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Medenica V, Ivanovic L, Milosevic N. Applicability of artificial intelligence in neuropsychological rehabilitation of patients with brain injury. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-28. [PMID: 38912923 DOI: 10.1080/23279095.2024.2364229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Neuropsychological rehabilitation plays a critical role in helping those recovering from brain injuries restore cognitive and functional abilities. Artificial Intelligence, with its potential, may revolutionize this field further; therefore, this article explores applications of AI for neuropsychological rehabilitation of patients suffering brain injuries. This study employs a systematic review methodology to comprehensively review existing literature regarding Artificial Intelligence use in neuropsychological rehabilitation for people with brain injuries. The systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of electronic databases (PubMed, Scopus, PsycINFO, etc.) showed a total of 212 potentially relevant articles. After removing duplicates and screening titles and abstracts, 186 articles were selected for assessment. Following the assessment, 55 articles met the inclusion criteria and were included in this systematic review. A thematic analysis approach is employed to analyze and synthesize the extracted data. Themes, patterns, and trends are identified across the included studies, allowing for a comprehensive understanding of the applicability of AI in neuropsychological rehabilitation for patients with brain injuries. The identified topics were: AI Applications in Diagnostics of Brain Injuries and their Neuropsychological Repercussions; AI in Personalization and Monitoring of Neuropsychological Rehabilitation for traumatic brain injury (TBI); Leveraging AI for Predicting and Optimizing Neuropsychological Rehabilitation Outcomes in TBI Patients. Based on the review, it was concluded that AI has the potential to enhance neuropsychological rehabilitation for patients with brain injuries. By leveraging AI techniques, personalized rehabilitation programs can be developed, treatment outcomes can be predicted, and interventions can be optimized.
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Affiliation(s)
- Veselin Medenica
- Department of Occupational Therapy, The College of Human Development, Belgrade, Serbia
| | - Lidija Ivanovic
- Department of Occupational Therapy, The College of Human Development, Belgrade, Serbia
| | - Neda Milosevic
- Department of Occupational Therapy, The College of Human Development, Belgrade, Serbia
- Department of Speech Therapy, The College of Human Development, Belgrade, Serbia
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2
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Nguyen P, Albayram M, Tuna I. Intramyelinic edema manifesting as central white matter diffusion restriction associated with brain contusion in pediatric patients. Neuroradiol J 2024:19714009241260796. [PMID: 38856642 DOI: 10.1177/19714009241260796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
In traumatic brain injury, white matter diffusion restriction can be an imaging manifestation of non-hemorrhagic axonal injury. In this article, a different pattern of widespread white matter diffusion restriction associated with ipsilateral cortical damage, all noted in pediatric and young adult TBI patients, is presented. Its atypical pattern of distribution and extensive scope on imaging suggest excitotoxicity and intramyelinic edema as possible underlying mechanisms.
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Affiliation(s)
- Phuong Nguyen
- Department of Radiology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Mehmet Albayram
- Department of Radiology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ibrahim Tuna
- Department of Radiology, College of Medicine, University of Florida, Gainesville, FL, USA
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Delteil C, Manlius T, Bailly N, Godio-Raboutet Y, Piercecchi-Marti MD, Tuchtan L, Hak JF, Velly L, Simeone P, Thollon L. Traumatic axonal injury: Clinic, forensic and biomechanics perspectives. Leg Med (Tokyo) 2024; 70:102465. [PMID: 38838409 DOI: 10.1016/j.legalmed.2024.102465] [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: 03/26/2024] [Revised: 05/21/2024] [Accepted: 06/01/2024] [Indexed: 06/07/2024]
Abstract
Identification of Traumatic axonal injury (TAI) is critical in clinical practice, particularly in terms of long-term prognosis, but also for medico-legal issues, to verify whether the death or the after-effects were attributable to trauma. Multidisciplinary approaches are an undeniable asset when it comes to solving these problems. The aim of this work is therefore to list the different techniques needed to identify axonal lesions and to understand the lesion mechanisms involved in their formation. Imaging can be used to assess the consequences of trauma, to identify indirect signs of TAI, to explain the patient's initial symptoms and even to assess the patient's prognosis. Three-dimensional reconstructions of the skull can highlight fractures suggestive of trauma. Microscopic and immunohistochemical techniques are currently considered as the most reliable tools for the early identification of TAI following trauma. Finite element models use mechanical equations to predict biomechanical parameters, such as tissue stresses and strains in the brain, when subjected to external forces, such as violent impacts to the head. These parameters, which are difficult to measure experimentally, are then used to predict the risk of injury. The integration of imaging data with finite element models allows researchers to create realistic and personalized computational models by incorporating actual geometry and properties obtained from imaging techniques. The personalization of these models makes their forensic approach particularly interesting.
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Affiliation(s)
- Clémence Delteil
- Forensic Department, Assistance Publique-Hôpitaux de Marseille, La Timone, 264 rue St Pierre, 13385 Marseille Cedex 05, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France.
| | - Thais Manlius
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France.
| | - Nicolas Bailly
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France; Neuroimagery Department, Assistance Publique-Hôpitaux de Marseille, La Timone, 264 rue St Pierre, 13385 Marseille Cedex 05, France.
| | | | - Marie-Dominique Piercecchi-Marti
- Forensic Department, Assistance Publique-Hôpitaux de Marseille, La Timone, 264 rue St Pierre, 13385 Marseille Cedex 05, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France.
| | - Lucile Tuchtan
- Forensic Department, Assistance Publique-Hôpitaux de Marseille, La Timone, 264 rue St Pierre, 13385 Marseille Cedex 05, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France.
| | | | - Lionel Velly
- Département d'Anesthésie-Réanimation, Assistance Publique-Hôpitaux de Marseille, La Timone, Marseille, France; Université Aix-Marseille/CNRS, Institut des Neurosciences de la Timone, UMR7289, Marseille, France.
| | - Pierre Simeone
- Département d'Anesthésie-Réanimation, Assistance Publique-Hôpitaux de Marseille, La Timone, Marseille, France; Université Aix-Marseille/CNRS, Institut des Neurosciences de la Timone, UMR7289, Marseille, France.
| | - Lionel Thollon
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France.
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Şahin S, Botan E, Gün E, Yüksel MF, Süt NY, Kartal AT, Gurbanov A, Kahveci F, Özen H, Havan M, Yıldırım M, Şahap SK, Bektaş Ö, Teber S, Fitoz S, Kendirli T. Correlation between early computed tomography findings and neurological outcome in pediatric traumatic brain injury patients. Neurol Sci 2024:10.1007/s10072-024-07511-x. [PMID: 38622450 DOI: 10.1007/s10072-024-07511-x] [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: 01/11/2024] [Accepted: 03/30/2024] [Indexed: 04/17/2024]
Abstract
Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children. Head computed tomography (CT) is frequently utilized for evaluating trauma-related characteristics, selecting treatment options, and monitoring complications in the early stages. This study assessed the relationship between cranial CT findings and early and late neurological outcomes in pediatric TBI patients admitted to the pediatric intensive care unit (PICU). The study included children aged 1 month to 18 years who were admitted to the PICU due to TBI between 2014 and 2020. Sociodemographic data, clinical characteristics, and cranial CT findings were analyzed. Patients were categorized based on their Glasgow Coma Scale (GCS) score. Of the 129 patients, 83 (64%) were male, and 46 (36%) were female, with a mean age of 6.8 years. Falls (n = 51, 39.5%) and in-vehicle traffic accidents (n = 35, 27.1%) were the most common trauma types observed. Normal brain imaging findings were found in 62.7% of the patients, while 37.3% exhibited intracranial pathology. Hemorrhage was the most frequent CT finding. Severe TBI (n = 26, p = 0.032) and mortality (n = 9, p = 0.017) were more prevalent in traffic accidents. The overall mortality rate in the study population was 10.1%. In children with TBI, cranial CT imaging serves as an essential initial method for patients with neurological manifestations. Particularly, a GCS score of ≤ 8, multiple hemorrhages, diffuse cerebral edema, and intraventricular bleeding are associated with sequelae and mortality.
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Affiliation(s)
- Süleyman Şahin
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey.
| | - Edin Botan
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Emrah Gün
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Merve Feyza Yüksel
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Nurşah Yeniay Süt
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Ayşe Tuğba Kartal
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Anar Gurbanov
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Fevzi Kahveci
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Hasan Özen
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Merve Havan
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Miraç Yıldırım
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Seda Kaynak Şahap
- Department of Pediatric Radiology, Ankara University Medical School, Çocuk Radyoloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Ömer Bektaş
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Serap Teber
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Suat Fitoz
- Department of Pediatric Radiology, Ankara University Medical School, Çocuk Radyoloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Tanıl Kendirli
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
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Chen PM, Lee S, Cruz LD, Lopez M, Thomas A, Chen JW, Grigorian A, Nahmias J, Lekawa M. iPad-Based Neurocognitive Testing (ImPACT-QT) in Acute Adult Mild Traumatic Brain Injury/Concussion: Study on Practicality and Bedside Cognitive Scores in a Level-1 Trauma Center. Am Surg 2024:31348241246168. [PMID: 38592191 DOI: 10.1177/00031348241246168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND There lacks rapid standardized bedside testing to screen cognitive deficits following mild traumatic brain injury (mTBI). Immediate Post-Concussion Assessment & Cognitive Testing-Quick Test (ImPACT-QT) is an abbreviated-iPad form of computerized cognitive testing. The aim of this study is to test ImPACT-QT utility in inpatient settings. We hypothesize ImPACT-QT is feasible in the acute trauma setting. METHOD Trauma patients ages 12-70 were administered ImPACT-QT (09/2022-09/2023). Encephalopathic/medically unstable patients were excluded. Mild traumatic brain injury was defined as documented-head trauma with loss-of-consciousness <30 minutes and arrival Glasgow Coma Scale 13-15. Patients answered Likert-scale surveys. Bivariate analyses compared demographics, attention, motor speed, and memory scores between mTBI and non-TBI controls. Multivariable logistic regression assessed memory score as a predictor of mTBI diagnosis. RESULTS Of 233 patients evaluated (36 years [IQR 23-50], 71% [166/233] female), 179 (76%) were mTBI patients. For all patients, mean test-time was 9.3 ± 2 minutes with 93% (73/76) finding the test "easy to understand." Mild traumatic brain injury patients than non-TBI control had lower memory scores (25 [IQR 7-100] vs 43 [26-100], P = .001) while attention (5 [1-23] vs 11 [1-32]) and motor score (14 [3-28] vs 13 [4-32]) showed no significant differences. Multivariable-regression (adjustment: age, sex, race, education level, ISS, and time to test) demonstrated memory score predicted mTBI positive status (OR .96, CI .94-.98, P = .004). DISCUSSION Immediate Post-Concussion Assessment & Cognitive Testing-Quick Test is feasible in trauma patients. Preliminary findings suggest acute mTBIs have lower memory but not attention/motor scores vs non-TBI trauma controls.
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Affiliation(s)
- Patrick M Chen
- Neurology Traumatic Brain Injury & Concussion (NTBIC) Program, Department of Neurology, University of California Irvine, Orange, CA, USA
| | - Sean Lee
- Neurology Traumatic Brain Injury & Concussion (NTBIC) Program, Department of Neurology, University of California Irvine, Orange, CA, USA
| | - Lillian D Cruz
- Department of Surgery, University of California Irvine, Orange, CA, USA
| | - Michael Lopez
- Neurology Traumatic Brain Injury & Concussion (NTBIC) Program, Department of Neurology, University of California Irvine, Orange, CA, USA
| | - Aaron Thomas
- Neurology Traumatic Brain Injury & Concussion (NTBIC) Program, Department of Neurology, University of California Irvine, Orange, CA, USA
| | - Jefferson W Chen
- Department of Neurosurgery, University of California Irvine, Orange, CA, USA
| | - Areg Grigorian
- Department of Surgery, University of California Irvine, Orange, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, University of California Irvine, Orange, CA, USA
| | - Michael Lekawa
- Department of Surgery, University of California Irvine, Orange, CA, USA
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Tang S, Xu S, Wilder D, Medina AE, Li X, Fiskum GM, Jiang L, Kakulavarapu VR, Long JB, Gullapalli RP, Sajja VS. Longitudinal Biochemical and Behavioral Alterations in a Gyrencephalic Model of Blast-Related Mild Traumatic Brain Injury. Neurotrauma Rep 2024; 5:254-266. [PMID: 38515547 PMCID: PMC10956534 DOI: 10.1089/neur.2024.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Blast-related traumatic brain injury (bTBI) is a major cause of neurological disorders in the U.S. military that can adversely impact some civilian populations as well and can lead to lifelong deficits and diminished quality of life. Among these types of injuries, the long-term sequelae are poorly understood because of variability in intensity and number of the blast exposure, as well as the range of subsequent symptoms that can overlap with those resulting from other traumatic events (e.g., post-traumatic stress disorder). Despite the valuable insights that rodent models have provided, there is a growing interest in using injury models using species with neuroanatomical features that more closely resemble the human brain. With this purpose, we established a gyrencephalic model of blast injury in ferrets, which underwent blast exposure applying conditions that closely mimic those associated with primary blast injuries to warfighters. In this study, we evaluated brain biochemical, microstructural, and behavioral profiles after blast exposure using in vivo longitudinal magnetic resonance imaging, histology, and behavioral assessments. In ferrets subjected to blast, the following alterations were found: 1) heightened impulsivity in decision making associated with pre-frontal cortex/amygdalar axis dysfunction; 2) transiently increased glutamate levels that are consistent with earlier findings during subacute stages post-TBI and may be involved in concomitant behavioral deficits; 3) abnormally high brain N-acetylaspartate levels that potentially reveal disrupted lipid synthesis and/or energy metabolism; and 4) dysfunction of pre-frontal cortex/auditory cortex signaling cascades that may reflect similar perturbations underlying secondary psychiatric disorders observed in warfighters after blast exposure.
