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Dogahe MH, Ramezani S, Reihanian Z, Raminfard S, Feizkhah A, Alijani B, Herfeh SS. Role of brain metabolites during acute phase of mild traumatic brain injury in prognosis of post-concussion syndrome: A 1H-MRS study. Psychiatry Res Neuroimaging 2023; 335:111709. [PMID: 37688998 DOI: 10.1016/j.pscychresns.2023.111709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 06/20/2023] [Accepted: 08/24/2023] [Indexed: 09/11/2023]
Abstract
This study has investigated the potency and accuracy of early magnetic resonance spectroscopy (MRS) to predict post-concussion syndrome (PCS) in adult patients with a single mild traumatic brain injury (mTBI) without abnormality on a routine brain scan. A total of 48 eligible mTBI patients and 24 volunteers in the control group participated in this project. Brain MRS over regions of interest (ROI) and signal stop task (SST) were done within the first 72 hours of TBI onset. After six months, PCS appearance and severity were determined. In non-PCS patients, N-acetyl aspartate (NAA) levels significantly increased in the dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC) relative to the control group, however, this increase of NAA levels were recorded in all ROI versus PCS subjects. There were dramatic declines in creatinine (Cr) levels of all ROI and a decrease in choline levels of corpus callosum (CC) in the PCS group versus control and non-PCS ones. NAA and NAA/Cho values in ACC were the main predictors of PCS appearance. The Cho/Cr level in ACC was the first predictor of PCS severity. Predicting accuracy was higher in ACC than in other regions. This study suggested the significance of neuro-markers in ACC for optimal prediction of PCS and rendered a new insight into the biological mechanism of mTBI that underpins PCS.
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Affiliation(s)
| | - Sara Ramezani
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran; Department of Food Science and Nutrition, California State University, Fresno, CA, USA; Neuroscience Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Zoheir Reihanian
- Department of Neurosurgery, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Samira Raminfard
- Neuroimaging and Analysis Group, Research Center of Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Feizkhah
- Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran; Department of Medical Physics, Guilan University of Medical Sciences, Rasht, Iran
| | - Babak Alijani
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran; Department of Neurosurgery, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Sina Sedaghat Herfeh
- Neuroscience Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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2
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Pinggera D, Geiger P, Thomé C. [Traumatic brain injury]. DER NERVENARZT 2023; 94:960-972. [PMID: 37676293 PMCID: PMC10575816 DOI: 10.1007/s00115-023-01546-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/08/2023]
Abstract
Traumatic brain injury (TBI) describes parenchymal brain damage caused by external forces to the head. It has a massive personal and socioeconomic impact, as it is a disease with high morbidity and mortality. Both young and old people are affected, as a result of traffic or sports accidents as well as due to falls at home. The term TBI encompasses various clinical pictures, differing considerably in cause, prognosis and therapy. What they all have in common is the pathophysiological cascade that develops immediately after the initial trauma and which can persist for several days and weeks. In this phase, medical treatment, whether surgical or pharmacological, attempts to reduce the consequences of the primary damage. The aim is to maintain adequate cerebral perfusion pressure and to reduce intracranial pressure.
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Affiliation(s)
- D Pinggera
- Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
| | - P Geiger
- Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - C Thomé
- Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
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3
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Devoto C, Vorn R, Mithani S, Meier TB, Lai C, Broglio SP, McAllister T, Giza CC, Huber D, Harezlak J, Cameron KL, McGinty G, Jackson J, Guskiewicz K, Mihalik JP, Brooks A, Duma S, Rowson S, Nelson LD, Pasquina P, Turtzo C, Latour L, McCrea MA, Gill JM. Plasma phosphorylated tau181 as a biomarker of mild traumatic brain injury: findings from THINC and NCAA-DoD CARE Consortium prospective cohorts. Front Neurol 2023; 14:1202967. [PMID: 37662031 PMCID: PMC10470112 DOI: 10.3389/fneur.2023.1202967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/18/2023] [Indexed: 09/05/2023] Open
Abstract
Objective The aim of this study was to investigate phosphorylated tau (p-tau181) protein in plasma in a cohort of mild traumatic brain injury (mTBI) patients and a cohort of concussed athletes. Methods This pilot study comprised two independent cohorts. The first cohort-part of a Traumatic Head Injury Neuroimaging Classification (THINC) study-with a mean age of 46 years was composed of uninjured controls (UIC, n = 30) and mTBI patients (n = 288) recruited from the emergency department with clinical computed tomography (CT) and research magnetic resonance imaging (MRI) findings. The second cohort-with a mean age of 19 years-comprised 133 collegiate athletes with (n = 112) and without (n = 21) concussions. The participants enrolled in the second cohort were a part of a multicenter, prospective, case-control study conducted by the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium at six CARE Advanced Research Core (ARC) sites between 2015 and 2019. Blood was collected within 48 h of injury for both cohorts. Plasma concentration (pg/ml) of p-tau181 was measured using the Single Molecule Array ultrasensitive assay. Results Concentrations of plasma p-tau181 in both cohorts were significantly elevated compared to controls within 48 h of injury, with the highest concentrations of p-tau181 within 18 h of injury, with an area under the curve (AUC) of 0.690-0.748, respectively, in distinguishing mTBI patients and concussed athletes from controls. Among the mTBI patients, the levels of plasma p-tau181 were significantly higher in patients with positive neuroimaging (either CT+/MRI+, n = 74 or CT-/MRI+, n = 89) compared to mTBI patients with negative neuroimaging (CT-/MRI-, n = 111) findings and UIC (P-values < 0.05). Conclusion These findings indicate that plasma p-tau181 concentrations likely relate to brain injury, with the highest levels in patients with neuroimaging evidence of injury. Future research is needed to replicate and validate this protein assay's performance as a possible early diagnostic biomarker for mTBI/concussions.
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Affiliation(s)
- Christina Devoto
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
| | - Rany Vorn
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Sara Mithani
- School of Nursing, University of Texas Health at San Antonio, San Antonio, TX, United States
| | - Timothy B. Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Chen Lai
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University and Health Science, Bethesda, MD, United States
| | - Steven P. Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, United States
| | - Thomas McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Christopher C. Giza
- Departments of Pediatrics and Neurosurgery, UCLA Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Daniel Huber
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - Kenneth L. Cameron
- John A. Feagin Sports Medicine Fellowship, Keller Army Hospital, West Point, NY, United States
| | - Gerald McGinty
- United States Air Force Academy, Colorado Springs, CO, United States
| | - Jonathan Jackson
- United States Air Force Academy, Colorado Springs, CO, United States
| | - Kevin Guskiewicz
- Matthew Gfeller Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jason P. Mihalik
- Matthew Gfeller Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Alison Brooks
- Department of Orthopedics and Sports Medicine, University of Wisconsin, Madison, WI, United States
| | - Stefan Duma
- Department of Biomedical Engineering, Virginia Tech, Blacksburg, VA, United States
| | - Steven Rowson
- Department of Biomedical Engineering, Virginia Tech, Blacksburg, VA, United States
| | - Lindsay D. Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Paul Pasquina
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University and Health Science, Bethesda, MD, United States
| | - Christine Turtzo
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Lawrence Latour
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Michael A. McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jessica M. Gill
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
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Nishimura K, Cordeiro JG, Ahmed AI, Yokobori S, Gajavelli S. Advances in Traumatic Brain Injury Biomarkers. Cureus 2022; 14:e23804. [PMID: 35392277 PMCID: PMC8978594 DOI: 10.7759/cureus.23804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/05/2022] Open
Abstract
Traumatic brain injury (TBI) is increasingly a major cause of disability across the globe. The current methods of diagnosis are inadequate at classifying patients and prognosis. TBI is a diagnostic and therapeutic challenge. There is no Food and Drug Administration (FDA)-approved treatment for TBI yet. It took about 16 years of preclinical research to develop accurate and objective diagnostic measures for TBI. Two brain-specific protein biomarkers, namely, ubiquitin C-terminal hydrolase-L1 and glial fibrillary acidic protein, have been extensively characterized. Recently, the two biomarkers were approved by the FDA as the first blood-based biomarker, Brain Trauma Indicator™ (BTI™), via the Breakthrough Devices Program. This scoping review presents (i) TBI diagnosis challenges, (ii) the process behind the FDA approval of biomarkers, and (iii) known unknowns in TBI biomarker biology. The current lag in TBI incidence and hospitalization can be reduced if digital biomarkers such as hard fall detection are standardized and used as a mechanism to alert paramedics to an unresponsive trauma patient.
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5
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Whitehouse DP, Vile AR, Adatia K, Herlekar R, Roy AS, Mondello S, Czeiter E, Amrein K, Büki A, Maas AIR, Menon DK, Newcombe VFJ. Blood Biomarkers and Structural Imaging Correlations Post-Traumatic Brain Injury: A Systematic Review. Neurosurgery 2022; 90:170-179. [PMID: 34995235 DOI: 10.1227/neu.0000000000001776] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Blood biomarkers are of increasing importance in the diagnosis and assessment of traumatic brain injury (TBI). However, the relationship between them and lesions seen on imaging remains unclear. OBJECTIVE To perform a systematic review of the relationship between blood biomarkers and intracranial lesion types, intracranial lesion injury patterns, volume/number of intracranial lesions, and imaging classification systems. METHODS We searched Medical Literature Analysis and Retrieval System Online, Excerpta Medica dataBASE, and Cumulative Index to Nursing and Allied Health Literature from inception to May 2021, and the references of included studies were also screened. Heterogeneity in study design, biomarker types, imaging modalities, and analyses inhibited quantitative analysis, with a qualitative synthesis presented. RESULTS Fifty-nine papers were included assessing one or more biomarker to imaging comparisons per paper: 30 assessed imaging classifications or injury patterns, 28 assessed lesion type, and 11 assessed lesion volume or number. Biomarker concentrations were associated with the burden of brain injury, as assessed by increasing intracranial lesion volume, increasing numbers of traumatic intracranial lesions, and positive correlations with imaging classification scores. There were inconsistent findings associating different biomarkers with specific imaging phenotypes including diffuse axonal injury, cerebral edema, and intracranial hemorrhage. CONCLUSION Blood-based biomarker concentrations after TBI are consistently demonstrated to correlate burden of intracranial disease. The relation with specific injury types is unclear suggesting a lack of diagnostic specificity and/or is the result of the complex and heterogeneous nature of TBI.
