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Markicevic M, Mandino F, Toyonaga T, Cai Z, Fesharaki-Zadeh A, Shen X, Strittmatter SM, Lake E. Repetitive mild closed-head injury induced synapse loss and increased local BOLD-fMRI signal homogeneity. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.24.595651. [PMID: 38826468 PMCID: PMC11142233 DOI: 10.1101/2024.05.24.595651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Repeated mild head injuries due to sports, or domestic violence and military service are increasingly linked to debilitating symptoms in the long term. Although symptoms may take decades to manifest, potentially treatable neurobiological alterations must begin shortly after injury. Better means to diagnose and treat traumatic brain injuries, requires an improved understanding of the mechanisms underlying progression and means through which they can be measured. Here, we employ a repetitive mild closed-head injury (rmTBI) and chronic variable stress (CVS) mouse model to investigate emergent structural and functional brain abnormalities. Brain imaging is achieved with [ 18 F]SynVesT-1 positron emission tomography, with the synaptic vesicle glycoprotein 2A ligand marking synapse density and BOLD (blood-oxygen-level-dependent) functional magnetic resonance imaging (fMRI). Animals were scanned six weeks after concluding rmTBI/Stress procedures. Injured mice showed widespread decreases in synaptic density coupled with an i ncrease in local BOLD-fMRI synchrony detected as regional homogeneity. Injury-affected regions with higher synapse density showed a greater increase in fMRI regional homogeneity. Taken together, these observations may reflect compensatory mechanisms following injury. Multimodal studies are needed to provide deeper insights into these observations.
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2
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Psycho-affective health, cognition, and neurophysiological functioning following sports-related concussion in symptomatic and asymptomatic athletes, and control athletes. Sci Rep 2021; 11:13838. [PMID: 34226626 PMCID: PMC8257649 DOI: 10.1038/s41598-021-93218-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/31/2021] [Indexed: 11/08/2022] Open
Abstract
Little is known about the neuropsychiatric and neurophysiological differences that characterize abnormal recovery following a concussion. The present study aimed to investigate the psycho-affective, cognitive, and neurophysiological profiles of symptomatic, slow-to-recover, concussed athletes, asymptomatic concussed athletes, and control athletes. Seventy-eight athletes (26 symptomatic, 26 asymptomatic, 26 control) completed the Beck Depression Inventory-II, Profile of Mood States, and 2-Back task. Additionally, event-related brain potentials were recorded during an experimental three-stimulus visual Oddball paradigm. Compared to asymptomatic and control groups, the symptomatic group reported greater depression symptoms and negatively altered mood states. Symptomatic athletes also exhibited poorer cognitive performance on the 2-Back task, indicated by more errors and slower reaction time. ERP analyses indicated prolonged P3b latency for both symptomatic and asymptomatic groups, but symptomatic athletes also exhibited reduced P3b amplitude compared to both asymptomatic and control groups. For the asymptomatic group, correlations were observed between time since last concussion and functioning, but no relations were observed within the symptomatic group for any measure. The current findings provide valuable information regarding the psycho-affective, cognitive, and neurophysiological profiles of athletes with and without persistent symptoms following a concussion and highlight the need to assess and treat symptomatic, slow-to-recover athletes from a multidimensional and integrative perspective.
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3
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Shih RY, Burns J, Ajam AA, Broder JS, Chakraborty S, Kendi AT, Lacy ME, Ledbetter LN, Lee RK, Liebeskind DS, Pollock JM, Prall JA, Ptak T, Raksin PB, Shaines MD, Tsiouris AJ, Utukuri PS, Wang LL, Corey AS. ACR Appropriateness Criteria® Head Trauma: 2021 Update. J Am Coll Radiol 2021; 18:S13-S36. [PMID: 33958108 DOI: 10.1016/j.jacr.2021.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/14/2021] [Indexed: 12/13/2022]
Abstract
Head trauma (ie, head injury) is a significant public health concern and is a leading cause of morbidity and mortality in children and young adults. Neuroimaging plays an important role in the management of head and brain injury, which can be separated into acute (0-7 days), subacute (<3 months), then chronic (>3 months) phases. Over 75% of acute head trauma is classified as mild, of which over 75% have a normal Glasgow Coma Scale score of 15, therefore clinical practice guidelines universally recommend selective CT scanning in this patient population, which is often based on clinical decision rules. While CT is considered the first-line imaging modality for suspected intracranial injury, MRI is useful when there are persistent neurologic deficits that remain unexplained after CT, especially in the subacute or chronic phase. Regardless of time frame, head trauma with suspected vascular injury or suspected cerebrospinal fluid leak should also be evaluated with CT angiography or thin-section CT imaging of the skull base, respectively. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Judah Burns
- Panel Chair, Montefiore Medical Center, Bronx, New York
| | | | - Joshua S Broder
- Duke University School of Medicine, Durham, North Carolina, American College of Emergency Physicians, Residency Program Director for Emergency Medicine, Vice Chief for Education, Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine