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Affiliation(s)
- Shiyu Tang
- Department of Diagnostic Radiology and Nuclear Medicine, Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Center for Advanced Imaging Research (CAIR), Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Su Xu
- Department of Diagnostic Radiology and Nuclear Medicine, Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Center for Advanced Imaging Research (CAIR), Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Donna Wilder
- Blast Induced Neurotrauma Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Alexandre E. Medina
- Department of Pediatrics, Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Xin Li
- Department of Diagnostic Radiology and Nuclear Medicine, Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Center for Advanced Imaging Research (CAIR), Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Gary M. Fiskum
- Department of Anesthesiology, Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Shock, Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Li Jiang
- Department of Diagnostic Radiology and Nuclear Medicine, Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Center for Advanced Imaging Research (CAIR), Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Venkata R. Kakulavarapu
- Blast Induced Neurotrauma Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Joseph B. Long
- Blast Induced Neurotrauma Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Rao P. Gullapalli
- Department of Diagnostic Radiology and Nuclear Medicine, Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Center for Advanced Imaging Research (CAIR), Trauma, and Anesthesiology Research Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Yang DX, Sun Z, Yu MM, Zou QQ, Li PY, Zhang JK, Wu X, Li YH, Wang ML. Associations of MRI-Derived Glymphatic System Impairment With Global White Matter Damage and Cognitive Impairment in Mild Traumatic Brain Injury: A DTI-ALPS Study. J Magn Reson Imaging 2024; 59:639-647. [PMID: 37276070 DOI: 10.1002/jmri.28797] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Assessing the glymphatic function using diffusion tensor image analysis along the perivascular space (DTI-ALPS) may be helpful for mild traumatic brain injury (mTBI) management. PURPOSE To assess glymphatic function using DTI-ALPS and its associations with global white matter damage and cognitive impairment in mTBI. STUDY TYPE Prospective. POPULATION Thirty-four controls (44.1% female, mean age 49.2 years) and 58 mTBI subjects (43.1% female, mean age 48.7 years), including uncomplicated mTBI (N = 32) and complicated mTBI (N = 26). FIELD STRENGTH/SEQUENCE 3-T, single-shot echo-planar imaging sequence. ASSESSMENT Magnetic resonance imaging (MRI) was done within 1 month since injury. DTI-ALPS was performed to assess glymphatic function, and peak width of skeletonized mean diffusivity (PSMD) was used to assess global white matter damage. Cognitive tests included Auditory Verbal Learning Test and Digit Span Test (forward and backward). STATISTICAL TESTS Neuroimaging findings comparisons were done between mTBI and control groups. Partial correlation and multivariable linear regression assessed the associations between DTI-ALPS, PSMD, and cognitive impairment. Mediation effects of PSMD on the relationship between DTI-ALPS and cognitive impairment were explored. P-value <0.05 was considered statistically significant, except for cognitive correlational analyses with a Bonferroni-corrected P-value set at 0.05/3 ≈ 0.017. RESULTS mTBI showed lower DTI-ALPS and higher PSMD, especially in complicated mTBI. DTI-ALPS was significantly correlated with verbal memory (r = 0.566), attention abilities (r = 0.792), executive function (r = 0.618), and PSMD (r = -0.533). DTI-ALPS was associated with verbal memory (β = 8.77, 95% confidence interval [CI] 5.00, 12.54), attention abilities (β = 5.67, 95% CI 4.56, 6.97), executive function (β = 2.34, 95% CI 1.49, 3.20), and PSMD (β = -0.79, 95% CI -1.15, -0.43). PSMD mediated 46.29%, 20.46%, and 24.36% of the effects for the relationship between DTI-ALPS and verbal memory, attention abilities, and executive function. DATA CONCLUSION Glymphatic function may be impaired in mTBI reflected by DTI-ALPS. Glymphatic dysfunction may cause cognitive impairment related to global white matter damage after mTBI. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Dian-Xu Yang
- Department of Neurosurgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zheng Sun
- Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meng-Meng Yu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Qiao-Qiao Zou
- Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng-Yang Li
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth, University, Richmond, Virginia, USA
| | - Jing-Kun Zhang
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, California, USA
| | - Xue Wu
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Yue-Hua Li
- Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ming-Liang Wang
- Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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8
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Saxena B, Bohra B, Lad KA. Weight-Drop Method for Inducing Closed Head Diffuse Traumatic Brain Injury. Methods Mol Biol 2024; 2761:569-588. [PMID: 38427262 DOI: 10.1007/978-1-0716-3662-6_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Traumatic brain injury (TBI) is one of the foremost causes of disability and death globally. Prerequisites for successful therapy of disabilities associated with TBI involved improved knowledge of the neurobiology of TBI, measurement of quantitative changes in recovery dynamics brought about by therapy, and the translation of quantitative methodologies and techniques that were successful in tracking recovery in preclinical models to human TBI. Frequently used animal models of TBI in research and development include controlled cortical impact, fluid percussion injury, blast injury, penetrating blast brain injury, and weight-drop impact acceleration models. Preclinical models of TBI benefit from controlled injury settings and the best prospects for biometric quantification of injury and therapy-induced gradual recovery from disabilities. Impact acceleration closed head TBI paradigm causes diffuse TBI (DTBI) without substantial focal brain lesions in rats. DTBI is linked to a significant rate of death, morbidity, and long-term disability. DTBI is difficult to diagnose at the time of hospitalization with imaging techniques making it challenging to take prompt therapeutic action. The weight-drop method without craniotomy is an impact acceleration closed head DTBI model that is used to induce mild/moderate diffuse brain injuries in rodents. Additionally, we have characterized neuropathological and neurobehavioral outcomes of the weight-drop model without craniotomy for inducing closed head DTBI of graded severity with a range of mass of weights (50-450 gm). This chapter also discusses techniques and protocols for measuring numerous functional disabilities and pathological changes in the brain brought on by DTBI.
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Affiliation(s)
- Bhagawati Saxena
- Department of Pharmacology, Institute of Pharmacy, Nirma University, Ahmedabad, India.
| | - Bhavna Bohra
- Department of Pharmacology, Institute of Pharmacy, Nirma University, Ahmedabad, India
| | - Krishna A Lad
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research-Ahmedabad, Gandhinagar, Gujarat, India
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Kitagawa M, Abiko K, Sheriff S, Maudsley AA, Li X, Sawamura D, Ahn S, Tha KK. Brain Temperature as an Indicator of Cognitive Function in Traumatic Brain Injury Patients. Metabolites 2023; 14:17. [PMID: 38248820 PMCID: PMC10818445 DOI: 10.3390/metabo14010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/27/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Whether brain temperature noninvasively extracted by magnetic resonance imaging has a role in identifying brain changes in the later phases of mild to moderate traumatic brain injury (TBI) is not known. This prospective study aimed to evaluate if TBI patients in subacute and chronic phases had altered brain temperature measured by whole-brain magnetic resonance spectroscopic imaging (WB-MRSI) and if the measurable brain temperature had any relationship with cognitive function scores. WB-MRSI was performed on eight TBI patients and fifteen age- and sex-matched control subjects. Brain temperature (T) was extracted from the brain's major metabolites and compared between the two groups. The T of the patients was tested for correlation with cognitive function test scores. The results showed significantly lower brain temperature in the TBI patients (p < 0.05). Brain temperature derived from N-acetylaspartate (TNAA) strongly correlated with the 2 s paced auditory serial addition test (PASAT-2s) score (p < 0.05). The observation of lower brain temperature in TBI patients may be due to decreased metabolic activity resulting from glucose and oxygen depletion. The correlation of brain temperature with PASAT-2s may imply that noninvasive brain temperature may become a noninvasive index reflecting cognitive performance.
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Affiliation(s)
- Maho Kitagawa
- Laboratory for Biomarker Imaging Science, Graduate School of Biomedical Science and Engineering, Hokkaido University, N15 W7, Kita-ku, Sapporo 060-8638, Japan; (M.K.); (X.L.)
| | - Kagari Abiko
- Department of Rehabilitation, Hokkaido University Hospital, Sapporo 060-8648, Japan;
- Department of Rehabilitation, Sapporo Azabu Neurosurgical Hospital, Sapporo 065-0022, Japan
| | - Sulaiman Sheriff
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (S.S.); (A.A.M.)
| | - Andrew A. Maudsley
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (S.S.); (A.A.M.)
| | - Xinnan Li
- Laboratory for Biomarker Imaging Science, Graduate School of Biomedical Science and Engineering, Hokkaido University, N15 W7, Kita-ku, Sapporo 060-8638, Japan; (M.K.); (X.L.)
| | - Daisuke Sawamura
- Department of Rehabilitation Science, Hokkaido University Faculty of Health Sciences, Sapporo 060-0812, Japan;
| | - Sinyeob Ahn
- Siemens Healthineers, San Francisco, CA 94553, USA;
| | - Khin Khin Tha
- Laboratory for Biomarker Imaging Science, Graduate School of Biomedical Science and Engineering, Hokkaido University, N15 W7, Kita-ku, Sapporo 060-8638, Japan; (M.K.); (X.L.)
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, N15 W7, Kita-ku, Sapporo 060-8638, Japan
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10
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Aaltonen J, Heikkinen V, Kaltiainen H, Salmelin R, Renvall H. Sensor-level MEG combined with machine learning yields robust classification of mild traumatic brain injury patients. Clin Neurophysiol 2023; 153:79-87. [PMID: 37459668 DOI: 10.1016/j.clinph.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/06/2023] [Accepted: 06/09/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE Diagnosis of mild traumatic brain injury (mTBI) is challenging despite its high incidence, due to the unspecificity and variety of symptoms and the frequent lack of structural imaging findings. There is a need for reliable and simple-to-use diagnostic tools that would be feasible across sites and patient populations. METHODS We evaluated linear machine learning (ML) methods' ability to separate mTBI patients from healthy controls, based on their sensor-level magnetoencephalographic (MEG) power spectra in the subacute phase (<2 months) after a head trauma. We recorded resting-state MEG data from 25 patients and 25 age-sex matched controls and utilized a previously collected data set of 20 patients and 20 controls from a different site. The data sets were analyzed separately with three ML methods. RESULTS The median classification accuracies varied between 80 and 95%, without significant differences between the applied ML methods or data sets. The classification accuracies were significantly higher with ML than with traditional sensor-level MEG analysis based on detecting pathological low-frequency activity. CONCLUSIONS Easily applicable linear ML methods provide reliable and replicable classification of mTBI patients using sensor-level MEG data. SIGNIFICANCE Power spectral estimates combined with ML can classify mTBI patients with high accuracy and have high promise for clinical use.
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Affiliation(s)
- Juho Aaltonen
- BioMag Laboratory, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki University and Aalto University School of Science, P.O. Box 340, 00029 HUS Helsinki, Finland; Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Aalto University, P.O. Box 12200, 00760 AALTO, Finland.
| | - Verna Heikkinen
- BioMag Laboratory, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki University and Aalto University School of Science, P.O. Box 340, 00029 HUS Helsinki, Finland; Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Aalto University, P.O. Box 12200, 00760 AALTO, Finland
| | - Hanna Kaltiainen
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Aalto University, P.O. Box 12200, 00760 AALTO, Finland; Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, Neurology, University of Helsinki, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Riitta Salmelin
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Aalto University, P.O. Box 12200, 00760 AALTO, Finland
| | - Hanna Renvall
- BioMag Laboratory, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki University and Aalto University School of Science, P.O. Box 340, 00029 HUS Helsinki, Finland; Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Aalto University, P.O. Box 12200, 00760 AALTO, Finland; Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, Neurology, University of Helsinki, P.O. Box 340, 00029 HUS, Helsinki, Finland
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11
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Sanchez-Molano J, Blaya MO, Padgett KR, Moreno WJ, Zhao W, Dietrich WD, Bramlett HM. Multimodal magnetic resonance imaging after experimental moderate and severe traumatic brain injury: A longitudinal correlative assessment of structural and cerebral blood flow changes. PLoS One 2023; 18:e0289786. [PMID: 37549175 PMCID: PMC10406285 DOI: 10.1371/journal.pone.0289786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/25/2023] [Indexed: 08/09/2023] Open
Abstract
Traumatic brain injury (TBI) is a worldwide problem that results in death or disability for millions of people every year. Progressive neurological complications and long-term impairment can significantly disrupt quality of life. We demonstrated the feasibility of multiple magnetic resonance imaging (MRI) modalities to investigate and predict aberrant changes and progressive atrophy of gray and white matter tissue at several acute and chronic time points after moderate and severe parasagittal fluid percussion TBI. T2-weighted imaging, diffusion tensor imaging (DTI), and perfusion weighted imaging (PWI) were performed. Adult Sprague-Dawley rats were imaged sequentially on days 3, 14, and 1, 4, 6, 8, and 12 months following surgery. TBI caused dynamic white and gray matter alterations with significant differences in DTI values and injury-induced alterations in cerebral blood flow (CBF) as measured by PWI. Regional abnormalities after TBI were observed in T2-weighted images that showed hyperintense cortical lesions and significant cerebral atrophy in these hyperintense areas 1 year after TBI. Temporal DTI values indicated significant injury-induced changes in anisotropy in major white matter tracts, the corpus callosum and external capsule, and in gray matter, the hippocampus and cortex, at both early and chronic time points. These alterations were primarily injury-severity dependent with severe TBI exhibiting a greater degree of change relative to uninjured controls. PWI evaluating CBF revealed sustained global reductions in the cortex and in the hippocampus at most time points in an injury-independent manner. We next sought to investigate prognostic correlations across MRI metrics, timepoints, and cerebral pathology, and found that diffusion abnormalities and reductions in CBF significantly correlated with specific vulnerable structures at multiple time points, as well as with the degree of cerebral atrophy observed 1 year after TBI. This study further supports using DTI and PWI as a means of prognostic imaging for progressive structural changes after TBI and emphasizes the progressive nature of TBI damage.