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Affiliation(s)
- Daniel P Whitehouse
- Department of Medicine, University Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | | | - Krishma Adatia
- Department of Medicine, University Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Rahul Herlekar
- School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Akangsha Sur Roy
- School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Endre Czeiter
- Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary
- Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
- MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
| | - Krisztina Amrein
- Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary
- Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - András Büki
- Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary
- Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - David K Menon
- Department of Medicine, University Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Virginia F J Newcombe
- Department of Medicine, University Division of Anaesthesia, University of Cambridge, Cambridge, UK
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6
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Whitehouse DP, Monteiro M, Czeiter E, Vyvere TV, Valerio F, Ye Z, Amrein K, Kamnitsas K, Xu H, Yang Z, Verheyden J, Das T, Kornaropoulos EN, Steyerberg E, Maas AIR, Wang KKW, Büki A, Glocker B, Menon DK, Newcombe VFJ. Relationship of admission blood proteomic biomarkers levels to lesion type and lesion burden in traumatic brain injury: A CENTER-TBI study. EBioMedicine 2022; 75:103777. [PMID: 34959133 PMCID: PMC8718895 DOI: 10.1016/j.ebiom.2021.103777] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 11/12/2021] [Accepted: 12/10/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND We aimed to understand the relationship between serum biomarker concentration and lesion type and volume found on computed tomography (CT) following all severities of TBI. METHODS Concentrations of six serum biomarkers (GFAP, NFL, NSE, S100B, t-tau and UCH-L1) were measured in samples obtained <24 hours post-injury from 2869 patients with all severities of TBI, enrolled in the CENTER-TBI prospective cohort study (NCT02210221). Imaging phenotypes were defined as intraparenchymal haemorrhage (IPH), oedema, subdural haematoma (SDH), extradural haematoma (EDH), traumatic subarachnoid haemorrhage (tSAH), diffuse axonal injury (DAI), and intraventricular haemorrhage (IVH). Multivariable polynomial regression was performed to examine the association between biomarker levels and both distinct lesion types and lesion volumes. Hierarchical clustering was used to explore imaging phenotypes; and principal component analysis and k-means clustering of acute biomarker concentrations to explore patterns of biomarker clustering. FINDINGS 2869 patient were included, 68% (n=1946) male with a median age of 49 years (range 2-96). All severities of TBI (mild, moderate and severe) were included for analysis with majority (n=1946, 68%) having a mild injury (GCS 13-15). Patients with severe diffuse injury (Marshall III/IV) showed significantly higher levels of all measured biomarkers, with the exception of NFL, than patients with focal mass lesions (Marshall grades V/VI). Patients with either DAI+IVH or SDH+IPH+tSAH, had significantly higher biomarker concentrations than patients with EDH. Higher biomarker concentrations were associated with greater volume of IPH (GFAP, S100B, t-tau;adj r2 range:0·48-0·49; p<0·05), oedema (GFAP, NFL, NSE, t-tau, UCH-L1;adj r2 range:0·44-0·44; p<0·01), IVH (S100B;adj r2 range:0.48-0.49; p<0.05), Unsupervised k-means biomarker clustering revealed two clusters explaining 83·9% of variance, with phenotyping characteristics related to clinical injury severity. INTERPRETATION Interpretation: Biomarker concentration within 24 hours of TBI is primarily related to severity of injury and intracranial disease burden, rather than pathoanatomical type of injury. FUNDING CENTER-TBI is funded by the European Union 7th Framework programme (EC grant 602150).
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Affiliation(s)
- Daniel P Whitehouse
- University Division of Anaesthesia, Department of Medicine, University of Cambridge, UK
| | - Miguel Monteiro
- Biomedical Image Analysis Group, Department of Computing, Imperial College, London, UK
| | - Endre Czeiter
- Department of Neurosurgery, Medical School, University of Pécs, Rét u. 2, H-7623 Pécs, Hungary; Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs, Ifjúság útja 20, H-7624 Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group; Pécs, Hungary
| | - Thijs Vande Vyvere
- Research and Development, Icometrix, Leuven, Belgium; Department of Radiology, Antwerp University Hospital and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Fernanda Valerio
- University Division of Anaesthesia, Department of Medicine, University of Cambridge, UK
| | - Zheng Ye
- University Division of Anaesthesia, Department of Medicine, University of Cambridge, UK
| | - Krisztina Amrein
- Department of Neurosurgery, Medical School, University of Pécs, Rét u. 2, H-7623 Pécs, Hungary; Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs, Ifjúság útja 20, H-7624 Pécs, Hungary
| | | | - Haiyan Xu
- Program for Neurotrauma, Neuroproteomics and Biomarker Research, Departments of Emergency Medicine, Psychiatry and Neuroscience, University of Florida, McKnight Brain Institute, L4-100L 1149 South Newell Drive, Gainesville, FL 32611, USA
| | - Zhihui Yang
- Program for Neurotrauma, Neuroproteomics and Biomarker Research, Departments of Emergency Medicine, Psychiatry and Neuroscience, University of Florida, McKnight Brain Institute, L4-100L 1149 South Newell Drive, Gainesville, FL 32611, USA
| | - Jan Verheyden
- Research and Development, Icometrix, Leuven, Belgium
| | - Tilak Das
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | | | - Ewout Steyerberg
- Center for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Wijlrijkstraat 10, 2650 Edegem, Belgium
| | - Kevin K W Wang
- Program for Neurotrauma, Neuroproteomics and Biomarker Research, Departments of Emergency Medicine, Psychiatry and Neuroscience, University of Florida, McKnight Brain Institute, L4-100L 1149 South Newell Drive, Gainesville, FL 32611, USA; Brain Rehabilitation Research Center, Malcom Randall Veterans Affairs Medical Center (VAMC), 1601 SW, Archer Rd. Gainesville FL 32608, USA
| | - András Büki
- Department of Neurosurgery, Medical School, University of Pécs, Rét u. 2, H-7623 Pécs, Hungary; Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs, Ifjúság útja 20, H-7624 Pécs, Hungary
| | - Ben Glocker
- Biomedical Image Analysis Group, Department of Computing, Imperial College, London, UK
| | - David K Menon
- University Division of Anaesthesia, Department of Medicine, University of Cambridge, UK
| | - Virginia F J Newcombe
- University Division of Anaesthesia, Department of Medicine, University of Cambridge, UK.
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Wyatt S, Llabres-Diaz F, Lee CY, Beltran E. Early CT in dogs following traumatic brain injury has limited value in predicting short-term prognosis. Vet Radiol Ultrasound 2021; 62:181-189. [PMID: 33241888 DOI: 10.1111/vru.12933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 01/06/2023] Open
Abstract
Traumatic brain injury is associated with a high risk of mortality in veterinary patients, however publications describing valid prognostic indicators are currently lacking. The objective of this retrospective observational study was to determine whether early CT findings are associated with short-term prognosis following traumatic brain injury (TBI) in dogs. An electronic database was searched for dogs with TBI that underwent CT within 72 h of injury; 40 dogs met the inclusion criteria. CT findings were graded based on a Modified Advanced Imaging System (MAIS) from grade I (normal brain parenchyma) to VI (bilateral lesions affecting the brainstem with or without any foregoing lesions of lesser grades). Other imaging features recorded included presence of midline shift, intracranial hemorrhage, brain herniation, skull fractures, and percentage of total brain parenchyma affected. Outcome measures included survival to discharge and occurrence of immediate onset posttraumatic seizures. Thirty dogs (75%) survived to discharge. Seven dogs (17.5%) suffered posttraumatic seizures. There was no association between survival to discharge and posttraumatic seizures. No imaging features evaluated were associated with the study outcome measures. Therefore, the current study failed to identify any early CT imaging features with prognostic significance in canine TBI patients. Limitations associated with CT may preclude its use for prognostication; however, modifications to the current MAIS and evaluation in a larger study population may yield more useful results. Despite this, CT is a valuable tool in the detection of structural abnormalities following TBI in dogs that warrants further investigation.
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Affiliation(s)
- Sophie Wyatt
- Department of Veterinary Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - Francisco Llabres-Diaz
- Department of Veterinary Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - Chae Youn Lee
- Department of Veterinary Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - Elsa Beltran
- Department of Veterinary Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
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8
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Edwards KA, Pattinson CL, Guedes VA, Peyer J, Moore C, Davis T, Devoto C, Turtzo LC, Latour L, Gill JM. Inflammatory Cytokines Associate With Neuroimaging After Acute Mild Traumatic Brain Injury. Front Neurol 2020; 11:348. [PMID: 32508732 PMCID: PMC7248260 DOI: 10.3389/fneur.2020.00348] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/08/2020] [Indexed: 01/03/2023] Open
Abstract
Introduction: Elevated levels of blood-based proinflammatory cytokines are linked to acute moderate to severe traumatic brain injuries (TBIs), yet less is known in acute mild (m)TBI cohorts. The current study examined whether blood-based cytokines can differentiate patients with mTBI, with and without neuroimaging findings (CT and MRI). Material and Methods: Within 24 h of a mTBI, determined by a Glasgow Coma Scale (GCS) between 13 and 15, participants (n = 250) underwent a computed tomography (CT) and magnetic resonance imaging (MRI) scan and provided a blood sample. Participants were classified into three groups according to imaging findings; (1) CT+, (2) MRI+ (CT–), (3) Controls (CT– MRI–). Plasma levels of circulating cytokines (IL-6, IL-10, TNFα), and vascular endothelial growth factor (VEGF) were measured using an ultra-sensitive immunoassay. Results: Concentrations of inflammatory cytokines (IL-6, TNFα) and VEGF were elevated in CT+, as well as MRI+ groups (p < 0.001), compared to controls, even after controlling for age, sex and cardiovascular disease (CVD)-related risk factors; hypertension, and hyperlipidemia. Post-concussive symptoms were associated with imaging groupings, but not inflammatory cytokines in this cohort. Levels of VEGF, IL-6, and TNFα differentiated patients with CT+ findings from controls, with the combined biomarker model (VEGF, IL-6, TNFα, and IL-10) showing good discriminatory power (AUC 0.92, 95% CI 0.87–0.97). IL-6 was a fair predictor of MRI+ findings compared to controls (AUC 0.70, 95% CI 0.60–0.78). Finally, the combined biomarker model discriminated patients with MRI+ from CT+ with an AUC of 0.71 (95% CI 0.62–0.80). Conclusions: When combined, IL-6, TNFα, and VEGF may provide a promising biomarker cytokine panel to differentiate mTBI patients with CT+ imaging vs. controls. Singularly, IL-6 was a fair discriminator between each of the imaging groups. Future research directions may help elucidate mechanisms related to injury severity and potentially, recovery following an mTBI.
