1080/02699052.2016.1219064] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Difficulty providing accurate diagnosis and prognosis, especially after mild forms of traumatic brain injury (TBI), has increased efforts to detect changes in white matter microstructure using advanced neuroimaging techniques. Although methods such as diffusion tensor imaging (DTI) have greatly increased knowledge of white matter changes resulting from TBI, several shortcomings limit the utility of these techniques particularly when applied to populations with mild TBI (mTBI) history. In vivo imaging of myelin may be particularly well suited to detect changes in white matter microstructure resulting from mTBI. REVIEW This manuscript will briefly review the animal and histological data supporting the important role of myelin following TBI, contributions and shortcomings of the use of diffusion tensor imaging (DTI) in mild TBI and the utility of multi-component relaxometry (MCR) techniques as a method for improved visualizing of white matter microstructural integrity in myelin. CONCLUSION The use of MCR-based techniques has potential as a clinical and research tool to assess and track changes in myelin as well as the common behavioural changes such as slowed processing speed following TBI.
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Affiliation(s)
- S M Jurick
- a San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology , San Diego , CA , USA.,b Veterans Medical Research Foundation , San Diego , CA , USA
| | - K J Bangen
- c Department of Psychiatry , University of California San Diego , San Diego , CA , USA.,d Research Service
| | - N D Evangelista
- b Veterans Medical Research Foundation , San Diego , CA , USA.,d Research Service
| | | | - L Delano-Wood
- b Veterans Medical Research Foundation , San Diego , CA , USA.,c Department of Psychiatry , University of California San Diego , San Diego , CA , USA.,d Research Service.,e Psychology Service, VA San Diego Healthcare System , San Diego , CA , USA
| | - A J Jak
- b Veterans Medical Research Foundation , San Diego , CA , USA.,c Department of Psychiatry , University of California San Diego , San Diego , CA , USA.,d Research Service.,e Psychology Service, VA San Diego Healthcare System , San Diego , CA , USA
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32
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Dretsch MN, Lange RT, Katz JS, Goodman A, Daniel TA, Deshpande G, Denney TS, Iverson GL, Robinson JL. Examining Microstructural White Matter in Active Duty Soldiers with a History of Mild Traumatic Brain Injury and Traumatic Stress. Open Neuroimag J 2017; 11:46-57. [PMID: 28979609 PMCID: PMC5611700 DOI: 10.2174/1874440001711010046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 06/20/2017] [Accepted: 08/10/2017] [Indexed: 11/22/2022] Open
Abstract
Background: There is a high comorbidity of posttraumatic stress (PTS) and mild traumatic brain injury (mTBI), with largely overlapping symptomatology, in military service members. Objective: To examine white matter integrity associated with PTS and mTBI as assessed using diffusion tensor imaging (DTI). Method: Seventy-four active-duty U.S. soldiers with PTS (n = 16) and PTS with co-morbid history of mTBI (PTS/mTBI; n = 28) were compared to a military control group (n = 30). Participants received a battery of neurocognitive and clinical symptom measures. The number of abnormal DTI values was determined (>2 SDs from the mean of the control group) for fractional anisotropy (FA) and mean diffusivity (MD), and then compared between groups. In addition, mean DTI values from white matter tracts falling into three categories were compared between groups: (i) projection tracts: superior, middle, and inferior cerebellar peduncles, pontine crossing tract, and corticospinal tract; (ii) association tracts: superior longitudinal fasciculus; and (iii) commissure tracts: cingulum bundle (cingulum-cingulate gyrus and cingulum-hippocampus), and corpus callosum. Results: The comorbid PTS/mTBI group had significantly greater traumatic stress, depression, anxiety, and post-concussive symptoms, and they performed worse on neurocognitive testing than those with PTS alone and controls. The groups differed greatly on several clinical variables, but contrary to what we hypothesized, they did not differ greatly on primary and exploratory analytic approaches of hetero-spatial whole brain DTI analyses. Conclusion: The findings suggest that psychological health conditions rather than pathoanatomical changes may be contributing to symptom presentation in this population.