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Affiliation(s)
- Juliana Sanchez-Molano
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Meghan O. Blaya
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Kyle R. Padgett
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - William J. Moreno
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Weizhao Zhao
- Department of Biomedical Engineering, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - W. Dalton Dietrich
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Helen M. Bramlett
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida, United States of America
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12
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Shida AF, Massett RJ, Imms P, Vegesna RV, Amgalan A, Irimia A. Significant Acceleration of Regional Brain Aging and Atrophy After Mild Traumatic Brain Injury. J Gerontol A Biol Sci Med Sci 2023; 78:1328-1338. [PMID: 36879433 PMCID: PMC10395568 DOI: 10.1093/gerona/glad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Indexed: 03/08/2023] Open
Abstract
Brain regions' rates of age-related volumetric change after traumatic brain injury (TBI) are unknown. Here, we quantify these rates cross-sectionally in 113 persons with recent mild TBI (mTBI), whom we compare against 3 418 healthy controls (HCs). Regional gray matter (GM) volumes were extracted from magnetic resonance images. Linear regression yielded regional brain ages and the annualized average rates of regional GM volume loss. These results were compared across groups after accounting for sex and intracranial volume. In HCs, the steepest rates of volume loss were recorded in the nucleus accumbens, amygdala, and lateral orbital sulcus. In mTBI, approximately 80% of GM structures had significantly steeper rates of annual volume loss than in HCs. The largest group differences involved the short gyri of the insula and both the long gyrus and central sulcus of the insula. No significant sex differences were found in the mTBI group, regional brain ages being the oldest in prefrontal and temporal structures. Thus, mTBI involves significantly steeper regional GM loss rates than in HCs, reflecting older-than-expected regional brain ages.
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Affiliation(s)
- Alexander F Shida
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Roy J Massett
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Phoebe Imms
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Ramanand V Vegesna
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Anar Amgalan
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
- Corwin D. Denney Research Center, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
- Department of Quantitative & Computational Biology, Dana and David Dornsife College of Arts & Sciences, University of Southern California, Los Angeles, California, USA
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13
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Volumetric MRI Findings in Mild Traumatic Brain Injury (mTBI) and Neuropsychological Outcome. Neuropsychol Rev 2023; 33:5-41. [PMID: 33656702 DOI: 10.1007/s11065-020-09474-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
Region of interest (ROI) volumetric assessment has become a standard technique in quantitative neuroimaging. ROI volume is thought to represent a coarse proxy for making inferences about the structural integrity of a brain region when compared to normative values representative of a healthy sample, adjusted for age and various demographic factors. This review focuses on structural volumetric analyses that have been performed in the study of neuropathological effects from mild traumatic brain injury (mTBI) in relation to neuropsychological outcome. From a ROI perspective, the probable candidate structures that are most likely affected in mTBI represent the target regions covered in this review. These include the corpus callosum, cingulate, thalamus, pituitary-hypothalamic area, basal ganglia, amygdala, and hippocampus and associated structures including the fornix and mammillary bodies, as well as whole brain and cerebral cortex along with the cerebellum. Ventricular volumetrics are also reviewed as an indirect assessment of parenchymal change in response to injury. This review demonstrates the potential role and limitations of examining structural changes in the ROIs mentioned above in relation to neuropsychological outcome. There is also discussion and review of the role that post-traumatic stress disorder (PTSD) may play in structural outcome in mTBI. As emphasized in the conclusions, structural volumetric findings in mTBI are likely just a single facet of what should be a multimodality approach to image analysis in mTBI, with an emphasis on how the injury damages or disrupts neural network integrity. The review provides an historical context to quantitative neuroimaging in neuropsychology along with commentary about future directions for volumetric neuroimaging research in mTBI.
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14
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Barela M, Wong A, Chamberlain R. Concussion and Psychological Effects: A Review of Recent Literature. Curr Sports Med Rep 2023; 22:24-28. [PMID: 36606633 DOI: 10.1249/jsr.0000000000001031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
ABSTRACT The aim of this article is to provide an up-to-date review of psychological changes in association with postconcussive athletes. In particular, this article focused on the symptomatology, risk factors, and treatment of psychiatric diagnoses in patients who suffered a sports-related concussion (SRC). After an extensive review of prior and current literature, there is significant evidence that demonstrates an association of changes in mood and behavior, including new or worsening symptoms of anxiety, depression, and difficulty with attention and concentration in those who are recovering from a concussion. The goal of care in these patients is to identify and treat these psychological symptoms early to have more favorable long-term outcomes. Primary treatment should focus on psychotherapy; however, other considerations may be warranted in certain cases, such as selective serotonin reuptake inhibitors for depression and tricyclic antidepressants and gabapentin for short-term cognitive symptom improvement.
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Affiliation(s)
- Matthew Barela
- University of New Mexico School of Medicine, Albuquerque, NM
| | - Allen Wong
- Department of Family & Community Medicine, University of New Mexico, Albuquerque, NM
| | - Rachel Chamberlain
- Department of Family & Community Medicine, University of New Mexico, Albuquerque, NM
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15
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Yang Q, Wu Y, Li M, Cao S, Guo Y, Zhang L, Chen X, Liang W. Single-cell transcriptome study in forensic medicine: prospective applications. Int J Legal Med 2022; 136:1737-1743. [PMID: 36083564 DOI: 10.1007/s00414-022-02889-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
Next-generation sequencing and single-cell RNA sequencing (scRNA-seq) technologies have advanced rapidly in recent years. scRNA-seq reveals the unique gene expression of each cell type, providing directions for exploring cell heterogeneity, cell type-specific responses to injury/disease, and the mechanisms underlying these processes. The development of sequencing technology and improved sequencing throughput have brought about a revolution in single-cell transcriptome study, bringing great benefits to the fields of medicine and biomedical science. From our perspective, certain issues in forensic medicine may potentially be addressed using single-cell transcriptome studies; however, this powerful technique has not yet attracted sufficient attention in forensic medicine-associated research. Therefore, examining and reviewing the latest developments and applications of single-cell transcriptome studies, we present our views on the future directions of forensic research using this technology, aiming to expand the frontiers of forensic science.
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Affiliation(s)
- Qiuyun Yang
- Department of Forensic Genetics, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Yuhang Wu
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Manrui Li
- Department of Forensic Genetics, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Shuqiang Cao
- Department of Forensic Genetics, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Yadong Guo
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha, 410013, Hunan, China
| | - Lin Zhang
- Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xiameng Chen
- Department of Forensic Pathology and Forensic Clinical Medicine, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China.
| | - Weibo Liang
- Department of Forensic Genetics, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, 610041, China.
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16
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Pandimurugan V, Rajasoundaran S, Routray S, Prabu AV, Alyami H, Alharbi A, Ahmad S. Detecting and Extracting Brain Hemorrhages from CT Images Using Generative Convolutional Imaging Scheme. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:6671234. [PMID: 35571726 PMCID: PMC9106471 DOI: 10.1155/2022/6671234] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 02/27/2022] [Accepted: 04/08/2022] [Indexed: 12/12/2022]
Abstract
Purpose The need for computerized medical assistance for accurate detection of brain hemorrhage from Computer Tomography (CT) images is more mandatory than conventional clinical tests. Recent technologies and advanced computerized algorithms follow Artificial Intelligence (AI), Machine Learning (ML), and Deep Learning (DL) techniques to improve medical diagnosis platforms. This technology is making the diagnosis practice of brain issues easier for medical practitioners to analyze and identify diseases with an assured degree of precision and performance. Methods As the existing CT image analysis models use standard procedures to detect hemorrhages, the need for DL-based data analysis is essential to provide more accurate results. Generally, the existing techniques are limited with image training efficiency, image filtering procedures, and runtime system tuning modules. On the scope, this work develops a DL-based automated analysis of CT scan slices to find various levels of brain hemorrhages. Notably, this proposed system integrates Convolutional Neural Network (CNN) and Generative Adversarial Network (GAN) architectures as Integrated Generative Adversarial-Convolutional Imaging Model (IGACM) for extracting the CT image features for detecting brain hemorrhages. Results This system produces good results and takes lesser training time than existing techniques. This proposed system effectively works over CT images and classifies the abnormalities with more accuracy than current techniques. The experiments and results deliver the optimal detection of hemorrhages with better accuracy. It shows that the proposed system works with 5% to 10% of the better performance compared to other diagnostic techniques. Conclusion The complex nature of CT images leads to noncorrelated feature complexities in diagnosis models. Considering the issue, the proposed system used GAN-based effective sampling techniques for enriching complex image samples into CNN training phases. This concludes the effective contribution of the proposed IGACM technique for detecting brain hemorrhages than the existing diagnosis models.
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Affiliation(s)
- V. Pandimurugan
- School of Computing Science and Engineering, VIT Bhopal University, Madhya Pradesh, India
| | - S. Rajasoundaran
- School of Computing Science and Engineering, VIT Bhopal University, Madhya Pradesh, India
| | - Sidheswar Routray
- Department of Computer Science and Engineering, School of Engineering, Indrashil University, Rajpur, Mehsana, Gujarat, India
| | - A. V. Prabu
- Department of Electronics and Communication Engineering, Koneru Lakshmaiah Education Foundation, Guntur, India
| | - Hashem Alyami
- Department of Computer Science, College of Computers and Information Technology, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Abdullah Alharbi
- Department of Information Technology, College of Computers and Information Technology, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Sultan Ahmad
- Department of Computer Science, College of Computer Engineering and Sciences, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
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17
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Canseco JA, Franks RR, Karamian BA, Divi SN, Reyes AA, Mao JZ, Al Saiegh F, Donnally CJ, Schroeder GD, Harrop JS, Pepe MD, Vaccaro AR. Overview of Traumatic Brain Injury in American Football Athletes. Clin J Sport Med 2022; 32:236-247. [PMID: 33797476 DOI: 10.1097/jsm.0000000000000918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/17/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this review is to provide a summary of the epidemiology, clinical presentation, pathophysiology, and treatment of traumatic brain injury in collision athletes, particularly those participating in American football. DATA SOURCES A literature search was conducted using the PubMed/MEDLINE and Google Scholar databases for publications between 1990 and 2019. The following search phrases were used: "concussion," "professional athletes," "collision athletes," "mild traumatic brain injury," "severe traumatic brain injury," "management of concussion," "management of severe traumatic brain injury," and "chronic traumatic encephalopathy." Publications that did not present epidemiology, clinical presentation, pathophysiology, radiological evaluation, or management were omitted. Classic articles as per senior author recommendations were retrieved through reference review. RESULTS The results of the literature review yielded 147 references: 21 articles discussing epidemiology, 16 discussing clinical presentation, 34 discussing etiology and pathophysiology, 10 discussing radiological evaluation, 34 articles for on-field management, and 32 articles for medical and surgical management. CONCLUSION Traumatic brain injuries are frequent in professional collision athletes, and more severe injuries can have devastating and lasting consequences. Although sport-related concussions are well studied in professional American football, there is limited literature on the epidemiology and management of severe traumatic brain injuries. This article reviews the epidemiology, as well as the current practices in sideline evaluation, acute management, and surgical treatment of concussions and severe traumatic brain injury in professional collision athletes. Return-to-play decisions should be based on individual patient symptoms and recovery.
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Affiliation(s)
- Jose A Canseco
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - R Robert Franks
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
- Rothman Sports Concussion Institute, Rothman Institute, Philadelphia, Pennsylvania; and
| | - Brian A Karamian
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Srikanth N Divi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ariana A Reyes
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jennifer Z Mao
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Fadi Al Saiegh
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Chester J Donnally
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gregory D Schroeder
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - James S Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew D Pepe
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alexander R Vaccaro
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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18
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Mayer AR, Quinn DK. Neuroimaging Biomarkers of New-Onset Psychiatric Disorders Following Traumatic Brain Injury. Biol Psychiatry 2022; 91:459-469. [PMID: 34334188 PMCID: PMC8665933 DOI: 10.1016/j.biopsych.2021.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/24/2021] [Accepted: 06/06/2021] [Indexed: 02/07/2023]
Abstract
Traumatic brain injury (TBI) has traditionally been associated with cognitive and behavioral changes during both the acute and chronic phases of injury. Because of its noninvasive nature, neuroimaging has the potential to provide unique information on underlying macroscopic and microscopic biological mechanisms that may serve as causative agents for these neuropsychiatric sequelae. This broad scoping review identifies at least 4 common macroscopic pathways that exist between TBI and new-onset psychiatric disorders, as well as several examples of how neuroimaging is currently being utilized in clinical research. The review then critically examines the strengths and limitations of neuroimaging for elucidating TBI-related microscopic pathology, such as microstructural changes, neuroinflammation, proteinopathies, blood-brain barrier damage, and disruptions in cellular signaling. A summary is then provided for how neuroimaging is currently being used to investigate TBI-related pathology in new-onset neurocognitive disorders, depression, and posttraumatic stress disorder. Identified gaps in the literature include a lack of prospective studies to definitively associate imaging findings with the development of new-onset psychiatric disorders, as well as antemortem imaging studies subsequently confirmed with postmortem correlates in the same study cohort. Although the spatial resolution and specificity of imaging biomarkers has greatly improved over the last 2 decades, we conclude that neuroimaging biomarkers do not yet exist for the definitive in vivo diagnosis of cellular pathology. This represents a necessary next step for further elucidating causal relationships between TBI and new-onset psychiatric disorders.
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Affiliation(s)
- Andrew R. Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM 87106,Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM 87131,Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM 87131,Department of Psychology, University of New Mexico, Albuquerque, NM 87131,Corresponding author: Andrew Mayer, Ph.D., The Mind Research Network, Pete & Nancy Domenici Hall, 1101 Yale Blvd. NE, Albuquerque, NM 87106 USA; Tel: 505-272-0769; Fax: 505-272-8002;
| | - Davin K. Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM 87131
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19
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Bohyn C, Flores DV, Murray T, Mohr B, Cresswell M. Imaging Review of Snowboard Injuries. Semin Musculoskelet Radiol 2022; 26:54-68. [PMID: 35139559 DOI: 10.1055/s-0041-1731702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Snowboarding and skiing remain the two most popular winter sports worldwide. Musculoskeletal (MSK) injuries are common in snowboarding, and the number has increased significantly since the advent of snow parks. The number of injuries is the highest for novice snowboarders; more experienced boarders generally sustain more severe injuries. Snowboarders can experience a wide array of MSK injuries, but some injury types are more frequently encountered because of the specific injury mechanism unique to snowboarding. This article reviews the most common snowboarding injuries with a focus on the current understanding of the injury mechanism and provides an approach to imaging.