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Affiliation(s)
- Katie A Edwards
- National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, United States.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
| | - Cassandra L Pattinson
- National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, United States
| | - Vivian A Guedes
- National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, United States
| | - Jordan Peyer
- National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, United States
| | - Candace Moore
- National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, United States
| | - Tara Davis
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD, United States.,Johns Hopkins Suburban Hospital, Bethesda, MD, United States
| | - Christina Devoto
- National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, United States.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
| | - L Christine Turtzo
- National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Lawrence Latour
- National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Jessica M Gill
- National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, United States.,Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Biomarker Core, Bethesda, MD, United States
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9
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Sheth C, Prescot AP, Legarreta M, Renshaw PF, McGlade E, Yurgelun-Todd D. Increased myoinositol in the anterior cingulate cortex of veterans with a history of traumatic brain injury: a proton magnetic resonance spectroscopy study. J Neurophysiol 2020; 123:1619-1629. [DOI: 10.1152/jn.00765.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In this study of veterans, we used a state-of-the-art neuroimaging tool to probe the neurometabolic profile of the anterior cingulate cortex in veterans with traumatic brain injury (TBI). We report significantly elevated myoinositol levels in veterans with TBI compared with those without TBI.
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Affiliation(s)
- Chandni Sheth
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, Utah
| | - Andrew P. Prescot
- Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Margaret Legarreta
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, Utah
- George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC), Salt Lake City, Utah
| | - Perry F. Renshaw
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, Utah
- George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC), Salt Lake City, Utah
| | - Erin McGlade
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, Utah
- George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC), Salt Lake City, Utah
| | - Deborah Yurgelun-Todd
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, Utah
- George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC), Salt Lake City, Utah
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Yousefzadeh-Chabok S, Kapourchali FR, Ramezani S. Determinants of long-term health-related quality of life in adult patients with mild traumatic brain injury. Eur J Trauma Emerg Surg 2019; 47:839-846. [DOI: 10.1007/s00068-019-01252-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
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11
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Neuroanatomical and functional alterations of insula in mild traumatic brain injury patients at the acute stage. Brain Imaging Behav 2019; 14:907-916. [PMID: 30734204 DOI: 10.1007/s11682-019-00053-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cognitive impairment is a major cause of disability and decline in quality of life in mild traumatic brain injury (mTBI) survivors, but the underlying pathophysiology is still poorly understood. The insula has extensive connections to other cortex and is believed to responsible for integrating external and internal processes and controlling cognitive functions. To explore this hypothesis, we investigated early alterations in the gray matter volume (GMV) and brain functional connectivity (FC) of insula in mTBI patients within 7 days after injury and any possible correlations with cognitive function. A total of 58 mTBI patients at the acute stage and 32 matched healthy controls were recruited and underwentT1-weighted magnetic resonance imaging (MRI)andresting-state functional MRI scans within 7 days of injury. FC was characterized using seed-based region of interest analysis method. The patients' cognitive function was evaluated with Montreal Cognitive Assessment (MoCA) score. The resulting of GMV and FC of insula were correlated with cognitive alterations. We found that the GMV was significantly reduced only in the right insula in mTBI patients and no significant GMV increase was observed in either hemisphere. mTBI patients demonstrated decreased FC in the right parahippocampal gyrus and increased FC in the right supramargianl gyrus. In addition, compared to the healthy controls, the mTBI patients in the acute stage presented a decline in the visuospatial/executive (p = 0.013) and attention (p = 0.038) subcategories. In the mTBI group, the changes in GMV in the right insula were positively correlated with poor attention performance (r = 0.316, p = 0.016). Our data demonstrated alterations of the GMV and resting-stateFC of the right insula in mTBI patients at the acute stage. These early changes in GMV and resting-state FC perhaps serve as a potential biomarker for improving the understanding of cognitive decline for mTBI in the acute setting.
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12
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Gill J, Latour L, Diaz-Arrastia R, Motamedi V, Turtzo C, Shahim P, Mondello S, DeVoto C, Veras E, Hanlon D, Song L, Jeromin A. Glial fibrillary acidic protein elevations relate to neuroimaging abnormalities after mild TBI. Neurology 2018; 91:e1385-e1389. [PMID: 30209234 DOI: 10.1212/wnl.0000000000006321] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 06/29/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To determine whether a panel of blood-based biomarkers can discriminate between patients with suspected mild traumatic brain injury (mTBI) with and without neuroimaging findings (CT and MRI). METHODS Study participants presented to the emergency department with suspected mTBI (n = 277) with a CT and MRI scan and healthy controls (n = 49). Plasma concentrations of tau, glial fibrillary acidic protein (GFAP), ubiquitin carboxyl-terminal hydrolase L1, and neurofilament light chain (NFL) were measured using the single-molecule array technology. RESULTS Concentrations of GFAP, tau, and NFL were higher in patients with mTBI, compared with those of controls (p's < 0.01). GFAP yielded an area under the curve (AUC) of 0.93 (95% confidence interval [CI] 0.90-0.96), confirming its discriminatory power for distinguishing mTBI from controls. Levels of GFAP, tau, and NFL were higher in patients with trauma-related intracranial findings on CT compared with those with normal CT, with the only significant predictor being GFAP (AUC 0.77, 95% CI 0.70-0.84). Among patients with mTBI, tau, NFL, and GFAP differentiated subjects with and without MRI abnormalities with an AUC of 0.83, with GFAP being the strongest predictor. Combining tau, NFL, and GFAP showed a good discriminatory power (AUC 0.80, 95% CI 0.69-0.90) for detecting MRI abnormalities, even in patients with mTBI with a normal CT. CONCLUSION Our study confirms GFAP as a promising marker of brain injury in patients with acute mTBI. A combination of various biomarkers linked to different pathophysiologic mechanisms increases diagnostic subgroup accuracy. This multimarker strategy may guide medical decision making, facilitate the use of MRI scanning, and prove valuable in the stratification of patients with brain injuries in future clinical trials. CLASSIFICATION OF EVIDENCE Class I evidence that blood concentrations of GFAP, tau, and NFL discriminate patients with mTBI with and without neuroimaging findings.
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Affiliation(s)
- Jessica Gill
- From the National Institutes of Health (J.G., V.M., C.D.), National Institute of Nursing Research, the Center for Neuroscience and Regenerative Medicine (J.G., P.S.), Uniformed Services University of the Health Sciences, Biomarker Core, and the National Institutes of Health (L.L., C.T.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; the Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia, PA; the Department of Biomedical and Dental Sciences and Morphofunctional Imaging (S.M.), University of Messina, Italy; and the Quanterix Corporation (E.V., D.H., L.S., A.J.), Lexington, MA.