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Affiliation(s)
- Michael N Dretsch
- US Army Aeromedical Research Laboratory, Fort Rucker, AL; Human Dimension Division, Headquarters Training and Doctrine Command, 950 Jefferson Ave, Fort Eustis, VA, 23612, USA
| | - Rael T Lange
- National Intrepid Center of Excellence, Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Palmer Road, Bethesda, MD, 20814, USA
| | - Jeffery S Katz
- Department of Psychology, 226 Thach Hall, Auburn University, Auburn, AL, 36849, USA.,Auburn University MRI Research Center, Department of Electrical & Computer Engineering, 570 Devall Drive, Auburn University, Auburn, AL, 36832, USA.,Alabama Advanced Imaging Consortium, Auburn University and University of Alabama Birmingham, AL, USA
| | - Adam Goodman
- Department of Psychology, 226 Thach Hall, Auburn University, Auburn, AL, 36849, USA
| | - Thomas A Daniel
- Department of Psychology, 226 Thach Hall, Auburn University, Auburn, AL, 36849, USA
| | - Gopikrishna Deshpande
- Department of Psychology, 226 Thach Hall, Auburn University, Auburn, AL, 36849, USA.,Auburn University MRI Research Center, Department of Electrical & Computer Engineering, 570 Devall Drive, Auburn University, Auburn, AL, 36832, USA.,Alabama Advanced Imaging Consortium, Auburn University and University of Alabama Birmingham, AL, USA
| | - Thomas S Denney
- Department of Psychology, 226 Thach Hall, Auburn University, Auburn, AL, 36849, USA.,Auburn University MRI Research Center, Department of Electrical & Computer Engineering, 570 Devall Drive, Auburn University, Auburn, AL, 36832, USA.,Alabama Advanced Imaging Consortium, Auburn University and University of Alabama Birmingham, AL, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 First Avenue, Harvard Medical School, Boston, MA 02129; & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program; and Defense and Veterans Brain Injury Center, Bethesda, MD, USA
| | - Jennifer L Robinson
- Department of Psychology, 226 Thach Hall, Auburn University, Auburn, AL, 36849, USA.,Auburn University MRI Research Center, Department of Electrical & Computer Engineering, 570 Devall Drive, Auburn University, Auburn, AL, 36832, USA.,Alabama Advanced Imaging Consortium, Auburn University and University of Alabama Birmingham, AL, USA
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33
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Wylie GR, Dobryakova E, DeLuca J, Chiaravalloti N, Essad K, Genova H. Cognitive fatigue in individuals with traumatic brain injury is associated with caudate activation. Sci Rep 2017; 7:8973. [PMID: 28827779 PMCID: PMC5567054 DOI: 10.1038/s41598-017-08846-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 07/18/2017] [Indexed: 01/09/2023] Open
Abstract
We investigated differences in brain activation associated with cognitive fatigue between persons with traumatic brain injury (TBI) and healthy controls (HCs). Twenty-two participants with moderate-severe TBI and 20 HCs performed four blocks of a difficult working memory task and four blocks of a control task during fMRI imaging. Cognitive fatigue, assessed before and after each block, was used as a covariate to assess fatigue-related brain activation. The TBI group reported more fatigue than the HCs, though their performance was comparable. Regarding brain activation, the TBI group showed a Task X Fatigue interaction in the caudate tail resulting from a positive correlation between fatigue and brain activation for the difficult task and a negative relationship for the control task. The HC group showed the same Task X Fatigue interaction in the caudate head. Because we had prior hypotheses about the caudate, we performed a confirmatory analysis of a separate dataset in which the same subjects performed a processing speed task. A relationship between Fatigue and brain activation was evident in the caudate for this task as well. These results underscore the importance of the caudate nucleus in relation to cognitive fatigue.