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Affiliation(s)
- Cedric Bohyn
- Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dyan V Flores
- Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,Institute of Radiology, St. Luke's Medical Center Global City, Metro Manila, Philippines
| | - Timothy Murray
- Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bruce Mohr
- Whistler Health Care Center, Whistler, British Columbia, Canada
| | - Mark Cresswell
- Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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20
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Zhao P, Zhu P, Zhang D, Yin B, Wang Y, Hussein NM, Yan Z, Liu X, Bai G. Sex Differences in Cerebral Blood Flow and Serum Inflammatory Cytokines and Their Relationships in Mild Traumatic Brain Injury. Front Neurol 2022; 12:755152. [PMID: 35153973 PMCID: PMC8825420 DOI: 10.3389/fneur.2021.755152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022] Open
Abstract
This study aimed to investigate sex differences in cerebral blood flow (CBF) and serum inflammatory cytokines, as well as their correlations in patients with acute-stage mild traumatic brain injury (mTBI). Forty-one patients with mTBI and 23 matched healthy controls underwent 3D-pseudo-continuous arterial spin labeling imaging on 3T magnetic resonance imaging. The patients underwent cognitive evaluations and measurement of a panel of ten serum cytokines: interleukin (IL)-1I, IL-4, IL-6, IL-8, IL-10, IL-12, C–C motif chemokine ligand 2, interferon-gamma, nerve growth factor-beta (β-NGF), and tumor necrosis factor-alpha (TNF-α). Spearman rank correlation analysis was performed to evaluate the relationship between inflammation levels and CBF. We found that both male and female patients showed increased IL-1L and IL-6 levels. Female patients also demonstrated overexpression of IL-8 and low expression of IL-4. As for CBF levels, three brain regions [the right superior frontal gyrus (SFG_R), left putamen, and right precuneus] increased in male patients while three brain regions [the right superior temporal gyrus (STG_R), left middle occipital gyrus, and right postcentral (PoCG_R)] decreased in female patients. Furthermore, the STG_R in female controls was positively correlated with β-NGF while the right PoCG_R in female patients was negatively correlated with IL-8. In addition, compared with male patients, female patients showed decreased CBF in the right pallidum, which was negatively correlated with IL-8. These findings revealed abnormal expression of serum inflammatory cytokines and CBF levels post-mTBI. Females may be more sensitive to inflammatory and CBF changes and thus more likely to get cognitive impairment. This may suggest the need to pay closer attention to the female mTBI group.
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Affiliation(s)
- Pinghui Zhao
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Pingyi Zhu
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Danbin Zhang
- Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bo Yin
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yu Wang
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Nimo Mohamed Hussein
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhihan Yan
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaozheng Liu
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- China-USA Neuroimaging Research Institute, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Xiaozheng Liu
| | - Guanghui Bai
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Wenzhou Key Laboratory of Basic Science and Translational Research of Radiation Oncology, Wenzhou, China
- *Correspondence: Guanghui Bai
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21
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Hageman G, Hof J, Nihom J. Susceptibility-Weighted MRI and Microbleeds in Mild Traumatic Brain Injury: Prediction of Posttraumatic Complaints? Eur Neurol 2022; 85:177-185. [PMID: 35038701 DOI: 10.1159/000521389] [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: 09/02/2021] [Accepted: 12/03/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Only in 7-15% of patients with mild traumatic brain injury (mTBI), traumatic CT-abnormalities are found. Nevertheless, 40% of mTBI patients suffer from posttraumatic complaints not resolving after 6 months. We discuss the ability of susceptibility-weighted imaging (SWI), sensitive for microbleeds, to detect more subtle brain abnormalities. SUMMARY After a search on PubMed, we selected 15 studies on SWI in adult mTBI patients; 11 studies on 3T MRI, and 4 studies on 1.5T MRI. All 1.5T studies showed that, compared to T2, gradient echo, diffusion-weighted imaging, or fluid-attenuated inversion recovery sequences, SWI is more sensitive for microbleeds. Only two 1.5T studies described the association between SWI findings and outcome. In 3 of the 4 studies, no control group was present. The mean number of microbleeds varied from 3.2 to 6.4 per patient. In the 3T studies, the percentage of patients with traumatic microbleeds varied from 5.7 to 28.8%, compared to 0-13.3% in normal controls. Microbleeds were particularly located subcortical or juxtacortical. The number of microbleeds in mTBI varied from 1 to 10 per patient. mTBI patients with microbleeds appeared to have higher symptom severity at 12 months and perform worse on tests of psychomotor speed and speed of information processing after 3 and 12 months, compared to mTBI patients without microbleeds. Key Messages: There is some evidence that traumatic microbleeds predict cognitive outcome and persistent posttraumatic complaints in patients with mTBI.
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Affiliation(s)
- Gerard Hageman
- Department of Neurology, Medical Spectrum Twente, Hospital Enschede, Enschede, The Netherlands
| | - Jurrit Hof
- Department of Radiology, Medical Spectrum Twente, Hospital Enschede, Enschede, The Netherlands
| | - Jik Nihom
- Department of Neurology, Medical Spectrum Twente, Hospital Enschede, Enschede, The Netherlands
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22
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Zhao H, Wang J, Ma Y. Comparative study on the application of MRI and CT in acute craniocerebral injury. Minerva Surg 2021; 77:414-416. [PMID: 34714028 DOI: 10.23736/s2724-5691.21.09212-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Hailing Zhao
- Department of Radiology, The First People's Hospital of Wenling, Wenling, China
| | - Junsong Wang
- Department of Radiology, The First People's Hospital of Wenling, Wenling, China
| | - Yanxu Ma
- Department of Radiology, The First People's Hospital of Wenling, Wenling, China -
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23
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Meshkini A, Ghorbani Haghjo A, Hasanpour Segherlou Z, Nouri-Vaskeh M. S100 Calcium-Binding Protein B and Glial Fibrillary Acidic Protein in Patients with Mild Traumatic Brain Injury. Bull Emerg Trauma 2021; 9:183-187. [PMID: 34692869 PMCID: PMC8525696 DOI: 10.30476/beat.2021.89355.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 06/13/2021] [Accepted: 06/19/2021] [Indexed: 11/22/2022] Open
Abstract
Objective: To examine the GFAP and S100B ability in prevention unnecessary brain Computed tomography (CT) scan in mild traumatic brain injury (mTBI) and compare them with the single extremity fracture in orthopedic patients. Methods: In this prospective cohort study, two orthopedics patients’ groups and mTBI patients were studied to assess the biomarkers’ ability in prevention unnecessary brain CT scan at the emergency setting. There were 40 orthopedics’ patients with single extremity fracture and 41 mTBI patients. Brain CT scans were done for all mTBI patients. Results: Brain CT scans showed no intracranial traumatic lesions. The median levels for S100B in the mTBI group was 14.8 (4.4-335.9) ng/L, and in orthopedic patients’ group was 13.3 (5-353.10) ng/L. Statistically significant differences were observed between both groups in S100B levels (p=0.006). The median Glial Fibrillary Acidic Protein (GFAP) levels in the mTBI patients’ group were 600 (400-16300) and in the orthopedic patients’ groups was 60 ng/L (300-14900). Statistically significant differences were observed between groups in GFAP (p=0.041). Conclusion: Our results showed that S100B and GFAP serum levels were significantly higher in patients with mTBI than in patients with a single limb fracture.
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Affiliation(s)
- Ali Meshkini
- Road Injuries Prevention Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Ghorbani Haghjo
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Masoud Nouri-Vaskeh
- Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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24
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Bohyn C, Vyvere TV, Keyzer FD, Sima DM, Demaerel P. Morphometric evaluation of traumatic axonal injury and the correlation with post-traumatic cerebral atrophy and functional outcome. Neuroradiol J 2021; 35:468-476. [PMID: 34643120 PMCID: PMC9437508 DOI: 10.1177/19714009211049714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Imaging plays a crucial role in the diagnosis, prognosis and follow-up of traumatic brain injury. Whereas computed tomography plays a pivotal role in the acute setting, magnetic resonance imaging is best suited to detect the true extent of traumatic brain injury, and more specifically diffuse axonal injury. Post-traumatic brain atrophy is a well-known complication of traumatic brain injury. PURPOSE This study investigated the correlation between diffuse axonal injury detected with fluid-attenuated inversion recovery and susceptibility-weighted imaging magnetic resonance imaging, post-traumatic brain atrophy and functional outcome (Glasgow outcome scale - extended). MATERIALS AND METHODS Twenty patients with a closed head injury and diffuse axonal injury detected with fluid-attenuated inversion recovery and susceptibility-weighted imaging were included. The total volumes of the diffuse axonal injury fluid-attenuated inversion recovery lesions were determined for each subject's initial (<14 days) and follow-up magnetic resonance scan (average: day 303 ± 83 standard deviation). The different brain volumes were automatically quantified using a validated and both US Food and Drug Administration-cleared and CE-marked machine learning algorithm (icobrain). The number of susceptibility-weighted imaging lesions and functional outcome scores (Glasgow outcome scale - extended) were retrieved from the Collaborative European NeuroTrauma Effectiveness Research Traumatic Brain Injury dataset. RESULTS The volumetric fluid-attenuated inversion recovery diffuse axonal injury lesion load showed a significant inverse correlation with functional outcome (Glasgow outcome scale - extended) (r = -0.57; P = 0.0094) and white matter volume change (r = -0.50; P = 0.027). In addition, white matter volume change correlated significantly with the Glasgow outcome scale - extended score (P = 0.0072; r = 0.58). Moreover, there was a strong inverse correlation between longitudinal fluid-attenuated inversion recovery lesion volume change and whole brain volume change (r = -0.63; P = 0.0028). No significant correlation existed between the number of diffuse axonal injury susceptibility-weighted imaging lesions, brain atrophy and functional outcome. CONCLUSIONS Volumetric analysis of diffuse axonal injury on fluid-attenuated inversion recovery imaging and automated brain atrophy calculation are potentially useful tools in the clinical management and follow-up of traumatic brain injury patients with diffuse axonal injury.
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Affiliation(s)
- Cedric Bohyn
- Department of Radiology, University Hospital Leuven, Belgium
| | | | - Frederik De Keyzer
- Department of Medical Physics and Quality Control, University Hospital Leuven, Belgium
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25
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Mortaheb S, Filippini MM, Kaux JF, Annen J, Lejeune N, Martens G, Calderón MAF, Laureys S, Thibaut A. Neurophysiological Biomarkers of Persistent Post-concussive Symptoms: A Scoping Review. Front Neurol 2021; 12:687197. [PMID: 34566837 PMCID: PMC8459021 DOI: 10.3389/fneur.2021.687197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: Persistent post-concussive symptoms (PCS) consist of neurologic and psychological complaints persisting after a mild traumatic brain injury (mTBI). It affects up to 50% of mTBI patients, may cause long-term disability, and reduce patients' quality of life. The aim of this review was to examine the possible use of different neuroimaging modalities in PCS. Methods: Articles from Pubmed database were screened to extract studies that investigated the relationship between any neuroimaging features and symptoms of PCS. Descriptive statistics were applied to report the results. Results: A total of 80 out of 939 papers were included in the final review. Ten examined conventional MRI (30% positive finding), 24 examined diffusion weighted imaging (54.17% positive finding), 23 examined functional MRI (82.61% positive finding), nine examined electro(magneto)encephalography (77.78% positive finding), and 14 examined other techniques (71% positive finding). Conclusion: MRI was the most widely used technique, while functional techniques seem to be the most sensitive tools to evaluate PCS. The common functional patterns associated with symptoms of PCS were a decreased anti-correlation between the default mode network and the task positive network and reduced brain activity in specific areas (most often in the prefrontal cortex). Significance: Our findings highlight the importance to use functional approaches which demonstrated a functional alteration in brain connectivity and activity in most studies assessing PCS.
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Affiliation(s)
- Sepehr Mortaheb
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Brain Clinic, University Hospital of Liège, Liège, Belgium.,Physiology of Cognition Lab., GIGA-Consciousness, University of Liège, Liège, Belgium
| | - Maria Maddalena Filippini
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Brain Clinic, University Hospital of Liège, Liège, Belgium.,Neuromotor and Rehabilitation Department, Azienda Unita Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico (USL-IRCSS) di Reggio Emilia, Reggio Emilia, Italy
| | - Jean-François Kaux
- Physical Medicine and Sport Traumatology Department, Sports, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athletes Health, FIMS Collaborative Centre of Sport Medicine, University and University Hospital of Liège, Liège, Belgium
| | - Jitka Annen
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Brain Clinic, University Hospital of Liège, Liège, Belgium
| | - Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Brain Clinic, University Hospital of Liège, Liège, Belgium.,Institute of NeuroScience, University of Louvain, Brussels, Belgium
| | - Géraldine Martens
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Physical Medicine and Sport Traumatology Department, Sports, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athletes Health, FIMS Collaborative Centre of Sport Medicine, University and University Hospital of Liège, Liège, Belgium
| | | | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Brain Clinic, University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Brain Clinic, University Hospital of Liège, Liège, Belgium
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26
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Huie JR, Mondello S, Lindsell CJ, Antiga L, Yuh EL, Zanier ER, Masson S, Rosario BL, Ferguson AR. Biomarkers for Traumatic Brain Injury: Data Standards and Statistical Considerations. J Neurotrauma 2021; 38:2514-2529. [PMID: 32046588 PMCID: PMC8403188 DOI: 10.1089/neu.2019.6762] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Recent biomarker innovations hold potential for transforming diagnosis, prognostic modeling, and precision therapeutic targeting of traumatic brain injury (TBI). However, many biomarkers, including brain imaging, genomics, and proteomics, involve vast quantities of high-throughput and high-content data. Management, curation, analysis, and evidence synthesis of these data are not trivial tasks. In this review, we discuss data management concepts and statistical and data sharing strategies when dealing with biomarker data in the context of TBI research. We propose that application of biomarkers involves three distinct steps-discovery, evaluation, and evidence synthesis. First, complex/big data has to be reduced to useful data elements at the stage of biomarker discovery. Second, inferential statistical approaches must be applied to these biomarker data elements for assessment of biomarker clinical utility and validity. Last, synthesis of relevant research is required to support practice guidelines and enable health decisions informed by the highest quality, up-to-date evidence available. We focus our discussion around recent experiences from the International Traumatic Brain Injury Research (InTBIR) initiative, with a specific focus on four major clinical projects (Transforming Research and Clinical Knowledge in TBI, Collaborative European NeuroTrauma Effectiveness Research in TBI, Collaborative Research on Acute Traumatic Brain Injury in Intensive Care Medicine in Europe, and Approaches and Decisions in Acute Pediatric TBI Trial), which are currently enrolling subjects in North America and Europe. We discuss common data elements, data collection efforts, data-sharing opportunities, and challenges, as well as examine the statistical techniques required to realize successful adoption and use of biomarkers in the clinic as a foundation for precision medicine in TBI.