| | - Lawrence Latour
- From the National Institutes of Health (J.G., V.M., C.D.), National Institute of Nursing Research, the Center for Neuroscience and Regenerative Medicine (J.G., P.S.), Uniformed Services University of the Health Sciences, Biomarker Core, and the National Institutes of Health (L.L., C.T.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; the Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia, PA; the Department of Biomedical and Dental Sciences and Morphofunctional Imaging (S.M.), University of Messina, Italy; and the Quanterix Corporation (E.V., D.H., L.S., A.J.), Lexington, MA
| | - Ramon Diaz-Arrastia
- From the National Institutes of Health (J.G., V.M., C.D.), National Institute of Nursing Research, the Center for Neuroscience and Regenerative Medicine (J.G., P.S.), Uniformed Services University of the Health Sciences, Biomarker Core, and the National Institutes of Health (L.L., C.T.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; the Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia, PA; the Department of Biomedical and Dental Sciences and Morphofunctional Imaging (S.M.), University of Messina, Italy; and the Quanterix Corporation (E.V., D.H., L.S., A.J.), Lexington, MA
| | - Vida Motamedi
- From the National Institutes of Health (J.G., V.M., C.D.), National Institute of Nursing Research, the Center for Neuroscience and Regenerative Medicine (J.G., P.S.), Uniformed Services University of the Health Sciences, Biomarker Core, and the National Institutes of Health (L.L., C.T.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; the Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia, PA; the Department of Biomedical and Dental Sciences and Morphofunctional Imaging (S.M.), University of Messina, Italy; and the Quanterix Corporation (E.V., D.H., L.S., A.J.), Lexington, MA
| | - Christine Turtzo
- From the National Institutes of Health (J.G., V.M., C.D.), National Institute of Nursing Research, the Center for Neuroscience and Regenerative Medicine (J.G., P.S.), Uniformed Services University of the Health Sciences, Biomarker Core, and the National Institutes of Health (L.L., C.T.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; the Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia, PA; the Department of Biomedical and Dental Sciences and Morphofunctional Imaging (S.M.), University of Messina, Italy; and the Quanterix Corporation (E.V., D.H., L.S., A.J.), Lexington, MA
| | - Pashtun Shahim
- From the National Institutes of Health (J.G., V.M., C.D.), National Institute of Nursing Research, the Center for Neuroscience and Regenerative Medicine (J.G., P.S.), Uniformed Services University of the Health Sciences, Biomarker Core, and the National Institutes of Health (L.L., C.T.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; the Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia, PA; the Department of Biomedical and Dental Sciences and Morphofunctional Imaging (S.M.), University of Messina, Italy; and the Quanterix Corporation (E.V., D.H., L.S., A.J.), Lexington, MA
| | - Stefania Mondello
- From the National Institutes of Health (J.G., V.M., C.D.), National Institute of Nursing Research, the Center for Neuroscience and Regenerative Medicine (J.G., P.S.), Uniformed Services University of the Health Sciences, Biomarker Core, and the National Institutes of Health (L.L., C.T.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; the Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia, PA; the Department of Biomedical and Dental Sciences and Morphofunctional Imaging (S.M.), University of Messina, Italy; and the Quanterix Corporation (E.V., D.H., L.S., A.J.), Lexington, MA
| | - Christina DeVoto
- From the National Institutes of Health (J.G., V.M., C.D.), National Institute of Nursing Research, the Center for Neuroscience and Regenerative Medicine (J.G., P.S.), Uniformed Services University of the Health Sciences, Biomarker Core, and the National Institutes of Health (L.L., C.T.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; the Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia, PA; the Department of Biomedical and Dental Sciences and Morphofunctional Imaging (S.M.), University of Messina, Italy; and the Quanterix Corporation (E.V., D.H., L.S., A.J.), Lexington, MA
| | - Eliseo Veras
- From the National Institutes of Health (J.G., V.M., C.D.), National Institute of Nursing Research, the Center for Neuroscience and Regenerative Medicine (J.G., P.S.), Uniformed Services University of the Health Sciences, Biomarker Core, and the National Institutes of Health (L.L., C.T.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; the Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia, PA; the Department of Biomedical and Dental Sciences and Morphofunctional Imaging (S.M.), University of Messina, Italy; and the Quanterix Corporation (E.V., D.H., L.S., A.J.), Lexington, MA
| | - David Hanlon
- From the National Institutes of Health (J.G., V.M., C.D.), National Institute of Nursing Research, the Center for Neuroscience and Regenerative Medicine (J.G., P.S.), Uniformed Services University of the Health Sciences, Biomarker Core, and the National Institutes of Health (L.L., C.T.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; the Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia, PA; the Department of Biomedical and Dental Sciences and Morphofunctional Imaging (S.M.), University of Messina, Italy; and the Quanterix Corporation (E.V., D.H., L.S., A.J.), Lexington, MA
| | - Linan Song
- From the National Institutes of Health (J.G., V.M., C.D.), National Institute of Nursing Research, the Center for Neuroscience and Regenerative Medicine (J.G., P.S.), Uniformed Services University of the Health Sciences, Biomarker Core, and the National Institutes of Health (L.L., C.T.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; the Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia, PA; the Department of Biomedical and Dental Sciences and Morphofunctional Imaging (S.M.), University of Messina, Italy; and the Quanterix Corporation (E.V., D.H., L.S., A.J.), Lexington, MA
| | - Andreas Jeromin
- From the National Institutes of Health (J.G., V.M., C.D.), National Institute of Nursing Research, the Center for Neuroscience and Regenerative Medicine (J.G., P.S.), Uniformed Services University of the Health Sciences, Biomarker Core, and the National Institutes of Health (L.L., C.T.), National Institute of Neurological Disorders and Stroke, Bethesda, MD; the Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia, PA; the Department of Biomedical and Dental Sciences and Morphofunctional Imaging (S.M.), University of Messina, Italy; and the Quanterix Corporation (E.V., D.H., L.S., A.J.), Lexington, MA
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13
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Bendinelli C, Cooper S, Evans T, Bivard A, Pacey D, Parson M, Balogh ZJ. Perfusion Abnormalities are Frequently Detected by Early CT Perfusion and Predict Unfavourable Outcome Following Severe Traumatic Brain Injury. World J Surg 2018; 41:2512-2520. [PMID: 28455815 DOI: 10.1007/s00268-017-4030-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND In patients with severe traumatic brain injury (TBI), early CT perfusion (CTP) provides additional information beyond the non-contrast CT (NCCT) and may alter clinical management. We hypothesized that this information may prognosticate functional outcome. METHODS Five-year prospective observational study was performed in a level-1 trauma centre on consecutive severe TBI patients. CTP (obtained in conjunction with first routine NCCT) was interpreted as: abnormal, area of altered perfusion more extensive than on NCCT, and the presence of ischaemia. Six months Glasgow Outcome Scale-Extended of four or less was considered an unfavourable outcome. Logistic regression analysis of CTP findings and core variables [preintubation Glasgow Coma Scale (GCS), Rotterdam score, base deficit, age] was conducted using Bayesian model averaging to identify the best predicting model for unfavourable outcome. RESULTS Fifty patients were investigated with CTP (one excluded for the absence of TBI) [male: 80%, median age: 35 (23-55), prehospital intubation: 7 (14.2%); median GCS: 5 (3-7); median injury severity score: 29 (20-36); median head and neck abbreviated injury scale: 4 (4-5); median days in ICU: 10 (5-15)]. Thirty (50.8%) patients had an unfavourable outcome. GCS was a moderate predictor of unfavourable outcome (AUC = 0.74), while CTP variables showed greater predictive ability (AUC for abnormal CTP = 0.92; AUC for area of altered perfusion more extensive than NCCT = 0.83; AUC for the presence of ischaemia = 0.81). CONCLUSION Following severe TBI, CTP performed at the time of the first follow-up NCCT, is a non-invasive and extremely valuable tool for early outcome prediction. The potential impact on management and its cost effectiveness deserves to be evaluated in large-scale studies. LEVEL OF EVIDENCE III Prospective study.
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Affiliation(s)
- Cino Bendinelli
- Department of Traumatology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Shannon Cooper
- Department of Traumatology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Tiffany Evans
- Clinical Research Design, Information Technology and Statistical Support, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Andrew Bivard
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Dianne Pacey
- Department of Rehabilitation, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Mark Parson
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia.
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14
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Shetty VS, Reis MN, Aulino JM, Berger KL, Broder J, Choudhri AF, Kendi AT, Kessler MM, Kirsch CF, Luttrull MD, Mechtler LL, Prall JA, Raksin PB, Roth CJ, Sharma A, West OC, Wintermark M, Cornelius RS, Bykowski J. ACR Appropriateness Criteria Head Trauma. J Am Coll Radiol 2017; 13:668-79. [PMID: 27262056 DOI: 10.1016/j.jacr.2016.02.023] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 10/21/2022]
Abstract
Neuroimaging plays an important role in the management of head trauma. Several guidelines have been published for identifying which patients can avoid neuroimaging. Noncontrast head CT is the most appropriate initial examination in patients with minor or mild acute closed head injury who require neuroimaging as well as patients with moderate to severe acute closed head injury. In short-term follow-up neuroimaging of acute traumatic brain injury, CT and MRI may have complementary roles. In subacute to chronic traumatic brain injury, MRI is the most appropriate initial examination, though CT may have a complementary role in select circumstances. Advanced neuroimaging techniques are areas of active research but are not considered routine clinical practice at this time. In suspected intracranial vascular injury, CT angiography or venography or MR angiography or venography is the most appropriate imaging study. In suspected posttraumatic cerebrospinal fluid leak, high-resolution noncontrast skull base CT is the most appropriate initial imaging study to identify the source, with cisternography reserved for problem solving. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Affiliation(s)
| | - Martin N Reis
- St Louis University School of Medicine, St Louis, Missouri
| | | | | | - Joshua Broder
- Duke University Division of Emergency Medicine, Cary, North Carolina, American College of Emergency Physicians
| | - Asim F Choudhri
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Marcus M Kessler
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | | | - Laszlo L Mechtler
- Dent Neurologic Institute, Amherst, New York, American Academy of Neurology
| | | | | | | | - Aseem Sharma
- Mallinckrodt Institute of Radiology, St Louis, Missouri
| | | | | | | | - Julie Bykowski
- University of California, San Diego, Health Center, San Diego, California
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15
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Shinoda J, Asano Y. Disorder of Executive Function of the Brain after Head Injury and Mild Traumatic Brain Injury - Neuroimaging and Diagnostic Criteria for Implementation of Administrative Support in Japan. Neurol Med Chir (Tokyo) 2017; 57:199-209. [PMID: 28381654 PMCID: PMC5447811 DOI: 10.2176/nmc.ra.2016-0293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The diagnotic criteria for disorder of the executive function of the brain (DEFB) as a syndrome of sequela were administratively established (ad-DEFB) in Japan in 2006 to support disabled patients whose impairment, limited to cognition (memory, attention, execution, and behavior), emerges after organic brain injuries regardless of physical deficits. However, some patients suffering from traumatic brain injury (TBI) have been excluded from receiving medico-social services. In particular, this tendency is more prominent in patients with mild TBI because no lesions are apparent on conventional computed tomography (CT) or magnetic resonance imaging (MRI) in the chronic phase. Recent development of new MRI neuroimaging modalities and positron emission tomography (PET) imaging makes it possible to detect regions of minute organic lesions and metabolic dysfunction in the brain where organic lesions may be absent or cannot be detected on conventional CT or MRI. In this review, we discuss diagnostic criteria for mild TBI and ad-DEFB, the relationship between the two disorders, characteristic neuroimaging [(MRI and 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET)] of diffuse brain injury including cerebral concussion, which is the principal cause of mild TBI, and suggested pathological mechanisms of ad-DEFB in DBI.