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Affiliation(s)
- G R Wylie
- Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, New Jersey, 07936, USA. .,Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, NJ, 07101, USA. .,The War Related Illness and Injury Study Center, The Department of Veterans' Affairs, New Jersey Healthcare System, East Orange Campus, East Orange, NJ, 07018, USA.
| | - E Dobryakova
- Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, New Jersey, 07936, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, NJ, 07101, USA
| | - J DeLuca
- Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, New Jersey, 07936, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, NJ, 07101, USA.,Department of Neurology, Rutgers University, New Jersey Medical School, Newark, NJ, 07101, USA
| | - N Chiaravalloti
- Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, New Jersey, 07936, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, NJ, 07101, USA
| | - K Essad
- Dartmouth College, Dartmouth College Medical School, Hanover, NH, 03755, USA
| | - H Genova
- Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, New Jersey, 07936, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, NJ, 07101, USA
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Narayana PA. White matter changes in patients with mild traumatic brain injury: MRI perspective. Concussion 2017; 2:CNC35. [PMID: 30202576 PMCID: PMC6093760 DOI: 10.2217/cnc-2016-0028] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 02/10/2017] [Indexed: 12/20/2022] Open
Abstract
This review focuses on white matter (WM) changes in mild traumatic brain injury (mTBI) as assessed by multimodal MRI. All the peer reviewed publications on WM changes in mTBI from January 2011 through September 2016 are included in this review. This review is organized as follows: introduction to mTBI, the basics of multimodal MRI techniques that are potentially useful for probing the WM integrity, summary and critical evaluation of the published literature on the application of multimodal MRI techniques to assess the changes of WM in mTBI, and correlation of MRI measures with behavioral deficits. The MRI–pathology correlation studies based on preclinical models of mTBI are also reviewed. Finally, the author's perspective of future research directions is described.
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Affiliation(s)
- Ponnada A Narayana
- Department of Diagnostic & Interventional Imaging, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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Sinha SP, Avcu P, Spiegler KM, Komaravolu S, Kim K, Cominski T, Servatius RJ, Pang KCH. Startle suppression after mild traumatic brain injury is associated with an increase in pro-inflammatory cytokines, reactive gliosis and neuronal loss in the caudal pontine reticular nucleus. Brain Behav Immun 2017; 61:353-364. [PMID: 28089558 DOI: 10.1016/j.bbi.2017.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 12/12/2016] [Accepted: 01/08/2017] [Indexed: 01/15/2023] Open
Abstract
Mild traumatic brain injury (mTBI) can produce somatic symptoms such as headache, dizziness, fatigue, sleep disturbances and sensorimotor dysfunction. Sensorimotor function can be measured by tests such as the acoustic startle reflex (ASR), an evolutionarily conserved defensive response to a brief yet sharp acoustic stimulus. mTBI produces a long-lasting suppression of ASR in rodents and humans; however, the mechanism of this suppression is unknown. The present study examined whether inflammatory processes in the brainstem (particularly the caudal pontine reticular nucleus, PnC) could account for the suppression of ASR after mTBI, because the PnC is an essential nucleus of the ASR circuit. Furthermore, while inflammation after mTBI is commonly observed in brain regions proximal to the site of impact (cortex and hippocampus), the effects of mTBI in brainstem structures remains largely understudied. The present study demonstrated a suppression of ASR one day after injury and lasting at least three weeks after an mTBI, replicating previous findings. Within the PnC, transient elevations of IL-1β and TNF-α mRNA were observed at one day after injury, while IL-1α mRNA exhibited a delayed increase at three weeks after injury. Reactive gliosis (via IBA-1-ir for microglia and GFAP-ir for astrocytes) were also observed in the PnC, at one day and seven days after injury, respectively. Finally, the number of giant neurons (the major functional cell population in the PnC) was decreased three weeks after injury. The results indicate that glial activation precedes neuronal loss in the PnC, and correlates with the behavioral suppression of the ASR. The results also raise implications for brainstem involvement in the development of post-traumatic symptoms.