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Affiliation(s)
- J. Russell Huie
- Brain and Spinal Injury Center, Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Christopher J. Lindsell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Esther L. Yuh
- Brain and Spinal Injury Center, Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Elisa R. Zanier
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Serge Masson
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Bedda L. Rosario
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Adam R. Ferguson
- Brain and Spinal Injury Center, Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Medical Center (SFVAMC), San Francisco, California, USA
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27
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Xu L, Ware JB, Kim JJ, Shahim P, Silverman E, Magdamo B, Dabrowski C, Wesley L, Le MD, Morrison J, Zamore H, Lynch CE, Petrov D, Chen HI, Schuster J, Diaz-Arrastia R, Sandsmark DK. Arterial Spin Labeling Reveals Elevated Cerebral Blood Flow with Distinct Clusters of Hypo- and Hyperperfusion after Traumatic Brain Injury. J Neurotrauma 2021; 38:2538-2548. [PMID: 34115539 PMCID: PMC8403182 DOI: 10.1089/neu.2020.7553] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Imaging detection of brain perfusion alterations after traumatic brain injury (TBI) may provide prognostic insights. In this study, we used arterial spin labeling (ASL) to quantify cross-sectional and longitudinal changes in cerebral blood flow (CBF) after TBI and correlated changes with clinical outcome. We analyzed magnetic resonance imaging scans from adult participants with TBI requiring hospitalization in the acute (2 weeks post-injury, n = 33) and chronic (6 months post-injury, n = 16) phases, with 13 participants scanned longitudinally at both time points. We also analyzed 18 age- and sex-matched healthy controls. Whole-brain CBF maps were derived using a three-dimensional pseudo-continuous arterial spin label technique. Mean CBF across tissue-based regions (whole brain, gray matter, and white matter) was compared cross-sectionally and longitudinally. In addition, individual-level clusters of abnormal perfusion were identified using voxel-based z-score analysis of relative CBF maps, and number and volume of abnormally hypo- and hyperperfused clusters were assessed cross-sectionally and longitudinally. Finally, all CBF measures were correlated with clinical outcome measures. Mean global and gray matter CBF were significantly elevated in acute and chronic TBI participants compared to controls. Participants with better outcome at 6 months post-injury tended to have higher CBF in the acute phase compared to those with poorer outcome. Acute TBI participants had a significantly greater volume of hypo- and hyperperfused brain tissue compared to controls, with these regions partially normalizing by the chronic phase. Our findings demonstrate global elevation of CBF with focal hypo- and hyperperfusion in the early post-injury period and suggest a reparative role for acute elevation in CBF post-TBI.
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Affiliation(s)
- Linda Xu
- The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jeffrey B. Ware
- The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Junghoon J. Kim
- CUNY School of Medicine, The City College of New York, New York, New York, USA
| | | | - Erika Silverman
- The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Brigid Magdamo
- The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Cian Dabrowski
- The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Leroy Wesley
- The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - My Duyen Le
- The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Justin Morrison
- The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Hannah Zamore
- The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Cillian E. Lynch
- The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Dmitriy Petrov
- The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - H. Isaac Chen
- The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - James Schuster
- The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ramon Diaz-Arrastia
- The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Danielle K. Sandsmark
- The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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28
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Symons GF, Clough M, Fielding J, O'Brien WT, Shepherd CE, Wright DK, Shultz SR. The Neurological Consequences of Engaging in Australian Collision Sports. J Neurotrauma 2021; 37:792-809. [PMID: 32056505 DOI: 10.1089/neu.2019.6884] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Collision sports are an integral part of Australian culture. The most common collision sports in Australia are Australian rules football, rugby union, and rugby league. Each of these sports often results in participants sustaining mild brain traumas, such as concussive and subconcussive injuries. However, the majority of previous studies and reviews pertaining to the neurological implications of sustaining mild brain traumas, while engaging in collision sports, have focused on those popular in North America and Europe. As part of this 2020 International Neurotrauma Symposium special issue, which highlights Australian neurotrauma research, this article will therefore review the burden of mild brain traumas in Australian collision sports athletes. Specifically, this review will first provide an overview of the consequences of mild brain trauma in Australian collision sports, followed by a summary of the previous studies that have investigated neurocognition, ocular motor function, neuroimaging, and fluid biomarkers, as well as neuropathological outcomes in Australian collision sports athletes. A review of the literature indicates that although Australians have contributed to the field, several knowledge gaps and limitations currently exist. These include important questions related to sex differences, the identification and implementation of blood and imaging biomarkers, the need for consistent study designs and common data elements, as well as more multi-modal studies. We conclude that although Australia has had an active history of investigating the neurological impact of collision sports participation, further research is clearly needed to better understand these consequences in Australian athletes and how they can be mitigated.
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Affiliation(s)
- Georgia F Symons
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Meaghan Clough
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Joanne Fielding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - William T O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Claire E Shepherd
- Neuroscience Research Australia, The University of New South Wales, Sydney, New South Wales, Australia
| | - David K Wright
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
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29
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Shi J, Teng J, Du X, Li N. Multi-Modal Analysis of Resting-State fMRI Data in mTBI Patients and Association With Neuropsychological Outcomes. Front Neurol 2021; 12:639760. [PMID: 34079510 PMCID: PMC8165539 DOI: 10.3389/fneur.2021.639760] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Various cognitive disorders have been reported for mild traumatic brain injury (mTBI) patients during the acute stage. This acute stage provides an opportunity for clinicians to optimize treatment protocols, which are based on the evaluation of brain structural connectivity. So far, most brain functional magnetic resonance imaging studies are focused on moderate to severe traumatic brain injuries (TBIs). In this study, we prospectively collected resting state data on 50 mTBI within 3 days of injury and 50 healthy volunteers and analyzed them using Amplitude of low-frequency fluctuation (ALFF), Regional Homogeneity (ReHo), graph theory methods and behavior measure, to explore the dysfunctional brain regions in acute mTBI. In our study, a total of 50 patients suffering <3 days mTBI and 50 healthy subjects were tested in rs-fMRI, as well as under neuropsychological examinations including the Wechsler Intelligence Scale and Stroop Color and Word Test. The correlation analysis was conducted between graph theoretic parameters and neuropsychological results. For the mTBI group, the ReHo of the inferior temporal gyrus and the cerebellum superior are significantly lower than in the control group, and the ALFF of the left insula, the cerebellum inferior, and the middle occipital gyrus were significantly higher than in the control group, which implies the dysfunctionality usually observed in Parkinson's disease. Executive function disorder was significantly correlated with the global efficiencies of the dorsolateral superior frontal gyrus and the anterior cingulate cortex, which is consistent with the literature: the acute mTBI patients demonstrate abnormality in terms of motor speed, association, information processing speed, attention, and short-term memory function. Correlation analysis between the neuropsychological outcomes and the network efficiency for the mTBI group indicates that executive dysfunction might be caused by local brain changes. Our data support the idea that the cerebral internal network has compensatory reactions in response to sudden pathological and neurophysiological changes. In the future, multimode rs-fMRI analysis could be a valuable tool for evaluating dysfunctional brain regions after mTBI.
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Affiliation(s)
- Jian Shi
- Department of Spine Surgury, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jing Teng
- School of Control and Computer Engineering, North China Electric Power University, Beijing, China
| | - Xianping Du
- Department of Mechanical and Aerospace Engineering, Rutgers University, Piscataway, NJ, United States
| | - Na Li
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, China
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30
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Costenbader K, Huda F, Shand M, Brown D, Kraus M, Taheri R. Small subdural hemorrhages: Does size of intracranial hemorrhage impact symptoms after discharge? Am J Emerg Med 2021; 47:223-227. [PMID: 33915377 DOI: 10.1016/j.ajem.2021.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/09/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022] Open
Abstract
INTRO Patients with small intracranial hemorrhage at initial presentation (ICHi) have a relatively uneventful hospital course, as compared with larger ICHi. In this study, we tested the null hypothesis that ICHi does not impact the symptom profile of patients with traumatic brain injury (TBI) after discharge. METHODS In this retrospective study, TBI patients over 18 years of age with a head CT at initial presentation and at least one follow-up visit between 2015 and 2018 were included. Those with vascular risk factors, major psychiatric comorbidities, neurologic disorders, and TBI / CT evidence of ICH within five years were excluded. Patients were stratified based on the presence or absence of ICHi. Symptom profiles were characterized during early (0-3 months post-TBI) and late follow up (4-12 months post-TBI). An adapted 15-question Post-Concussion Symptom Scale and a vestibulo-oculomotor (VOM) exam were assessed by a TBI specialist. We compared the age adjusted clinical symptom profiles between those with and without ICHi. RESULTS 69 patients met inclusion/exclusion criteria. 26 (37.8%) had ICHi and 43 (62.32%) did not have ICH. The severity of measured symptoms or VOM findings were not more severe in those with ICHi. Age-adjusted analyses did not show any effect on these outcomes. CONCLUSION ICHi does not impact the symptom profile of patients with TBI in either short or long term.
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Affiliation(s)
- Kyle Costenbader
- George Washington University, School of Medicine and Health Sciences, United States of America.
| | - Fahimul Huda
- George Washington University, School of Medicine and Health Sciences, United States of America.
| | - Muhammed Shand
- George Washington University, School of Medicine and Health Sciences, United States of America.
| | - Derek Brown
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston, United States of America.
| | - Marilyn Kraus
- George Washington University, School of Medicine and Health Sciences, United States of America.
| | - Reza Taheri
- George Washington University, School of Medicine and Health Sciences, United States of America.
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Karr JE, Iverson GL, Williams MW, Huang SJ, Yang CC. Complicated versus uncomplicated mild traumatic brain injuries: A comparison of psychological, cognitive, and post-concussion symptom outcomes. J Clin Exp Neuropsychol 2020; 42:1049-1058. [PMID: 33161877 DOI: 10.1080/13803395.2020.1841118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION A complicated mild traumatic brain injury (MTBI) is defined as mild by all clinical severity indicators but is complicated due to a traumatic intracranial abnormality visible on neuroimaging. Researchers have reported mixed findings regarding whether neuropsychological and functional outcomes following complicated MTBI are worse than, or similar to, outcomes following uncomplicated MTBI. This study examined patients referred from a Taiwanese emergency department to a neurosurgical outpatient clinic. Participants with complicated MTBI, uncomplicated MTBI, and those who did not undergo head computed tomography (CT) were compared on psychological, neuropsychological, and post-concussion symptom outcomes within 21 days of injury. METHOD Participants with complicated MTBI (n = 42), uncomplicated MTBI (n = 77), and no head CT (n = 172) completed the Paced Auditory Serial Attention Test, Taiwanese Word Sequence Learning Test, a semantic Verbal Fluency Test, the Checklist of Post-Concussion Symptoms, and the Beck Depression and Anxiety Inventories. RESULTS No significant differences were observed between groups on any measure. For individual post-concussion symptoms, dizziness, anxiety, and attention difficulty were endorsed more often after uncomplicated MTBIs, but these group differences were not significant after controlling for multiple comparisons. CONCLUSIONS Participants with complicated MTBIs did not have worse acute or subacute outcomes than participants with uncomplicated MTBIs or no head CT. These results are consistent with many studies finding comparable outcomes between those with complicated and uncomplicated MTBIs. This study is limited by small sample size and minimal information on intracranial abnormalities, broadly categorizing groups based on positive or negative neuroimaging as opposed to specific lesion types and locations.