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Affiliation(s)
- Jun Shinoda
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital.,Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine
| | - Yoshitaka Asano
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital.,Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine
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16
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Thoughts on “Is advanced neuroimaging for neuroradiologists?” by S. Cocozza and the content of “Neuroradiolgy”. Neuroradiology 2017; 59:101-102. [DOI: 10.1007/s00234-017-1799-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 02/02/2017] [Indexed: 11/26/2022]
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17
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Snyder VS, Hansen LA. A Conceptual Overview of Axonopathy in Infants and Children with Allegedly Inflicted Head Trauma. Acad Forensic Pathol 2016; 6:608-621. [PMID: 31239934 DOI: 10.23907/2016.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/14/2016] [Accepted: 11/12/2016] [Indexed: 11/12/2022]
Abstract
Fatal, allegedly inflicted pediatric head trauma remains a controversial topic in forensic pathology. Recommendations for systematic neuropathologic evaluation of the brains of supposedly injured infants and children usually include the assessment of long white matter tracts in search of axonopathy - specifically, diffuse axonal injury. The ability to recognize, document, and interpret injuries to axons has significant academic and medicolegal implications. For example, more than two decades of inconsistent nosology have resulted in confusion about the definition of diffuse axonal injury between various medical disciplines including radiology, neurosurgery, pediatrics, neuropathology, and forensic pathology. Furthermore, in the pediatric setting, acceptance that "pure" shaking can cause axonal shearing in infants and young children is not widespread. Additionally, controversy abounds whether or not axonal trauma can be identified within regions of white matter ischemia - a debate with very significant implications. Immunohistochemistry is often used not only to document axonal injury, but also to estimate the time since injury. As a result, the estimated post-injury interval may then be used by law enforcement officers and prosecutors to narrow "exclusive opportunity" and thus, identify potential suspects. Fundamental to these highly complicated and controversial topics is a philosophical understanding of the diffuse axonal injury spectrum disorders.
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da Costa L, van Niftrik CB, Crane D, Fierstra J, Bethune A. Temporal Profile of Cerebrovascular Reactivity Impairment, Gray Matter Volumes, and Persistent Symptoms after Mild Traumatic Head Injury. Front Neurol 2016; 7:70. [PMID: 27242655 PMCID: PMC4862985 DOI: 10.3389/fneur.2016.00070] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 04/25/2016] [Indexed: 12/25/2022] Open
Abstract
Objective Increased awareness around neurocognitive deficits after mild traumatic brain injury (mTBI) has progressed the search for objective, diagnostic, and monitoring tools, yet imaging biomarkers for mTBI and recovery are not established in clinical use. It has been suggested that mTBI impairs cerebrovascular reactivity (CVR) to CO2, which could be related to post-concussive syndrome (PCS). We investigate CVR evolution after mTBI using blood-oxygen-level dependent (BOLD) magnetic resonance imaging (MRI) and possible correlation with PCS. Methods A prospective cohort of 25 mTBI patients and 18 matched controls underwent BOLD MRI CVR measurements. A subset of 19 mTBI patients underwent follow-up testing. Visits took place at a mean of 63 and 180 days after injury. Symptoms were assessed with the Sport Concussion Assessment Tool 2 (SCAT2). Symptoms, CVR and brain volume [gray matter (GM), white matter (WM), and whole brain (WB)], age, and sex, were examined between groups and longitudinally within traumatic brain injury (TBI) patients. Results Traumatic brain injury participants were 72% males, mean age being 42.7 years. Control participants were 61% with mean age of 38.7 years. SCAT2 scores tended to improve among those mTBI patients with follow-up visits (p = 0.07); however, they did not tend to recover to scores of the healthy controls. Brain volumes were not statistically different between groups at the first visit (WM p = 0.71; GM p = 0.36). In mTBI patients, there was a reduction in GM volume between visits 1 and 2 (p = 0.0046). Although mean CVR indexes were similar (WM p = 0.27; GM p = 0.36; and WB p = 0.35), the correlation between SCAT2 and CVR was negative in controls (WM-r = −0.59; p = 0.010; GM-r = −0.56; p = 0.016; brain-r = −0.58; p = 0.012) and weaker and positive in mTBI (brain-r = 0.4; p = 0.046; GM-r = 0.4; p = 0.048). SCAT2 correlated with GM volume (r = 0.5215, p = 0.0075) in mTBI but not in controls (r = 0.2945, p = 0.2355). Conclusion There is a correlation between lower GM CVR indexes and lower performance on SCAT2 in patients with mTBI, which seems to be associated with more symptoms. This correlation seems to persist well beyond 120 days. mTBI may lead to a decrease in GM volume in these patients.
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Affiliation(s)
- Leodante da Costa
- Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | - David Crane
- Brain Sciences Program, Sunnybrook Research Institute , Toronto, ON , Canada
| | - Jorn Fierstra
- Division of Neurosurgery, University Hospital Zurich , Zurich , Switzerland
| | - Allison Bethune
- Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto , Toronto, ON , Canada
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Spikman JM, Timmerman ME, Coers A, van der Naalt J. Early Computed Tomography Frontal Abnormalities Predict Long-Term Neurobehavioral Problems But Not Affective Problems after Moderate to Severe Traumatic Brain Injury. J Neurotrauma 2016; 33:22-8. [DOI: 10.1089/neu.2014.3788] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jacoba M. Spikman
- Department of Clinical and Developmental Neuropsychology, University of Groningen, the Netherlands
- Department of Neurology, University of Groningen, the Netherlands
| | - Marieke E. Timmerman
- Department of Psychometrics and Statistics, University of Groningen, the Netherlands
| | - Annemiek Coers
- Department of Neurology, University of Groningen, the Netherlands
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Currie S, Saleem N, Straiton JA, Macmullen-Price J, Warren DJ, Craven IJ. Imaging assessment of traumatic brain injury. Postgrad Med J 2015; 92:41-50. [PMID: 26621823 DOI: 10.1136/postgradmedj-2014-133211] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 10/20/2015] [Indexed: 11/04/2022]
Abstract
Traumatic brain injury (TBI) constitutes injury that occurs to the brain as a result of trauma. It should be appreciated as a heterogeneous, dynamic pathophysiological process that starts from the moment of impact and continues over time with sequelae potentially seen many years after the initial event. Primary traumatic brain lesions that may occur at the moment of impact include contusions, haematomas, parenchymal fractures and diffuse axonal injury. The presence of extra-axial intracranial lesions such as epidural and subdural haematomas and subarachnoid haemorrhage must be anticipated as they may contribute greatly to secondary brain insult by provoking brain herniation syndromes, cranial nerve deficits, oedema and ischaemia and infarction. Imaging is fundamental to the management of patients with TBI. CT remains the imaging modality of choice for initial assessment due to its ease of access, rapid acquisition and for its sensitivity for detection of acute haemorrhagic lesions for surgical intervention. MRI is typically reserved for the detection of lesions that may explain clinical symptoms that remain unresolved despite initial CT. This is especially apparent in the setting of diffuse axonal injury, which is poorly discerned on CT. Use of particular MRI sequences may increase the sensitivity of detecting such lesions: diffusion-weighted imaging defining acute infarction, susceptibility-weighted imaging affording exquisite data on microhaemorrhage. Additional advanced MRI techniques such as diffusion tensor imaging and functional MRI may provide important information regarding coexistent structural and functional brain damage. Gaining robust prognostic information for patients following TBI remains a challenge. Advanced MRI sequences are showing potential for biomarkers of disease, but this largely remains at the research level. Various global collaborative research groups have been established in an effort to combine imaging data with clinical and epidemiological information to provide much needed evidence for improvement in the characterisation and classification of TBI and in the identity of the most effective clinical care for this patient cohort. However, analysis of collaborative imaging data is challenging: the diverse spectrum of image acquisition and postprocessing limits reproducibility, and there is a requirement for a robust quality assurance initiative. Future clinical use of advanced neuroimaging should ensure standardised approaches to image acquisition and analysis, which can be used at the individual level, with the expectation that future neuroimaging advances, personalised to the patient, may improve prognostic accuracy and facilitate the development of new therapies.
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Affiliation(s)
- Stuart Currie
- Department of Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nayyar Saleem
- Department of Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - John A Straiton
- Department of Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Daniel J Warren
- Department of Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ian J Craven
- Department of Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Reis C, Wang Y, Akyol O, Ho WM, Ii RA, Stier G, Martin R, Zhang JH. What's New in Traumatic Brain Injury: Update on Tracking, Monitoring and Treatment. Int J Mol Sci 2015; 16:11903-65. [PMID: 26016501 PMCID: PMC4490422 DOI: 10.3390/ijms160611903] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/04/2015] [Accepted: 05/06/2015] [Indexed: 12/11/2022] Open
Abstract
Traumatic brain injury (TBI), defined as an alteration in brain functions caused by an external force, is responsible for high morbidity and mortality around the world. It is important to identify and treat TBI victims as early as possible. Tracking and monitoring TBI with neuroimaging technologies, including functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), positron emission tomography (PET), and high definition fiber tracking (HDFT) show increasing sensitivity and specificity. Classical electrophysiological monitoring, together with newly established brain-on-chip, cerebral microdialysis techniques, both benefit TBI. First generation molecular biomarkers, based on genomic and proteomic changes following TBI, have proven effective and economical. It is conceivable that TBI-specific biomarkers will be developed with the combination of systems biology and bioinformation strategies. Advances in treatment of TBI include stem cell-based and nanotechnology-based therapy, physical and pharmaceutical interventions and also new use in TBI for approved drugs which all present favorable promise in preventing and reversing TBI.
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Affiliation(s)
- Cesar Reis
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - Yuechun Wang
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
- Department of Physiology, School of Medicine, University of Jinan, Guangzhou 250012, China.
| | - Onat Akyol
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
| | - Wing Mann Ho
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
- Department of Neurosurgery, University Hospital Innsbruck, Tyrol 6020, Austria.
| | - Richard Applegate Ii
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - Gary Stier
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - Robert Martin
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - John H Zhang
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
- Department of Neurosurgery, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA.
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Van Der Naalt J. Resting functional imaging tools (MRS, SPECT, PET and PCT). HANDBOOK OF CLINICAL NEUROLOGY 2015; 127:295-308. [PMID: 25702224 DOI: 10.1016/b978-0-444-52892-6.00019-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Functional imaging includes imaging techniques that provide information about the metabolic and hemodynamic status of the brain. Most commonly applied functional imaging techniques in patients with traumatic brain injury (TBI) include magnetic resonance spectroscopy (MRS), single photon emission computed tomography (SPECT), positron emission tomography (PET) and perfusion CT (PCT). These imaging modalities are used to determine the extent of injury, to provide information for the prediction of outcome, and to assess evidence of cerebral ischemia. In TBI, secondary brain damage mainly comprises ischemia and is present in more than 80% of fatal cases with traumatic brain injury (Graham et al., 1989; Bouma et al., 1991; Coles et al., 2004). In particular, while SPECT measures cerebral perfusion and MRS determines metabolism, PET is able to assess both perfusion and cerebral metabolism. This chapter will describe the application of these techniques in traumatic brain injury separately for the major groups of severity comprising the mild and moderate to severe group. The application in TBI and potential difficulties of each technique is described. The use of imaging techniques in children will be separately outlined.