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Affiliation(s)
- Swamini P Sinha
- Graduate School of Biomedical Sciences, New Jersey Medical School-Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Pelin Avcu
- Graduate School of Biomedical Sciences, New Jersey Medical School-Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Kevin M Spiegler
- Graduate School of Biomedical Sciences, New Jersey Medical School-Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | | | - Kevin Kim
- B.S./M.D. Program, The College of New Jersey, Ewing, NJ, USA
| | - Tara Cominski
- Neurobehavioral Research Lab, Department of Veteran Affairs Medical Center-New Jersey Health Care System, East Orange, NJ, USA
| | - Richard J Servatius
- Department of Pharmacology, Physiology and Neurosciences, New Jersey Medical School - Rutgers Biomedical and Health Sciences, Newark, NJ, USA; Graduate School of Biomedical Sciences, New Jersey Medical School-Rutgers Biomedical and Health Sciences, Newark, NJ, USA; Syracuse Veterans Affairs Medical Center, Syracuse, NY, USA
| | - Kevin C H Pang
- Neurobehavioral Research Lab, Department of Veteran Affairs Medical Center-New Jersey Health Care System, East Orange, NJ, USA; Department of Pharmacology, Physiology and Neurosciences, New Jersey Medical School - Rutgers Biomedical and Health Sciences, Newark, NJ, USA; Graduate School of Biomedical Sciences, New Jersey Medical School-Rutgers Biomedical and Health Sciences, Newark, NJ, USA.
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Clark AL, Bangen KJ, Sorg SF, Schiehser DM, Evangelista ND, McKenna B, Liu TT, Delano-Wood L. Dynamic association between perfusion and white matter integrity across time since injury in Veterans with history of TBI. Neuroimage Clin 2016; 14:308-315. [PMID: 28210542 PMCID: PMC5299206 DOI: 10.1016/j.nicl.2016.12.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/14/2016] [Accepted: 12/16/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Cerebral blood flow (CBF) plays a critical role in the maintenance of neuronal integrity, and CBF alterations have been linked to deleterious white matter changes. Although both CBF and white matter microstructural alterations have been observed within the context of traumatic brain injury (TBI), the degree to which these pathological changes relate to one another and whether this association is altered by time since injury have not been examined. The current study therefore sought to clarify associations between resting CBF and white matter microstructure post-TBI. METHODS 37 veterans with history of mild or moderate TBI (mmTBI) underwent neuroimaging and completed health and psychiatric symptom questionnaires. Resting CBF was measured with multiphase pseudocontinuous arterial spin labeling (MPPCASL), and white matter microstructural integrity was measured with diffusion tensor imaging (DTI). The cingulate cortex and cingulum bundle were selected as a priori regions of interest for the ASL and DTI data, respectively, given the known vulnerability of these regions to TBI. RESULTS Regression analyses controlling for age, sex, and posttraumatic stress disorder (PTSD) symptoms revealed a significant time since injury × resting CBF interaction for the left cingulum (p < 0.005). Decreased CBF was significantly associated with reduced cingulum fractional anisotropy (FA) in the chronic phase; however, no such association was observed for participants with less remote TBI. CONCLUSIONS Our results showed that reduced CBF was associated with poorer white matter integrity in those who were further removed from their brain injury. Findings provide preliminary evidence of a possible dynamic association between CBF and white matter microstructure that warrants additional consideration within the context of the negative long-term clinical outcomes frequently observed in those with history of TBI. Additional cross-disciplinary studies integrating multiple imaging modalities (e.g., DTI, ASL) and refined neuropsychiatric assessment are needed to better understand the nature, temporal course, and dynamic association between brain changes and clinical outcomes post-injury.