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Affiliation(s)
- Justin E Karr
- Department of Psychology, University of Kentucky , Lexington, KY, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School , Boston, MA, USA.,Spaulding Rehabilitation Hospital , Charlestown, MA, USA.,Spaulding Research Institute , Charlestown, MA, USA.,Home Base, A Red Sox Foundation and Massachusetts General Hospital Program , Charlestown, MA, USA
| | | | | | - Chi-Cheng Yang
- Department of Psychology, National Chengchi University , Taipei, Taiwan.,Holistic Mental Health Center, Taipei City Hospital , Taipei, Taiwan
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Karlsen RH, Saksvik SB, Stenberg J, Lundervold AJ, Olsen A, Rautio I, Folvik L, Håberg AK, Vik A, Karr JE, Iverson GL, Skandsen T. Examining the Subacute Effects of Mild Traumatic Brain Injury Using a Traditional and Computerized Neuropsychological Test Battery. J Neurotrauma 2020; 38:74-85. [PMID: 32948095 DOI: 10.1089/neu.2019.6922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This study investigates subacute cognitive effects of mild traumatic brain injury (MTBI) in the Trondheim Mild TBI Study, as measured, in part, by the neuropsychological test battery of the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) program, including computerized tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) and traditional paper-and-pencil tests. We investigated whether cognitive function was associated with injury severity: intracranial traumatic lesions on neuroimaging, witnessed loss of consciousness (LOC), or post-traumatic amnesia (PTA) >1 h. Further, we explored which of the tests in the CENTER-TBI battery might be associated with the largest subacute effects of MTBI (i.e., at 2 weeks post-injury). We recruited 177 patients with MTBI (16-59 years of age) from a regional trauma center and an outpatient clinic,79 trauma control participants, and 81 community control participants. The MTBI group differed from community controls only on one traditional test of processing speed (coding; p = 0.009, Cliff's delta [Δ] = 0.20). Patients with intracranial abnormalities performed worse than those without on a traditional test (phonemic verbal fluency; p = 0.043, Δ = 0.27), and patients with LOC performed differently on the Attention Switching Task from the CANTAB (p = 0.020, Δ = -0.20). Patients with PTA >1 h performed worse than those with <1 h on 10 measures, from traditional tests and the CANTAB (Δ = 0.33-0.20), likely attributable, at least in part, to pre-existing differences in intellectual functioning between groups. In general, those with MTBI had good neuropsychological outcome 2 weeks after injury and no particular CENTER-TBI computerized or traditional tests seemed to be more sensitive to subtle cognitive deficits.
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Affiliation(s)
- Rune Hatlestad Karlsen
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Simen Berg Saksvik
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jonas Stenberg
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | | | - Alexander Olsen
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ida Rautio
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Line Folvik
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Asta Kristine Håberg
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,Department of Neurosurgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Vik
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,Department of Neurosurgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Justin E Karr
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Home Base Program, Red Sox Foundation and Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Home Base Program, Red Sox Foundation and Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Toril Skandsen
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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33
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Traumatic Microbleeds in the Hippocampus and Corpus Callosum Predict Duration of Posttraumatic Amnesia. J Head Trauma Rehabil 2020; 34:E10-E18. [PMID: 31033742 DOI: 10.1097/htr.0000000000000479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Radiologic predictors of posttraumatic amnesia (PTA) duration are lacking. We hypothesized that the number and distribution of traumatic microbleeds (TMBs) detected by gradient recalled echo (GRE) magnetic resonance imaging (MRI) predicts PTA duration. SETTING Academic, tertiary medical center. PARTICIPANTS Adults with traumatic brain injury (TBI). DESIGN We identified 65 TBI patients with acute GRE MRI. PTA duration was determined with the Galveston Orientation and Amnesia Test, Orientation Log, or chart review. TMBs were identified within memory regions (hippocampus, corpus callosum, fornix, thalamus, and temporal lobe) and control regions (internal capsule and global). Regression tree analysis was performed to identify radiologic predictors of PTA duration, controlling for clinical PTA predictors. MAIN MEASURES TMB distribution, PTA duration. RESULTS Sixteen patients (25%) had complicated mild, 4 (6%) had moderate, and 45 (69%) had severe TBI. Median PTA duration was 43 days (range, 0-240 days). In univariate analysis, PTA duration correlated with TMBs in the corpus callosum (R = 0.29, P = .02) and admission Glasgow Coma Scale (GCS) score (R = -0.34, P = .01). In multivariate regression analysis, admission GCS score was the only significant contributor to PTA duration. However, in regression tree analysis, hippocampal TMBs, callosal TMBs, age, and admission GCS score explained 26% of PTA duration variance and distinguished a subgroup with prolonged PTA. CONCLUSIONS Hippocampal and callosal TMBs are potential radiologic predictors of PTA duration.
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Puig J, Ellis MJ, Kornelsen J, Figley TD, Figley CR, Daunis-i-Estadella P, Mutch WAC, Essig M. Magnetic Resonance Imaging Biomarkers of Brain Connectivity in Predicting Outcome after Mild Traumatic Brain Injury: A Systematic Review. J Neurotrauma 2020; 37:1761-1776. [DOI: 10.1089/neu.2019.6623] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Josep Puig
- Department of Radiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - Michael J. Ellis
- Canada North Concussion Network, Winnipeg, Manitoba, Canada
- Department of Surgery and Pediatrics and Child Health, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Section of Neurosurgery, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Pan Am Concussion Program, Winnipeg, Manitoba, Canada
- Childrens Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer Kornelsen
- Department of Radiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Center, Winnipeg, Manitoba, Canada
- Department of Physiology and Pathophysiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Teresa D. Figley
- Department of Radiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Center, Winnipeg, Manitoba, Canada
| | - Chase R. Figley
- Department of Radiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Center, Winnipeg, Manitoba, Canada
- Department of Physiology and Pathophysiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Pepus Daunis-i-Estadella
- Department of Computer Science, Applied Mathematics and Statistics, Universitat de Girona, Girona, Spain
| | - W. Alan C. Mutch
- Canada North Concussion Network, Winnipeg, Manitoba, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Center, Winnipeg, Manitoba, Canada
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marco Essig
- Department of Radiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Canada North Concussion Network, Winnipeg, Manitoba, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Center, Winnipeg, Manitoba, Canada
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Stenberg J, Karr JE, Terry DP, Saksvik SB, Vik A, Skandsen T, Silverberg ND, Iverson GL. Developing Cognition Endpoints for the CENTER-TBI Neuropsychological Test Battery. Front Neurol 2020; 11:670. [PMID: 32765400 PMCID: PMC7379151 DOI: 10.3389/fneur.2020.00670] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/05/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Measuring cognitive functioning is common in traumatic brain injury (TBI) research, but no universally accepted method for combining several neuropsychological test scores into composite, or summary, scores exists. This study examined several possible composite scores for the test battery used in the large-scale study Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI). Methods: Participants with mild traumatic brain injury (MTBI; n = 140), orthopedic trauma (n = 72), and healthy community controls (n = 70) from the Trondheim MTBI follow-up study completed the CENTER-TBI test battery at 2 weeks after injury, which includes both traditional paper-and-pencil tests and tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Seven composite scores were calculated for the paper and pencil tests, the CANTAB tests, and all tests combined (i.e., 21 composites): the overall test battery mean (OTBM); global deficit score (GDS); neuropsychological deficit score-weighted (NDS-W); low score composite (LSC); and the number of scores ≤5th percentile, ≤16th percentile, or <50th percentile. Results: The OTBM and the number of scores <50th percentile composites had distributional characteristics approaching a normal distribution. The other composites were in general highly skewed and zero-inflated. When the MTBI group, the trauma control group, and the community control group were compared, effect sizes were negligible to small for all composites. Subgroups with vs. without loss of consciousness at the time of injury did not differ on the composite scores and neither did subgroups with complicated vs. uncomplicated MTBIs. Intercorrelations were high within the paper-and-pencil composites, the CANTAB composites, and the combined composites and lower between the paper-and-pencil composites and the CANTAB composites. Conclusion: None of the composites revealed significant differences between participants with MTBI and the two control groups. Some of the composite scores were highly correlated and may be redundant. Additional research on patients with moderate to severe TBIs is needed to determine which scores are most appropriate for TBI clinical trials.
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Affiliation(s)
- Jonas Stenberg
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Justin E Karr
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States.,Spaulding Rehabilitation Hospital, Charlestown, MA, United States.,Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States.,Spaulding Research Institute, Charlestown, MA, United States
| | - Douglas P Terry
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States.,Spaulding Rehabilitation Hospital, Charlestown, MA, United States.,Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
| | - Simen B Saksvik
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Vik
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Toril Skandsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada.,Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, BC, Canada.,Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver, BC, Canada
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States.,Spaulding Rehabilitation Hospital, Charlestown, MA, United States.,Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States.,Spaulding Research Institute, Charlestown, MA, United States
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36
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Johnson LW, Lundgren K, Henrich V, Phillips S. Factors influencing recovery from mild traumatic brain injury. Brain Inj 2020; 34:1202-1212. [PMID: 32705914 DOI: 10.1080/02699052.2020.1795719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PRIMARY OBJECTIVE This study determined whether initial GCS score, head CT results, cognitive performance on IMPACT testing, or APOE genotype most effectively predicted 1-month functional outcome after mild traumatic brain injury (mTBI). This study tested the hypotheses that participants with poor performance on initial cognitive testing and those with an APOEe4 genotype would exhibit a poorer 1-month recovery after mTBI. RESEARCH DESIGN Regression analysis determined which independent variables were most effective in predicting 1-month GOS-E or DRS score. Independent t-test procedures determined whether cognitive recovery varied across APOEe4 carriers. METHODS AND PROCEDURES 49 participants admitted to the hospital with mTBI received cognitive evaluation within 48 hours after injury and again one month later. DNA analysis provided participant APOE genotype. MAIN OUTCOMES AND RESULTS Results showed that no study variables significantly predicted GOS-E or DRS scores, however, differences were identified when APOE groups were compared. Participants who were noncarriers of APOEe4 had significantly slower reaction times compared to APOEe4 carriers. Participants who were homozygous APOEe4 carriers had significantly lower instances of impulsivity than noncarriers. CONCLUSIONS Further research is needed to understand how APOE allele status and performance on initial cognitive testing may influence short-term recovery after mTBI.
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Affiliation(s)
- Leslie Weaver Johnson
- Communications Disorders Program, North Carolina Central University , Durham, North Carolina, USA
| | - Kristine Lundgren
- Department of Communication and Sciences Disorders, University of North Carolina - Greensboro , Greensboro, North Carolina, USA
| | - Vincent Henrich
- Department of Biology, University of North Carolina - Greensboro , Greensboro, North Carolina, USA
| | - Susan Phillips
- Department of Communication and Sciences Disorders, University of North Carolina - Greensboro , Greensboro, North Carolina, USA
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A critical review of radiotracers in the positron emission tomography imaging of traumatic brain injury: FDG, tau, and amyloid imaging in mild traumatic brain injury and chronic traumatic encephalopathy. Eur J Nucl Med Mol Imaging 2020; 48:623-641. [DOI: 10.1007/s00259-020-04926-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/11/2020] [Indexed: 12/14/2022]
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Eisele A, Hill-Strathy M, Michels L, Rauen K. Magnetic Resonance Spectroscopy following Mild Traumatic Brain Injury: A Systematic Review and Meta-Analysis on the Potential to Detect Posttraumatic Neurodegeneration. NEURODEGENER DIS 2020; 20:2-11. [PMID: 32610337 DOI: 10.1159/000508098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 04/11/2020] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) is the most relevant external risk factor for dementia and a major global health burden. Mild TBI (mTBI) contributes to up to 90% of all TBIs, and the classification "mild" often misrepresents the patient's burden who suffer from neuropsychiatric long-term sequelae. Magnetic resonance spectroscopy (MRS) allows in vivo detection of compromised brain metabolism although it is not routinely used after TBI. OBJECTIVE Thus, we performed a systematic review and meta-analysis to elucidate if MRS has the potential to identify changes in brain metabolism in adult patients after a single mTBI with a negative routine brain scan (CCT and/or MRI scan) compared to aged- and sex-matched healthy controls (HC) during the acute or subacute postinjury phase (≤90 days after mTBI). METHODS A comprehensive literature search was conducted from the first edition of electronic databases until January 31, 2020. Group analyses were performed per metabolite using a random-effects model. RESULTS Four and 2 out of 5,417 articles met the inclusion criteria for the meta-analysis and systematic review, respectively. For the meta-analysis, 50 mTBI patients and 51 HC with a mean age of 31 and 30 years, respectively, were scanned using N-acetyl-aspartate (NAA), a marker for neuronal integrity. Glutamate (Glu), a marker for disturbed brain metabolism, choline (Cho), a marker for increased cell membrane turnover, and creatine (Cr) were used in 2 out of the 4 included articles. Regions of interests were the frontal lobe, the white matter around 1 cm above the lateral ventricles, or the whole brain. NAA was decreased in patients compared to HC with an effect size (ES) of -0.49 (95% CI -1.08 to 0.09), primarily measured in the frontal lobe. Glu was increased in the white matter in 22 mTBI patients compared to 22 HC (ES 0.79; 95% CI 0.17-1.41). Cho was decreased in 31 mTBI patients compared to 31 HC (ES -0.31; 95% CI -0.81 to 0.19). Cr was contradictory and, therefore, potentially not suitable as a reference marker after mTBI. CONCLUSIONS MRS pinpoints changes in posttraumatic brain metabolism that correlate with cognitive dysfunction and, thus, might possibly help to detect mTBI patients at risk for unfavorable outcome or posttraumatic neurodegeneration early.