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Affiliation(s)
- J Van Der Naalt
- Department of Neurology, University Medical Center Groningen, University of Groningen, The Netherlands.
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Bianchi A, Bhanu B, Obenaus A. Dynamic Low-Level Context for the Detection of Mild Traumatic Brain Injury. IEEE Trans Biomed Eng 2015; 62:145-53. [DOI: 10.1109/tbme.2014.2342653] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Dhandapani S, Sharma A, Sharma K, Das L. Comparative evaluation of MRS and SPECT in prognostication of patients with mild to moderate head injury. J Clin Neurosci 2014; 21:745-50. [DOI: 10.1016/j.jocn.2013.07.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 06/22/2013] [Accepted: 07/04/2013] [Indexed: 02/08/2023]
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Metting Z, Spikman JM, Rödiger LA, van der Naalt J. Cerebral perfusion and neuropsychological follow up in mild traumatic brain injury: Acute versus chronic disturbances? Brain Cogn 2014; 86:24-31. [DOI: 10.1016/j.bandc.2014.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 12/19/2013] [Accepted: 01/21/2014] [Indexed: 10/25/2022]
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Bianchi A, Bhanu B, Donovan V, Obenaus A. Visual and Contextual Modeling for the Detection of Repeated Mild Traumatic Brain Injury. IEEE TRANSACTIONS ON MEDICAL IMAGING 2014; 33:11-22. [PMID: 23797243 DOI: 10.1109/tmi.2013.2269317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Currently, there is a lack of computational methods for the evaluation of mild traumatic brain injury (mTBI) from magnetic resonance imaging (MRI). Further, the development of automated analyses has been hindered by the subtle nature of mTBI abnormalities, which appear as low contrast MR regions. This paper proposes an approach that is able to detect mTBI lesions by combining both the high-level context and low-level visual information. The contextual model estimates the progression of the disease using subject information, such as the time since injury and the knowledge about the location of mTBI. The visual model utilizes texture features in MRI along with a probabilistic support vector machine to maximize the discrimination in unimodal MR images. These two models are fused to obtain a final estimate of the locations of the mTBI lesion. The models are tested using a novel rodent model of repeated mTBI dataset. The experimental results demonstrate that the fusion of both contextual and visual textural features outperforms other state-of-the-art approaches. Clinically, our approach has the potential to benefit both clinicians by speeding diagnosis and patients by improving clinical care.
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Metting Z, Cerliani L, Rödiger LA, van der Naalt J. Pathophysiological concepts in mild traumatic brain injury: diffusion tensor imaging related to acute perfusion CT imaging. PLoS One 2013; 8:e64461. [PMID: 23704986 PMCID: PMC3660324 DOI: 10.1371/journal.pone.0064461] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 04/12/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A subgroup of patients with mild traumatic brain injury (TBI) experiences residual symptoms interfering with their return to work. The pathophysiological substrate of the suboptimal outcome in these patients is a source of debate. OBJECTIVE To provide greater insight into the pathophysiological mechanisms of mild TBI. METHODS Diffusion tensor imaging (DTI) was performed during follow-up of 18 patients with mild TBI and compared with healthy control subjects. DTI data of the patient group were also compared with perfusion CT imaging in the acute phase of injury. RESULTS In patients with mild TBI, a trend was observed for a decreased fractional anisotropy (FA) in widespread bilateral frontal white matter areas with increased mean diffusivity (MD) in the parieto-temporal regions, compared to healthy control subjects. Cerebral blood volume (CBV) correlated significantly with FA in several white matter tracts including the corpus callosum, the internal capsule, the inferior fronto-occipital fascicle, the corticospinal tract, the superior and the inferior longitudinal fascicle. CONCLUSION In mild TBI with normal conventional imaging significant associations between cerebral perfusion in the acute phase of injury and DTI analyses in the chronic phase of injury were discerned. The pathophysiological concept of these findings is being outlined.
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Affiliation(s)
- Zwany Metting
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands.
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Shinoda J, Asano Y. Neuroimaging of Patients with Impairments of Executive Brain Function Due to Traumatic Brain Injury. ACTA ACUST UNITED AC 2013. [DOI: 10.7887/jcns.22.842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bigler ED, Maxwell WL. Neuropathology of mild traumatic brain injury: relationship to neuroimaging findings. Brain Imaging Behav 2012; 6:108-36. [PMID: 22434552 DOI: 10.1007/s11682-011-9145-0] [Citation(s) in RCA: 220] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Neuroimaging identified abnormalities associated with traumatic brain injury (TBI) are but gross indicators that reflect underlying trauma-induced neuropathology at the cellular level. This review examines how cellular pathology relates to neuroimaging findings with the objective of more closely relating how neuroimaging findings reveal underlying neuropathology. Throughout this review an attempt will be made to relate what is directly known from post-mortem microscopic and gross anatomical studies of TBI of all severity levels to the types of lesions and abnormalities observed in contemporary neuroimaging of TBI, with an emphasis on mild traumatic brain injury (mTBI). However, it is impossible to discuss the neuropathology of mTBI without discussing what occurs with more severe injury and viewing pathological changes on some continuum from the mildest to the most severe. Historical milestones in understanding the neuropathology of mTBI are reviewed along with implications for future directions in the examination of neuroimaging and neuropathological correlates of TBI.
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Affiliation(s)
- Erin D Bigler
- Department of Psychology, Brigham Young University, Provo, UT, USA.
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Irimia A, Wang B, Aylward SR, Prastawa MW, Pace DF, Gerig G, Hovda DA, Kikinis R, Vespa PM, Van Horn JD. Neuroimaging of structural pathology and connectomics in traumatic brain injury: Toward personalized outcome prediction. NEUROIMAGE-CLINICAL 2012; 1:1-17. [PMID: 24179732 PMCID: PMC3757727 DOI: 10.1016/j.nicl.2012.08.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 08/14/2012] [Accepted: 08/15/2012] [Indexed: 11/01/2022]
Abstract
Recent contributions to the body of knowledge on traumatic brain injury (TBI) favor the view that multimodal neuroimaging using structural and functional magnetic resonance imaging (MRI and fMRI, respectively) as well as diffusion tensor imaging (DTI) has excellent potential to identify novel biomarkers and predictors of TBI outcome. This is particularly the case when such methods are appropriately combined with volumetric/morphometric analysis of brain structures and with the exploration of TBI-related changes in brain network properties at the level of the connectome. In this context, our present review summarizes recent developments on the roles of these two techniques in the search for novel structural neuroimaging biomarkers that have TBI outcome prognostication value. The themes being explored cover notable trends in this area of research, including (1) the role of advanced MRI processing methods in the analysis of structural pathology, (2) the use of brain connectomics and network analysis to identify outcome biomarkers, and (3) the application of multivariate statistics to predict outcome using neuroimaging metrics. The goal of the review is to draw the community's attention to these recent advances on TBI outcome prediction methods and to encourage the development of new methodologies whereby structural neuroimaging can be used to identify biomarkers of TBI outcome.
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Key Words
- 3D, three-dimensional
- AAL, Automatic Anatomical Labeling
- ADC, apparent diffusion coefficient
- ANTS, Advanced Normalization ToolS
- BOLD, blood oxygen level dependent
- CC, corpus callosum
- CT, computed tomography
- DAI, diffuse axonal injury
- DSI, diffusion spectrum imaging
- DTI, diffusion tensor imaging
- DWI, diffusion weighted imaging
- Diffusion tensor
- FA, fractional anisotropy
- FLAIR, Fluid Attenuated Inversion Recovery
- FSE, Functional Status Examination
- GCS, Glasgow Coma Score
- GM, gray matter
- GOS, Glasgow Outcome Score
- GRE, Gradient Recalled Echo
- HARDI, high-angular-resolution diffusion imaging
- IBA, Individual Brain Atlas
- LDA, linear discriminant analysis
- MRI, magnetic resonance imaging
- MRI/fMRI
- NINDS, National Institute of Neurological Disorders and Stroke
- Neuroimaging
- Outcome measures
- PCA, principal component analysis
- PROMO, PROspective MOtion Correction
- SPM, Statistical Parametric Mapping
- SWI, Susceptibility Weighted Imaging
- TBI, traumatic brain injury
- TBSS, tract-based spatial statistics
- Trauma
- WM, white matter
- fMRI, functional magnetic resonance imaging
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Affiliation(s)
- Andrei Irimia
- Laboratory of Neuro Imaging, Department of Neurology, University of California, Los Angeles, CA 90095, USA
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Geurts BHJ, Andriessen TMJC, Goraj BM, Vos PE. The reliability of magnetic resonance imaging in traumatic brain injury lesion detection. Brain Inj 2012; 26:1439-50. [PMID: 22731791 DOI: 10.3109/02699052.2012.694563] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study compares inter-rater-reliability, lesion detection and clinical relevance of T2-weighted imaging (T2WI), Fluid Attenuated Inversion Recovery (FLAIR), T2*-gradient recalled echo (T2*-GRE) and Susceptibility Weighted Imaging (SWI) in Traumatic Brain Injury (TBI). METHODS Three raters retrospectively scored 56 TBI patients' MR images (12-76 years old, median TBI-MRI interval 7 weeks) on number, volume, location and intensity. Punctate lesions (diameter <10 mm) were scored separately from large lesions (diameter ≥ 10 mm). Injury severity was assessed with the Glasgow Coma Scale (GCS), outcome with the Glasgow Outcome Scale-Extended (GOSE). RESULTS Inter-rater-reliability for lesion volume and punctate lesion count was good (ICC = 0.69-0.94) except for punctate lesion count on T2WI (ICC = 0.19) and FLAIR (ICC = 0.15). SWI showed the highest number of lesions (mean = 30.0), followed by T2*-GRE (mean = 15.4), FLAIR (mean = 3.1) and T2WI (mean = 2.2). Sequences did not differ in detected lesion volume. Punctate lesion count on T2*-GRE (r = -0.53) and SWI (r = -0.49) correlated with the GCS (p < 0.001). CONCLUSIONS T2*-GRE and SWI are more sensitive than T2WI and FLAIR in detecting (haemorrhagic) traumatic punctate lesions. The correlation between number of punctate lesions on T2*-GRE/SWI and the GCS indicates that haemorrhagic lesions are clinically relevant. The considerable inter-rater-disagreement in this study advocates cautiousness in interpretation of punctate lesions using T2WI and FLAIR.