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Affiliation(s)
- Alexandra L. Clark
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, United States
- VA San Diego Healthcare System (VASDHS), United States
| | - Katherine J. Bangen
- VA San Diego Healthcare System (VASDHS), United States
- University of California San Diego, School of Medicine, Department of Psychiatry, United States
| | - Scott F. Sorg
- VA San Diego Healthcare System (VASDHS), United States
- University of California San Diego, School of Medicine, Department of Psychiatry, United States
| | - Dawn M. Schiehser
- VA San Diego Healthcare System (VASDHS), United States
- Center of Excellence for Stress and Mental Health, VASDHS, United States
- University of California San Diego, School of Medicine, Department of Psychiatry, United States
| | - Nicole D. Evangelista
- VA San Diego Healthcare System (VASDHS), United States
- University of California San Diego, School of Medicine, Department of Psychiatry, United States
| | - Benjamin McKenna
- VA San Diego Healthcare System (VASDHS), United States
- University of California San Diego, School of Medicine, Department of Psychiatry, United States
| | - Thomas T. Liu
- University of California San Diego, Department of Radiology, Keck Center for Functional MRI, United States
| | - Lisa Delano-Wood
- VA San Diego Healthcare System (VASDHS), United States
- Center of Excellence for Stress and Mental Health, VASDHS, United States
- University of California San Diego, School of Medicine, Department of Psychiatry, United States
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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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Abstract
There is a paucity of accurate and reliable biomarkers to detect traumatic brain injury, grade its severity, and model post-traumatic brain injury (TBI) recovery. This gap could be addressed via advances in brain mapping which define injury signatures and enable tracking of post-injury trajectories at the individual level. Mapping of molecular and anatomical changes and of modifications in functional activation supports the conceptual paradigm of TBI as a disorder of large-scale neural connectivity. Imaging approaches with particular relevance are magnetic resonance techniques (diffusion weighted imaging, diffusion tensor imaging, susceptibility weighted imaging, magnetic resonance spectroscopy, functional magnetic resonance imaging, and positron emission tomographic methods including molecular neuroimaging). Inferences from mapping represent unique endophenotypes which have the potential to transform classification and treatment of patients with TBI. Limitations of these methods, as well as future research directions, are highlighted.
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Khong E, Odenwald N, Hashim E, Cusimano MD. Diffusion Tensor Imaging Findings in Post-Concussion Syndrome Patients after Mild Traumatic Brain Injury: A Systematic Review. Front Neurol 2016; 7:156. [PMID: 27698651 PMCID: PMC5027207 DOI: 10.3389/fneur.2016.00156] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/06/2016] [Indexed: 12/21/2022] Open
Abstract
Objectives To review the evidence for the use of diffusion tensor imaging (DTI) parameters in the human brain as a diagnostic tool for and predictor of post-concussion syndrome (PCS) after a mild traumatic brain injury (mTBI). Design Systematic review. Data sources All relevant studies in AMED, Embase, MEDLINE, Ovid, PubMed, Scopus, and Web of Science through 20 May, 2016. Study selection Studies that analyze traditional DTI measures [fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD)] and the severity of PCS symptoms or the development of PCS in humans after an mTBI. Data extraction Population studied, patient source, mTBI diagnosis method, PCS diagnosis method, DTI values measured, significant findings, and correlation between DTI findings and PCS. Data synthesis Ten studies investigated correlations between DTI values and PCS symptom severity or between DTI values and the development of PCS in mTBI patients. Decreased FA and increased MD and RD were associated with the development and severity of PCS. AD was not found to change significantly. Brain regions found to have significant changes in DTI parameters varied from study to study, although the corpus callosum was most frequently cited as having abnormal DTI parameters in PCS patients. Conclusion DTI abnormalities correlate with PCS incidence and symptom severity, as well as indicate an increased risk of developing PCS after mTBI. Abnormal DTI findings should prompt investigation of the syndrome to ensure optimal symptom management at the earliest stages. Currently, there is no consensus in the literature about the use of one DTI parameter in a specific region of the brain as a biomarker for PCS because no definite trends for DTI parameters in PCS subjects have been identified. Further research is required to establish a standard biomarker for PCS.
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Affiliation(s)
- Edrea Khong
- Department of Surgery, Division of Neurosurgery, Injury Prevention Research Office, Saint Michael's Hospital , Toronto, ON , Canada
| | - Nicole Odenwald
- Department of Surgery, Division of Neurosurgery, Injury Prevention Research Office, Saint Michael's Hospital , Toronto, ON , Canada
| | - Eyesha Hashim
- Department of Surgery, Division of Neurosurgery, Injury Prevention Research Office, Saint Michael's Hospital , Toronto, ON , Canada
| | - Michael D Cusimano
- Department of Surgery, Division of Neurosurgery, Injury Prevention Research Office, Saint Michael's Hospital , Toronto, ON , Canada
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40
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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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