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Affiliation(s)
- Amanda Eisele
- Department of Geriatric Psychiatry, Psychiatric Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - MaryJane Hill-Strathy
- Department of Geriatric Psychiatry, Psychiatric Hospital Zurich, University of Zurich, Zurich, Switzerland.,School of Psychology and Neuroscience, University of St Andrews, St Andrews, United Kingdom
| | - Lars Michels
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Katrin Rauen
- Department of Geriatric Psychiatry, Psychiatric Hospital Zurich, University of Zurich, Zurich, Switzerland, .,Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland,
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Steyerberg EW, Wiegers E, Sewalt C, Buki A, Citerio G, De Keyser V, Ercole A, Kunzmann K, Lanyon L, Lecky F, Lingsma H, Manley G, Nelson D, Peul W, Stocchetti N, von Steinbüchel N, Vande Vyvere T, Verheyden J, Wilson L, Maas AIR, Menon DK. Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI: a European prospective, multicentre, longitudinal, cohort study. Lancet Neurol 2020; 18:923-934. [PMID: 31526754 DOI: 10.1016/s1474-4422(19)30232-7] [Citation(s) in RCA: 269] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/21/2019] [Accepted: 05/23/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The burden of traumatic brain injury (TBI) poses a large public health and societal problem, but the characteristics of patients and their care pathways in Europe are poorly understood. We aimed to characterise patient case-mix, care pathways, and outcomes of TBI. METHODS CENTER-TBI is a Europe-based, observational cohort study, consisting of a core study and a registry. Inclusion criteria for the core study were a clinical diagnosis of TBI, presentation fewer than 24 h after injury, and an indication for CT. Patients were differentiated by care pathway and assigned to the emergency room (ER) stratum (patients who were discharged from an emergency room), admission stratum (patients who were admitted to a hospital ward), or intensive care unit (ICU) stratum (patients who were admitted to the ICU). Neuroimages and biospecimens were stored in repositories and outcome was assessed at 6 months after injury. We used the IMPACT core model for estimating the expected mortality and proportion with unfavourable Glasgow Outcome Scale Extended (GOSE) outcomes in patients with moderate or severe TBI (Glasgow Coma Scale [GCS] score ≤12). The core study was registered with ClinicalTrials.gov, number NCT02210221, and with Resource Identification Portal (RRID: SCR_015582). FINDINGS Data from 4509 patients from 18 countries, collected between Dec 9, 2014, and Dec 17, 2017, were analysed in the core study and from 22 782 patients in the registry. In the core study, 848 (19%) patients were in the ER stratum, 1523 (34%) in the admission stratum, and 2138 (47%) in the ICU stratum. In the ICU stratum, 720 (36%) patients had mild TBI (GCS score 13-15). Compared with the core cohort, the registry had a higher proportion of patients in the ER (9839 [43%]) and admission (8571 [38%]) strata, with more than 95% of patients classified as having mild TBI. Patients in the core study were older than those in previous studies (median age 50 years [IQR 30-66], 1254 [28%] aged >65 years), 462 (11%) had serious comorbidities, 772 (18%) were taking anticoagulant or antiplatelet medication, and alcohol was contributory in 1054 (25%) TBIs. MRI and blood biomarker measurement enhanced characterisation of injury severity and type. Substantial inter-country differences existed in care pathways and practice. Incomplete recovery at 6 months (GOSE <8) was found in 207 (30%) patients in the ER stratum, 665 (53%) in the admission stratum, and 1547 (84%) in the ICU stratum. Among patients with moderate-to-severe TBI in the ICU stratum, 623 (55%) patients had unfavourable outcome at 6 months (GOSE <5), similar to the proportion predicted by the IMPACT prognostic model (observed to expected ratio 1·06 [95% CI 0·97-1·14]), but mortality was lower than expected (0·70 [0·62-0·76]). INTERPRETATION Patients with TBI who presented to European centres in the core study were older than were those in previous observational studies and often had comorbidities. Overall, most patients presented with mild TBI. The incomplete recovery of many patients should motivate precision medicine research and the identification of best practices to improve these outcomes. FUNDING European Union 7th Framework Programme, the Hannelore Kohl Stiftung, OneMind, and Integra LifeSciences Corporation.
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Affiliation(s)
- Ewout W Steyerberg
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Eveline Wiegers
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Charlie Sewalt
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Andras Buki
- Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary; Neurotrauma Research Group, János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Giuseppe Citerio
- NeuroIntensive Care, ASST di Monza, Monza, Italy; School of Medicine and Surgery, Università Milano Bicocca, Milan, Italy
| | | | - Ari Ercole
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Kevin Kunzmann
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Linda Lanyon
- International Neuroinformatics Coordinating Facility, Karolinska Institute, Stockholm, Sweden
| | - Fiona Lecky
- Centre for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Hester Lingsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Geoffrey Manley
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - David Nelson
- Department of Physiology and Pharmacology, Section of Perioperative Medicine and Intensive Care, Karolinska Institute, Stockholm, Sweden
| | - Wilco Peul
- Leiden University Medical Centre and Haaglanden Medical Centre, University Neurosurgical Centre Holland, The Hague and Leiden, Netherlands
| | - Nino Stocchetti
- Department of Pathophysiology and Transplantation, Milan University, Milan, Italy; Neuroscience Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicole von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Thijs Vande Vyvere
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium; Division of Psychology, University of Stirling, Stirling, UK
| | | | - Lindsay Wilson
- Division of Psychology, University of Stirling, Stirling, UK
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium; University of Antwerp, Edegem, Belgium.
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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Voormolen DC, Zeldovich M, Haagsma JA, Polinder S, Friedrich S, Maas AIR, Wilson L, Steyerberg EW, Covic A, Andelic N, Plass AM, Wu YJ, Asendorf T, von Steinbüechel N. Outcomes after Complicated and Uncomplicated Mild Traumatic Brain Injury at Three-and Six-Months Post-Injury: Results from the CENTER-TBI Study. J Clin Med 2020; 9:jcm9051525. [PMID: 32443573 PMCID: PMC7291134 DOI: 10.3390/jcm9051525] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to provide a comprehensive examination of the relation of complicated and uncomplicated mild traumatic brain injury (mTBI) with multidimensional outcomes at three- and six-months after TBI. We analyzed data from the Collaborative European NeuroTrauma Effectiveness Research (CENTER-TBI) research project. Patients after mTBI (Glasgow Coma scale (GCS) score of 13-15) enrolled in the study were differentiated into two groups based on computed tomography (CT) findings: complicated mTBI (presence of any traumatic intracranial injury on first CT) and uncomplicated mTBI (absence of any traumatic intracranial injury on first CT). Multidimensional outcomes were assessed using seven instruments measuring generic and disease-specific health-related quality of life (HRQoL) (SF-36 and QOLIBRI), functional outcome (GOSE), and psycho-social domains including symptoms of post-traumatic stress disorder (PTSD) (PCL-5), depression (PHQ-9), and anxiety (GAD-7). Data were analyzed using a multivariate repeated measures approach (MANOVA-RM), which inspected mTBI groups at three- and six-months post injury. Patients after complicated mTBI had significantly lower GOSE scores, reported lower physical and mental component summary scores based on the SF-36 version 2, and showed significantly lower HRQoL measured by QOLIBRI compared to those after uncomplicated mTBI. There was no difference between mTBI groups when looking at psychological outcomes, however, a slight improvement in PTSD symptoms and depression was observed for the entire sample from three to six months. Patients after complicated mTBI reported lower generic and disease specific HRQoL and worse functional outcome compared to individuals after uncomplicated mTBI at three and six months. Both groups showed a tendency to improve from three to six months after TBI. The complicated mTBI group included more patients with an impaired long-term outcome than the uncomplicated group. Nevertheless, patients, clinicians, researchers, and decisions-makers in health care should take account of the short and long-term impact on outcome for patients after both uncomplicated and complicated mTBI.
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Affiliation(s)
- Daphne C. Voormolen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (J.A.H.); (S.P.); (E.W.S.)
- Correspondence: (D.C.V.); (M.Z.); Tel.: +31-628683742 (D.C.V.); Tel.: +49-551398195 (M.Z.)
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany; (A.C.); (A.M.P.); (Y.-J.W.)
- Correspondence: (D.C.V.); (M.Z.); Tel.: +31-628683742 (D.C.V.); Tel.: +49-551398195 (M.Z.)
| | - Juanita A. Haagsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (J.A.H.); (S.P.); (E.W.S.)
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (J.A.H.); (S.P.); (E.W.S.)
| | - Sarah Friedrich
- Department of Medical Statistics, University Medical Center Göttingen, 37073 Göttingen, Germany; (S.F.); (T.A.)
| | - Andrew I. R. Maas
- Department of Neurosurgery, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Neurosurgery, University of Antwerp, 2650 Edegem, Belgium
| | - Lindsay Wilson
- Department of Psychology, University of Stirling, Stirling FK9 4LJ, UK;
| | - Ewout W. Steyerberg
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (J.A.H.); (S.P.); (E.W.S.)
- Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 ZC Leiden, The Netherlands
| | - Amra Covic
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany; (A.C.); (A.M.P.); (Y.-J.W.)
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0450 Oslo, Norway;
- Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), University of Oslo, 0373 Oslo, Norway
| | - Anne Marie Plass
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany; (A.C.); (A.M.P.); (Y.-J.W.)
| | - Yi-Jhen Wu
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany; (A.C.); (A.M.P.); (Y.-J.W.)
| | - Thomas Asendorf
- Department of Medical Statistics, University Medical Center Göttingen, 37073 Göttingen, Germany; (S.F.); (T.A.)
| | - Nicole von Steinbüechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany; (A.C.); (A.M.P.); (Y.-J.W.)
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van Eijck MM, Herklots MW, Peluso J, Schoonman GG, Oldenbeuving AW, de Vries J, van der Naalt J, Roks G. Accuracy in prediction of long-term functional outcome in patients with traumatic axonal injury: a comparison of MRI scales. Brain Inj 2020; 34:595-601. [DOI: 10.1080/02699052.2020.1741683] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Marleen Maria van Eijck
- Department of Trauma TopCare, ETZ Hospital, Tilburg, The Netherlands
- Department of Neurology, ETZ Hospital, Tilburg, The Netherlands
| | | | - Jo Peluso
- Department of Radiology, ETZ Hospital, Tilburg, The Netherlands
| | | | | | - Jolanda de Vries
- Department of Trauma TopCare, ETZ Hospital, Tilburg, The Netherlands
- CoRPS, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Joukje van der Naalt
- Department of Neurology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Gerwin Roks
- Department of Trauma TopCare, ETZ Hospital, Tilburg, The Netherlands
- Department of Neurology, ETZ Hospital, Tilburg, The Netherlands
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42
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Warnock A, Toomey LM, Wright AJ, Fisher K, Won Y, Anyaegbu C, Fitzgerald M. Damage Mechanisms to Oligodendrocytes and White Matter in Central Nervous System Injury: The Australian Context. J Neurotrauma 2020; 37:739-769. [DOI: 10.1089/neu.2019.6890] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Andrew Warnock
- Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
| | - Lillian M. Toomey
- Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
| | - Alexander J. Wright
- Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
| | - Katherine Fisher
- School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Yerim Won
- School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Chidozie Anyaegbu
- Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
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Cook MJ, Gardner AJ, Wojtowicz M, Williams WH, Iverson GL, Stanwell P. Task-related functional magnetic resonance imaging activations in patients with acute and subacute mild traumatic brain injury: A coordinate-based meta-analysis. NEUROIMAGE-CLINICAL 2019; 25:102129. [PMID: 31891819 PMCID: PMC6939096 DOI: 10.1016/j.nicl.2019.102129] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 10/28/2019] [Accepted: 12/13/2019] [Indexed: 12/16/2022]
Abstract
ALE meta-analysis revealed functional activation differences in mTBI. Reduced activation identified within the right middle frontal gyrus. Suggests alteration of prefrontal region, associated with executive functioning. Need for addressing subject- and task-specific variation in future studies.
Task-based functional magnetic resonance imaging (fMRI) has been used to examine neuroanatomical and functional changes following mild traumatic brain injury (mTBI). Prior studies have lacked consistency in identifying common regions of altered neural activity during cognitive tasks. This may be partly due to differences in task paradigm, patient heterogeneity, and methods of fMRI analysis. We conducted a meta-analysis using an activation likelihood estimation (ALE) method to identify regions of differential brain activation in patients with mTBI compared to healthy controls. We included experiments that performed scans from acute to subacute time points post-injury. The seven included studies recruited a total sample of 174 patients with mTBIs and 139 control participants. The results of our coordinate based meta-analysis revealed a single cluster of reduced activation within the right middle frontal gyrus (MFG) that differentiated mTBI from healthy controls. We conclude that the cognitive impairments in memory and attention typically reported in mTBI patients may be associated with a deficit in the right MFG, which impacts the recruitment of neural networks important for attentional control.
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Affiliation(s)
- Michael J Cook
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Andrew J Gardner
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Hunter New England Local Health District Sports Concussion Clinic, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Magdalena Wojtowicz
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
| | - W Huw Williams
- Centre for Clinical Neuropsychology Research, University of Exeter, Exeter, Devon, UK
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA; Spaulding Rehabilitation Hospital, and Spaulding Research Institute, Charlestown, MA, USA; MassGeneral Hospital for Children™ Sports Concussion Program, Boston, MA, USA; Home Base, A Red Sox Foundation and Massachusetts General Hospital Home Base Program, Charlestown, MA, USA
| | - Peter Stanwell
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia; School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia.
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44
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Ye M, Solarana K, Rafi H, Patel S, Nabili M, Liu Y, Huang S, Fisher JAN, Krauthamer V, Myers M, Welle C. Longitudinal Functional Assessment of Brain Injury Induced by High-Intensity Ultrasound Pulse Sequences. Sci Rep 2019; 9:15518. [PMID: 31664091 PMCID: PMC6820547 DOI: 10.1038/s41598-019-51876-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/09/2019] [Indexed: 01/02/2023] Open
Abstract
Exposure of the brain to high-intensity stress waves creates the potential for long-term functional deficits not related to thermal or cavitational damage. Possible sources of such exposure include overpressure from blast explosions or high-intensity focused ultrasound (HIFU). While current ultrasound clinical protocols do not normally produce long-term neurological deficits, the rapid expansion of potential therapeutic applications and ultrasound pulse-train protocols highlights the importance of establishing a safety envelope beyond which therapeutic ultrasound can cause neurological deficits not detectable by standard histological assessment for thermal and cavitational damage. In this study, we assessed the neuroinflammatory response, behavioral effects, and brain micro-electrocorticographic (µECoG) signals in mice following exposure to a train of transcranial pulses above normal clinical parameters. We found that the HIFU exposure induced a mild regional neuroinflammation not localized to the primary focal site, and impaired locomotor and exploratory behavior for up to 1 month post-exposure. In addition, low frequency (δ) and high frequency (β, γ) oscillations recorded by ECoG were altered at acute and chronic time points following HIFU application. ECoG signal changes on the hemisphere ipsilateral to HIFU exposure are of greater magnitude than the contralateral hemisphere, and persist for up to three months. These results are useful for describing the upper limit of transcranial ultrasound protocols, and the neurological sequelae of injury induced by high-intensity stress waves.