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Affiliation(s)
- Bram H J Geurts
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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Affiliation(s)
- Emerson L. Gasparetto
- Universidade Federal do Rio de Janeiro; Clínicas de Diagnóstico Por Imagem; Multi-Imagem, Brasil
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Cazalis F, Babikian T, Giza C, Copeland S, Hovda D, Asarnow RF. Pivotal role of anterior cingulate cortex in working memory after traumatic brain injury in youth. Front Neurol 2011; 1:158. [PMID: 21270956 PMCID: PMC3026484 DOI: 10.3389/fneur.2010.00158] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 12/16/2010] [Indexed: 11/13/2022] Open
Abstract
In this fMRI study, the functions of the anterior cingulate cortex (ACC) were studied in a group of adolescents who had sustained a moderate to severe traumatic brain injury (TBI). A spatial working memory task with varying working memory loads, representing experimental conditions of increasing difficulty, was administered. In a cross-sectional comparison between the patients and a matched control group, patients performed worse than Controls, showing longer reaction times and lower response accuracy on the spatial working memory task. Brain imaging findings suggest a possible double-dissociation: activity of the ACC in the TBI group, but not in the Control group, was associated with task difficulty; conversely, activity of the left sensorimotor cortex (lSMC) in the Control group, but not in the TBI group, was correlated with task difficulty. In addition to the main cross-sectional study, a longitudinal study of a group of adolescent patients with moderate to severe TBI was done using fMRI and the same spatial working memory task. The patient group was studied at two time-points: one time-point during the post-acute phase and one time-point 12 months later, during the chronic phase. Results indicated that patients' behavioral performance improved over time, suggesting cognitive recovery. Brain imaging findings suggest that, over this 12-month period, patients recruited less of the ACC and more of the lSMC in response to increasing task difficulty. The role of ACC in executive functions following a moderate to severe brain injury in adolescence is discussed within the context of conflicting models of the ACC functions in the existing literature.
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Affiliation(s)
- Fabienne Cazalis
- Psychiatry and Biobehavioral Sciences, University of California Los Angeles David Geffen School of MedicineLos Angeles, CA, USA
- Department of Anatomy, Ross University School of MedicineRoseau, Commonwealth of Dominica
| | - Talin Babikian
- Psychiatry and Biobehavioral Sciences, University of California Los Angeles David Geffen School of MedicineLos Angeles, CA, USA
| | - Christopher Giza
- Department of Neurosurgery, University of California Los Angeles David Geffen School of MedicineLos Angeles, CA, USA
| | - Sarah Copeland
- Department of Neurosurgery, University of California Los Angeles David Geffen School of MedicineLos Angeles, CA, USA
| | - David Hovda
- Department of Neurosurgery, University of California Los Angeles David Geffen School of MedicineLos Angeles, CA, USA
| | - Robert F. Asarnow
- Psychiatry and Biobehavioral Sciences, University of California Los Angeles David Geffen School of MedicineLos Angeles, CA, USA
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Dhandapani SS, Sharma A, Rajan SK, Chand K, Das L. Single photon emission computed tomography evaluation in patients with mild to moderate head injury. INDIAN JOURNAL OF NEUROTRAUMA 2010. [DOI: 10.1016/s0973-0508(10)80024-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Warner MA, Marquez de la Plata C, Spence J, Wang JY, Harper C, Moore C, Devous M, Diaz-Arrastia R. Assessing spatial relationships between axonal integrity, regional brain volumes, and neuropsychological outcomes after traumatic axonal injury. J Neurotrauma 2010; 27:2121-30. [PMID: 20874032 DOI: 10.1089/neu.2010.1429] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Diffuse traumatic axonal injury (TAI) is a type of traumatic brain injury (TBI) characterized predominantly by white matter damage. While TAI is associated with cerebral atrophy, the relationship between gray matter volumes and TAI of afferent or efferent axonal pathways remains unknown. Moreover, it is unclear if deficits in cognition are associated with post-traumatic brain volumes in particular regions. The goal of this study was to determine the relationship between markers of TAI and volumes of cortical and subcortical structures, while also assessing the relationship between cognitive outcomes and regional brain volumes. High-resolution magnetic resonance imaging scans were performed in 24 patients with TAI within 1 week of injury and were repeated 8 months later. Diffusion tensor imaging (DTI) tractography was used to reconstruct prominent white matter tracts and calculate their fractional anisotropy (FA) and mean diffusivity (MD) values. Regional brain volumes were computed using semi-automated morphometric analysis. Pearson's correlation coefficients were used to assess associations between brain volumes, white matter integrity (i.e., FA and MD), and neuropsychological outcomes. Post-traumatic volumes of many gray matter structures were associated with chronic damage to related white matter tracts, and less strongly associated with measures of white matter integrity in the acute scans. For example, left and right hippocampal volumes correlated with FA in the fornix body (r = 0.600, p = 0.001; r = 0.714, p < 0.001, respectively). In addition, regional brain volumes were associated with deficits in corresponding neuropsychological domains. Our results suggest that TAI may be a primary mechanism of post-traumatic atrophy, and provide support for regional morphometry as a biomarker for cognitive outcome after injury.
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Affiliation(s)
- Matthew A Warner
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9036, USA
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Lull N, Noé E, Lull JJ, García-Panach J, Chirivella J, Ferri J, López-Aznar D, Sopena P, Robles M. Voxel-based statistical analysis of thalamic glucose metabolism in traumatic brain injury: Relationship with consciousness and cognition. Brain Inj 2010; 24:1098-107. [DOI: 10.3109/02699052.2010.494592] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Usefulness of functional MRI associated with PET scan and evoked potentials in the evaluation of brain functions after severe brain injury: Preliminary results. J Neuroradiol 2010; 37:159-66. [DOI: 10.1016/j.neurad.2009.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 07/09/2009] [Accepted: 07/29/2009] [Indexed: 11/21/2022]
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Tay SY, Ang BT, Lau XY, Meyyappan A, Collinson SL. Chronic impairment of prospective memory after mild traumatic brain injury. J Neurotrauma 2010; 27:77-83. [PMID: 19698071 DOI: 10.1089/neu.2009.1074] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Prospective memory (PM), the ability to recall future intentions, is crucial for independent living. Impairment of PM is a common complaint following head injury and is a significant impediment to good recovery, yet no studies have explored PM in mild traumatic brain injury (mTBI). In this study, prospective memory was examined in 31 mTBI patients and matched controls within a month of injury and 3 months after. mTBI patients performed more poorly than controls on the MIST task (Raskin, 2004) within the first month following injury, indicating that PM impairment is part of the acute cognitive sequelae of mTBI. These problems persisted beyond 3 months post-injury, suggesting that PM may be a sensitive indicator of cerebral compromise in mild brain injuries.
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Affiliation(s)
- Sze Yan Tay
- Department of Psychology, National University of Singapore, Faculty of Arts and Social Sciences, Singapore.
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Steinman K, Ross J, Lai S, Reiss A, Hoeft F. Structural and functional neuroimaging in Klinefelter (47,XXY) syndrome: a review of the literature and preliminary results from a functional magnetic resonance imaging study of language. ACTA ACUST UNITED AC 2010; 15:295-308. [PMID: 20014370 DOI: 10.1002/ddrr.84] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Klinefelter (47,XXY) syndrome (KS), the most common form of sex-chromosomal aneuploidy, is characterized by physical, endocrinologic, and reproductive abnormalities. Individuals with KS also exhibit a cognitive/behavioral phenotype characterized by language and language-based learning disabilities and executive and attentional dysfunction in the setting of normal general intelligence. The underlying neurobiologic mechanisms are just now beginning to be elucidated through structural and functional neuroimaging. Here, we review the literature of structural and functional neural findings in KS identified by neuroimaging and present preliminary results from a functional magnetic resonance imaging study examining brain activity during a verb generation task in KS.
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Affiliation(s)
- Kyle Steinman
- Division of Child Neurology, Department of Neurology, University of California-San Francisco, 350 Parnassus Ave, Suite 609, San Francisco, CA 94117, USA.
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Scheid R, von Cramon DY. Clinical findings in the chronic phase of traumatic brain injury: data from 12 years' experience in the Cognitive Neurology Outpatient Clinic at the University of Leipzig. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:199-205. [PMID: 20386669 PMCID: PMC2853149 DOI: 10.3238/arztebl.2010.0199] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 09/03/2009] [Indexed: 02/01/2023]
Abstract
BACKGROUND There are many unresolved issues in the diagnosis and treatment of persons with traumatic brain injury (TBI) in its post-acute and chronic phases. This article deals with two problems of clinical importance: (i) the interrelationships between structural brain damage, brain function, and clinical outcome, and (ii) post-traumatic epilepsy. METHODS Exploratory, retrospective analysis of clinical, neuroradiological (MRI), and neuropsychological data of all patients with TBI who were treated in a cognitive neurology outpatient clinic of a German university hospital over a period of 12 years (n=320). RESULTS 156 patients (48.8%) had brain contusions, 83 of them (25.9%) as the sole neuroradiological abnormality. Traumatic micro-hemorrhages were seen in 148 patients (46.2%) and were the sole neuroradiological abnormality in 79 of them (24.7%). 49 patients (15.3%) had no structural brain lesion. There was no obvious correlation between the neuroradiological findings and the clinical outcome, as measured either by a general outcome parameter such as the extended Glasgow Outcome Scale (GOSE) or by neuropsychological testing. 47 patients (14.7%) had post-traumatic epilepsy; its occurrence was positively correlated with the presence of brain contusions, but not with an isolated diagnosis of diffuse axonal injury (DAI). CONCLUSION A comparison of the findings of neuroradiological studies and neuropsychological tests among patients in the chronic phase of traumatic brain injury does not reveal any simple relationship between structural and functional brain abnormalities. Diffuse axonal injury is often present in combination with other findings, and it may well be the only structural abnormality in many cases; therefore, all symptomatic patients should undergo MRI of the brain. Patients with isolated DAI seem to be less prone to post-traumatic epilepsy than those with brain contusions.