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Affiliation(s)
- Meijun Ye
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA.
| | - Krystyna Solarana
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA
| | - Harmain Rafi
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA
| | - Shyama Patel
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA.,Division of Neurological and Physical Medicine Devices, Office of Device Evaluation, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA
| | - Marjan Nabili
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA.,Division of Radiological Health, Office of In Vitro Diagnostics and Radiological Health, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA
| | - Yunbo Liu
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA
| | | | - Jonathan A N Fisher
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA.,Department of Physiology, New York Medical College, Valhalla, NY, USA
| | - Victor Krauthamer
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA
| | - Matthew Myers
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA
| | - Cristin Welle
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA. .,Departments of Neurosurgery and Physiology & Biophysics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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45
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Mayer AR, Cohen DM, Wertz CJ, Dodd AB, Shoemaker J, Pluto C, Zumberge NA, Park G, Bangert BA, Lin C, Minich NM, Bacevice AM, Bigler ED, Campbell RA, Hanlon FM, Meier TB, Oglesbee SJ, Phillips JP, Pottenger A, Shaff NA, Taylor HG, Yeo RA, Arbogast KB, Leddy JJ, Master CL, Mannix R, Zemek RL, Yeates KO. Radiologic common data elements rates in pediatric mild traumatic brain injury. Neurology 2019; 94:e241-e253. [PMID: 31645467 DOI: 10.1212/wnl.0000000000008488] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 07/18/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The nosology for classifying structural MRI findings following pediatric mild traumatic brain injury (pmTBI) remains actively debated. Radiologic common data elements (rCDE) were developed to standardize reporting in research settings. However, some rCDE are more specific to trauma (probable rCDE). Other more recently proposed rCDE have multiple etiologies (possible rCDE), and may therefore be more common in all children. Independent cohorts of patients with pmTBI and controls were therefore recruited from multiple sites (New Mexico and Ohio) to test the dual hypothesis of a higher incidence of probable rCDE (pmTBI > controls) vs similar rates of possible rCDE on structural MRI. METHODS Patients with subacute pmTBI (n = 287), matched healthy controls (HC; n = 106), and orthopedically injured (OI; n = 71) patients underwent imaging approximately 1 week postinjury and were followed for 3-4 months. RESULTS Probable rCDE were specific to pmTBI, occurring in 4%-5% of each sample, rates consistent with previous large-scale CT studies. In contrast, prevalence rates for incidental findings and possible rCDE were similar across groups (pmTBI vs OI vs HC). The prevalence of possible rCDE was also the only finding that varied as a function of site. Possible rCDE and incidental findings were not associated with postconcussive symptomatology or quality of life 3-4 months postinjury. CONCLUSION Collectively, current findings question the trauma-related specificity of certain rCDE, as well how these rCDE are radiologically interpreted. Refinement of rCDE in the context of pmTBI may be warranted, especially as diagnostic schema are evolving to stratify patients with structural MRI abnormalities as having a moderate injury.
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Affiliation(s)
- Andrew R Mayer
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada.
| | - Daniel M Cohen
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Christopher J Wertz
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Andrew B Dodd
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Jody Shoemaker
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Charles Pluto
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Nicholas A Zumberge
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Grace Park
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Barbara A Bangert
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Cindy Lin
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Nori M Minich
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Ann M Bacevice
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Erin D Bigler
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Richard A Campbell
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Faith M Hanlon
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Timothy B Meier
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Scott J Oglesbee
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - John P Phillips
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Amy Pottenger
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Nicholas A Shaff
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - H Gerry Taylor
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Ronald A Yeo
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Kristy B Arbogast
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - John J Leddy
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Christina L Master
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Rebekah Mannix
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Roger L Zemek
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Keith Owen Yeates
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
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Morrison TR, Kulkarni P, Cai X, Iriah S, Aggarwal D, Lu SF, Simon NG, Madularu D, Ferris CF. Treating head injury using a novel vasopressin 1a receptor antagonist. Neurosci Lett 2019; 714:134565. [PMID: 31639422 DOI: 10.1016/j.neulet.2019.134565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/14/2019] [Indexed: 01/10/2023]
Abstract
Arginine vasopressin (AVP) is a chemical signal in the brain that influences cerebral vascular resistance and brain water permeability. Increases in AVP contribute to the pathophysiology of brain edema following traumatic brain injury (TBI). These effects are mediated through AVP V1a receptors that are expressed in cortical and subcortical brain areas. This exploratory study characterizes the effects of a novel, V1a receptor antagonist, AVN576, on behavioral and magnetic resonance imaging (MRI) measures after severe TBI. Male Sprague Dawley rats were impacted twice producing contusions in the forebrain, putative cerebral edema, and cognitive deficits. Rats were treated with AVN576 after initial impact for 5 days and then tested for changes in cognition. MRI was used to assess brain injury, enlargement of the ventricles, and resting state functional connectivity. Vehicle treated rats had significant deficits in learning and memory, enlarged ventricular volumes, and hypoconnectivity in hippocampal circuitry. AVN576 treatment eliminated the enlargement of the lateral ventricles and deficits in cognitive function while increasing connectivity in hippocampal circuitry. These data corroborate the extensive literature that drugs selectively targeting the AVP V1a receptor could be used to treat TBI in the clinic.
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Affiliation(s)
- Thomas R Morrison
- Northeastern University, Center for Translational NeuroImaging, Boston, MA, United States
| | - Praveen Kulkarni
- Northeastern University, Center for Translational NeuroImaging, Boston, MA, United States
| | - Xuezhu Cai
- Northeastern University, Center for Translational NeuroImaging, Boston, MA, United States
| | - Sade Iriah
- Northeastern University, Center for Translational NeuroImaging, Boston, MA, United States
| | - Dipak Aggarwal
- Northeastern University, Center for Translational NeuroImaging, Boston, MA, United States
| | - Shi-Fang Lu
- Azevan Pharmaceuticals, Bethlehem, PA, United States; Dept. of Biological Sciences, Lehigh University, Bethlehem, PA, United States
| | - Neal G Simon
- Azevan Pharmaceuticals, Bethlehem, PA, United States; Dept. of Biological Sciences, Lehigh University, Bethlehem, PA, United States
| | - Dan Madularu
- Northeastern University, Center for Translational NeuroImaging, Boston, MA, United States
| | - Craig F Ferris
- Northeastern University, Center for Translational NeuroImaging, Boston, MA, United States; Dept of Psychology and Pharmaceutical Sciences, Boston, MA, United States.
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47
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Isokuortti H, Iverson GL, Silverberg ND, Kataja A, Brander A, Öhman J, Luoto TM. Characterizing the type and location of intracranial abnormalities in mild traumatic brain injury. J Neurosurg 2019; 129:1588-1597. [PMID: 29328003 DOI: 10.3171/2017.7.jns17615] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/06/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVEThe incidence of intracranial abnormalities after mild traumatic brain injury (TBI) varies widely across studies. This study describes the characteristics of intracranial abnormalities (acute/preexisting) in a large representative sample of head-injured patients who underwent CT imaging in an emergency department.METHODSCT scans were systematically analyzed/coded in the TBI Common Data Elements framework. Logistic regression modeling was used to quantify risk factors for traumatic intracranial abnormalities in patients with mild TBIs. This cohort included all patients who were treated at the emergency department of the Tampere University Hospital (between 2010 and 2012) and who had undergone head CT imaging after suffering a suspected TBI (n = 3023), including 2766 with mild TBI and a reference group with moderate to severe TBI.RESULTSThe most common traumatic lesions seen on CT scans obtained in patients with mild TBIs and those with moderate to severe TBIs were subdural hematomas, subarachnoid hemorrhages, and contusions. Every sixth patient (16.1%) with mild TBI had an intracranial lesion compared with 5 of 6 patients (85.6%) in the group with moderate to severe TBI. The distribution of different types of acute traumatic lesions was similar among mild and moderate/severe TBI groups. Preexisting brain lesions were a more common CT finding among patients with mild TBIs than those with moderate to severe TBIs. Having a past traumatic lesion was associated with increased risk for an acute traumatic lesion but neurodegenerative and ischemic lesions were not. A lower Glasgow Coma Scale score, male sex, older age, falls, and chronic alcohol abuse were associated with higher risk of acute intracranial lesion in patients with mild TBI.CONCLUSIONSThese findings underscore the heterogeneity of neuropathology associated with the mild TBI classification. Preexisting brain lesions are common in patients with mild TBI, and the incidence of preexisting lesions increases with age. Acute traumatic lesions are fairly common in patients with mild TBI; every sixth patient had a positive CT scan. Older adults (especially men) who fall represent a susceptible group for acute CT-positive TBI.
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Affiliation(s)
| | - Grant L Iverson
- 2Department of Physical Medicine and Rehabilitation, Harvard Medical School.,6Spaulding Rehabilitation Hospital.,7Sports Concussion Program, MassGeneral Hospital for Children; and.,8Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts
| | - Noah D Silverberg
- 2Department of Physical Medicine and Rehabilitation, Harvard Medical School.,3Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia; and.,8Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts.,9GF Strong Rehab Centre, Vancouver, British Columbia, Canada
| | - Anneli Kataja
- 4Medical Imaging Centre, Department of Radiology, and
| | - Antti Brander
- 4Medical Imaging Centre, Department of Radiology, and
| | - Juha Öhman
- 5Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
| | - Teemu M Luoto
- 5Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
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Karr JE, Iverson GL, Berghem K, Kotilainen AK, Terry DP, Luoto TM. Complicated mild traumatic brain injury in older adults: Post-concussion symptoms and functional outcome at one week post injury. Brain Inj 2019; 34:26-33. [DOI: 10.1080/02699052.2019.1669825] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Justin E. Karr
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Spaulding Rehabilitation Hospital, Boston, MA, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Spaulding Rehabilitation Hospital, Boston, MA, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA
- Spaulding Research Institute, Boston, MA, USA
| | - Ksenia Berghem
- Medical Imaging Centre, Department of Radiology, Tampere University Hospital, Tampere, Finland
| | | | - Douglas P. Terry
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Spaulding Rehabilitation Hospital, Boston, MA, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA
| | - Teemu M. Luoto
- Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere, Finland
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Results of scoping review do not support mild traumatic brain injury being associated with a high incidence of chronic cognitive impairment: Commentary on McInnes et al. 2017. PLoS One 2019; 14:e0218997. [PMID: 31525205 PMCID: PMC6746392 DOI: 10.1371/journal.pone.0218997] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 01/06/2023] Open
Abstract
A recently published review of 45 studies concluded that approximately half of individuals who sustain a single mild traumatic brain injury (MTBI) experience long-term cognitive impairment (McInnes et al. Mild Traumatic Brain Injury (mTBI) and chronic cognitive impairment: A scoping review. PLoS ONE 2017;12:e0174847). Stratified by age, they reported that 50% of children and 58% of adults showed some form of cognitive impairment. We contend that the McInnes et al. review used a definition of “cognitive impairment” that was idiosyncratic, not applicable to individual patients or subjects, inconsistent with how cognitive impairment is defined in clinical practice and research, and resulted in a large number of false positive cases of cognitive impairment. For example, if a study reported a statistically significant difference on a single cognitive test, the authors concluded that every subject with a MTBI in that study was cognitively impaired–an approach that cannot be justified statistically or psychometrically. The authors concluded that impairment was present in various cognitive domains, such as attention, memory, and executive functioning, but they did not analyze or report the results from any of these specific cognitive domains. Moreover, their analyses and conclusions regarding many published studies contradicted the interpretations provided by the original authors of those studies. We re-reviewed all 45 studies and extracted the main conclusions from each. We conclude that a single MTBI is not associated with a high incidence of chronic cognitive impairment.
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Einarsen CE, Moen KG, Håberg AK, Eikenes L, Kvistad KA, Xu J, Moe HK, Tollefsen MH, Vik A, Skandsen T. Patients with Mild Traumatic Brain Injury Recruited from Both Hospital and Primary Care Settings: A Controlled Longitudinal Magnetic Resonance Imaging Study. J Neurotrauma 2019; 36:3172-3182. [PMID: 31280698 PMCID: PMC6818486 DOI: 10.1089/neu.2018.6360] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
With an emphasis on traumatic axonal injury (TAI), frequency and evolution of traumatic intracranial lesions on 3T clinical magnetic resonance imaging (MRI) were assessed in a combined hospital and community-based study of patients with mild traumatic brain injury (mTBI). The findings were related to post-concussion symptoms (PCS) at 3 and 12 months. Prospectively, 194 patients (16–60 years of age) were recruited from the emergency departments at a level 1 trauma center and a municipal outpatient clinic into the Trondheim mTBI follow-up study. MRI was acquired within 72 h (n = 194) and at 3 (n = 165) and 12 months (n = 152) in patients and community controls (n = 78). The protocol included T2, diffusion weighted imaging, fluid attenuated inversion recovery (FLAIR), and susceptibility weighted imaging (SWI). PCS was assessed with British Columbia Post Concussion Symptom Inventory in patients and controls. Traumatic lesions were present in 12% on very early MRI, and in 5% when computed tomography (CT) was negative. TAI was found in 6% and persisted for 12 months on SWI, whereas TAI lesions on FLAIR disappeared or became less conspicuous on follow-up. PCS occurred in 33% of patients with lesions on MRI and in 19% in patients without lesions at 3 months (p = 0.12) and in 21% with lesions and 14% without lesions at 12 months (p = 0.49). Very early MRI depicted cases of TAI in patients with mTBI with microbleeds persisting for 12 months. Patients with traumatic lesions may have a more protracted recovery, but the study was underpowered to detect significant differences for PCS because of the low frequency of trauma-related MRI lesions.
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Affiliation(s)
- Cathrine Elisabeth Einarsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kent Gøran Moen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Radiology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Asta Kristine Håberg
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Live Eikenes
- Department of Circulation and Medical Imaging Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjell Arne Kvistad
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jian Xu
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hans Kristian Moe
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marie Hexeberg Tollefsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Vik
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Toril Skandsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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