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Affiliation(s)
- Rainer Scheid
- Max-Planck-Institut für Kognitions- und Neurowissenschaften, Stephanstr. 1A, 04103 Leipzig, Germany.
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Traumatic brain injury affects the frontomedian cortex--an event-related fMRI study on evaluative judgments. Neuropsychologia 2010; 48:185-93. [PMID: 19747929 DOI: 10.1016/j.neuropsychologia.2009.09.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 08/18/2009] [Accepted: 09/03/2009] [Indexed: 11/23/2022]
Abstract
Traumatic brain injuries represent the leading cause of death and disability in young adults in industrialized countries. Recently, it has been suggested that dysfunctions of the frontomedian cortex, which enables social cognition, are responsible for clinical deficits in the long-term. To validate this hypothesis, we examined brain activation in seven young adults suffering from diffuse axonal injury during a cognitive task that specifically depends on frontomedian structures, namely evaluative judgments, contrasted with semantic memory retrieval. Brain activation in patients was compared with healthy age and gender matched control subjects using event-related functional magnetic resonance imaging. Evaluative judgments were related to a neural network discussed in the context of self-referential processing and theory of mind. More precisely, the neural network consisted of frontomedian regions, the temporal pole, and the posterior superior temporal gyrus and sulcus/angular gyrus. Patients showed higher activations in this network and the inferior frontal gyrus, whereas healthy control subjects activated more dopaminergic structures, namely the ventral tegmental area, during evaluative judgments. One possible interpretation of the data is that deficits in the ventral tegmental area, and consequently the mesocorticolimbic projection system, have to be compensated for by higher brain activations in the frontomedian and anterior cingulate cortex in patients with diffuse axonal injury. In conclusion, our study supports the hypothesis that traumatic brain injury is characterized by frontomedian dysfunctions, which may be responsible for clinical deficits in the long-term and which might be modified by rehabilitative strategies in the future.
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Jacobs B, Beems T, van der Vliet TM, Borm GF, Vos PE. The Status of the Fourth Ventricle and Ambient Cisterns Predict Outcome in Moderate and Severe Traumatic Brain Injury. J Neurotrauma 2010; 27:331-40. [DOI: 10.1089/neu.2009.1105] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bram Jacobs
- Department of Neurology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Tjemme Beems
- Department of Neurosurgery, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Ton M. van der Vliet
- Department of Radiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - George F. Borm
- Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Pieter E. Vos
- Department of Neurology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Goddard T, Mankad K. Imaging the Brain-Injured Patient. Neurocrit Care 2010. [DOI: 10.1007/978-1-84882-070-8_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McKinlay A. Controversies and outcomes associated with mild traumatic brain injury in childhood and adolescences. Child Care Health Dev 2010; 36:3-21. [PMID: 19719771 DOI: 10.1111/j.1365-2214.2009.01006.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A McKinlay
- Department of Psychology, University of Canterbury, Private Bag 4800, Christchurch, New Zealand.
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Christensen J, Pedersen MG, Pedersen CB, Sidenius P, Olsen J, Vestergaard M. Long-term risk of epilepsy after traumatic brain injury in children and young adults: a population-based cohort study. Lancet 2009; 373:1105-10. [PMID: 19233461 DOI: 10.1016/s0140-6736(09)60214-2] [Citation(s) in RCA: 228] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The risk of epilepsy shortly after traumatic brain injury is high, but how long this high risk lasts is unknown. We aimed to assess the risk of epilepsy up to 10 years or longer after traumatic brain injury, taking into account sex, age, severity, and family history. METHODS We identified 1 605 216 people born in Denmark (1977-2002) from the Civil Registration System. We obtained information on traumatic brain injury and epilepsy from the National Hospital Register and estimated relative risks (RR) with Poisson analyses. FINDINGS Risk of epilepsy was increased after a mild brain injury (RR 2.22, 95% CI 2.07-2.38), severe brain injury (7.40, 6.16-8.89), and skull fracture (2.17, 1.73-2.71). The risk was increased more than 10 years after mild brain injury (1.51, 1.24-1.85), severe brain injury (4.29, 2.04-9.00), and skull fracture (2.06, 1.37-3.11). RR increased with age at mild and severe injury and was especially high among people older than 15 years of age with mild (3.51, 2.90-4.26) and severe (12.24, 8.52-17.57) injury. The risk was slightly higher in women (2.49, 2.25-2.76) than in men (2.01, 1.83-2.22). Patients with a family history of epilepsy had a notably high risk of epilepsy after mild (5.75, 4.56-7.27) and severe brain injury (10.09, 4.20-24.26). INTERPRETATION The longlasting high risk of epilepsy after brain injury might provide a window for prevention of post-traumatic epilepsy.
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Affiliation(s)
- Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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Formisano R, Bivona U, Catani S, D'Ippolito M, Buzzi MG. Post-traumatic headache: facts and doubts. J Headache Pain 2009; 10:145-52. [PMID: 19294482 PMCID: PMC3451986 DOI: 10.1007/s10194-009-0108-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 02/03/2009] [Indexed: 11/26/2022] Open
Abstract
The International Classification of Headache Disorders does not separate the moderate from severe/very severe traumatic brain injury (TBI), since they are all defined by Glasgow coma scale (GCS) < 13. The distinction between the severe and very severe TBI (GCS < 8) should be made upon coma duration that in the latter may be longer than 15 days up to months in the case of vegetative state. Post-traumatic amnesia duration may double the coma duration itself. Therefore, the 3-month parameter proposed to define the occurrence or resolution of post-traumatic headache (PTH) appears inadequate. Following TBI, neuropathic pain, central pain, thalamic pain, combined pain are all possible and they call for proper pharmacological approaches. One more reason for having difficulties in obtaining information about headache in the early phase after regaining consciousness is the presence of concomitant medications that may affect pain perception. Post-traumatic stress disorder (PTSD) develops days or weeks after stress and tends to improve or disappear within 3 months after exposure; interestingly, this spontaneous timing resembles that of PTH. In our experience the number of TBI patients with PTH at 1-year follow-up is lower in those with longer coma duration and more severe TBI. Cognitive functioning evaluated after at least 12 months from TBI, showed mild or no impairment in these patients with severe TBI and PTH, whereas they have psychopathological changes, namely anxiety and depression. The majority of patients with PTH after severe/very severe TBI had skull fractures or dural lacerations and paroxystic EEG abnormalities. The combination of psychological changes (depression and anxiety) and organic features (skull fractures, dural lacerations, epileptic EEG abnormalities) in PTH may be inversely correlated with the severity of TBI, with prevalence of psychological disturbances in mild TBI and of organic lesions in severe TBI. On the other hand, only in severe TBI patients with good cognitive recovery the influence of the psychopathological disorders may play a role. In fact, the affective pain perception is probably related to the integrity of cognitive functions as in mild TBI and in severe TBI with good cognitive outcome.
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Affiliation(s)
- Rita Formisano
- Post-Coma Unit and Headache Center, IRCCS Fondazione Santa Lucia, Rome, Italy.
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Abstract
OBJECTIVE AND BACKGROUND Decision under ambiguity and decision under risk are fundamental in every-day life. METHODS We investigated these 2 types of decision in traumatic brain injury (TBI) patients through the Iowa Gambling Task (IGT), the Probability-Associated Gambling (PAG) task, and a counsel version of the PAG task. Although in the IGT rules for gain and losses are implicit and probability information is missing, in the PAG task and the counsel task rules are explicit and probabilities are well-defined. RESULTS In the IGT, TBI patients selected more disadvantageously than healthy controls and failed to develop an advantageous strategy over time. Patients also made less advantageous choices than controls in the PAG task and the counsel task. Compared with controls, TBI patients gambled more frequently with low probabilities and less frequently with high probabilities. Overall, participants decided more advantageously in the counsel task, which does not provide feedback, than in the PAG task. Importantly, our results indicate that TBI patients' performance on all decision tasks correlated with executive functions. CONCLUSIONS Our study shows that TBI patients have difficulties in decision under risk and decision under ambiguity. Difficulties may be attributed to deficient learning from feedback and to reduced risk estimation, but not to impulsive risk taking behavior.
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Courtney AC, Courtney MW. A thoracic mechanism of mild traumatic brain injury due to blast pressure waves. Med Hypotheses 2008; 72:76-83. [PMID: 18829180 DOI: 10.1016/j.mehy.2008.08.015] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 07/31/2008] [Accepted: 08/03/2008] [Indexed: 10/21/2022]
Abstract
The mechanisms by which blast pressure waves cause mild-to-moderate traumatic brain injury (mTBI) are an open question. Possibilities include acceleration of the head, direct passage of the blast wave via the cranium, and propagation of the blast wave to the brain via a thoracic mechanism. The hypothesis that the blast pressure wave reaches the brain via a thoracic mechanism is considered in light of ballistic and blast pressure wave research. Ballistic pressure waves, caused by penetrating ballistic projectiles or ballistic impacts to body armor, can only reach the brain via an internal mechanism and have been shown to cause cerebral effects. Similar effects have been documented when a blast pressure wave has been applied to the whole body or focused on the thorax in animal models. While vagotomy reduces apnea and bradycardia due to ballistic or blast pressure waves, it does not eliminate neural damage in the brain, suggesting that the pressure wave directly affects the brain cells via a thoracic mechanism. An experiment is proposed which isolates the thoracic mechanism from cranial mechanisms of mTBI due to blast wave exposure. Results have implications for evaluating risk of mTBI due to blast exposure and for developing effective protection.
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Affiliation(s)
- A C Courtney
- Department of Physics, United States Military Academy, West Point, NY 10996, United States.
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