| | - Santanu Chakraborty
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada, Canadian Association of Radiologists, CAR representative in ACR Quality Commission
| | - A Tuba Kendi
- Mayo Clinic, Rochester, Minnesota, Head of Nuclear Medicine Therapies at Mayo Clinic
| | - Mary E Lacy
- University of New Mexico, Albuquerque, New Mexico, American College of Physicians
| | | | - Ryan K Lee
- Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - David S Liebeskind
- University of California Los Angeles, Los Angeles, California, American Academy of Neurology, President of SVIN
| | - Jeffrey M Pollock
- Oregon Health and Science University, Portland, Oregon, Editor, ACR Case in Point; Functional MRI Director, Oregon Health and Science University
| | - J Adair Prall
- Littleton Adventist Hospital, Littleton, Colorado, Neurosurgery expert, Chair, Guidelines Committee, Joint Section for Trauma and Critical Care
| | - Thomas Ptak
- R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, Vice Chair of Community Radiology, University of Maryland Medical Center, Chief of Emergency and Trauma Imaging, R Adams Cowley Shock Trauma Center
| | - P B Raksin
- John H. Stroger Jr Hospital of Cook County, Chicago, Illinois, Neurosurgery expert, Chair Elect, American Association of Neurological Surgeons/Congress of Neurological Surgeons Section on Neurotrauma & Neurocritical Care; Vice Chair, American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Guidelines Review Committee; Director, Neurosurgery ICU
| | - Matthew D Shaines
- Albert Einstein College of Medicine Montefiore Medical Center, Bronx, New York, Internal Medicine Physician, Associate Program Director for the Moses-Weiler Internal Medicine Residency Program, Albert Einstein College of Medicine; Associate Chief, Division of Hospital Medicine
| | | | | | - Lily L Wang
- University of Cincinnati Medical Center, Cincinnati, Ohio, Neuroradiology Fellowship Program Director
| | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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4
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Khetani A, Rohr CS, Sojoudi A, Bray S, Barlow KM. Alteration in Cerebral Activation during a Working Memory Task after Pediatric Mild Traumatic Brain Injury: A Prospective Controlled Cohort Study. J Neurotrauma 2019; 36:3274-3283. [DOI: 10.1089/neu.2018.6117] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Aneesh Khetani
- Department of Neuroscience and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Child and Adolescent Imaging Program, Calgary, Alberta, Canada
| | - Christiane S. Rohr
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Child and Adolescent Imaging Program, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Alireza Sojoudi
- Biomedical Engineering, University of Calgary, Calgary, Alberta, Canada
| | - Signe Bray
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Child and Adolescent Imaging Program, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Karen M. Barlow
- Faculty of Medicine, Child Health Research Centre, The University of Queensland, Queensland, Australia
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5
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Leung A, Yang E, Lim M, Metzger-Smith V, Theilmann R, Song D, Lin L, Tsai A, Lee R. Pain-related white matter tract abnormalities in mild traumatic brain injury patients with persistent headache. Mol Pain 2018; 14:1744806918810297. [PMID: 30324850 PMCID: PMC6311536 DOI: 10.1177/1744806918810297] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The occurrence of debilitating chronic persistent (24/7) headache after mild traumatic brain injury represents a central neuropathic pain state. Previous studies suggest that this chronic headache state can be attributed to altered supraspinal modulatory functional connectivity in both resting and evoked pain states. Abnormalities in the myelin sheaths along the supraspinal superior longitudinal fasciculus and anterior thalamic radiation are frequently associated with alteration in pain modulation related to functional connectivity deficit with the prefrontal cortex. This study assessed the correlated axonal injury-related white matter tract abnormality underlying these previously observed prefrontal functional connectivity deficits by comparing the fractional anisotropy, axial diffusivity, and radial diffusivity of brain white matter in patients with mild traumatic brain injury-related headache to healthy controls. Result Diffusion tensor imaging data from patients (N = 12, average age ± SD = 35.0 ± 8.0 years old, 10 male) with mild traumatic brain injury-headache were compared with images acquired from healthy controls. The mild traumatic brain injury cohort demonstrated two areas of significant (P < 0.01, F value >16, cluster size >50 voxels) white matter tract abnormalities closely related to pain affective and modulatory functions in (1) the left superior longitudinal fasciculus which connects the prefrontal cortices with the parietal cortices and (2) the right anterior thalamic radiation connecting the prefrontal cortices with the anterior cingulate cortex. In addition, a significant (P < 0.01) decrease in axial diffusivity and increase in radial diffusivity at the superior longitudinal fasciculus cluster were noted in the mild traumatic brain injury cohort. Conclusion The identified white matter tract abnormalities may represent a state of Wallerian degeneration which correlates with the functional connectivity deficit in pain modulation and can contribute to the development of the chronic persistent headache in the patients with mild traumatic brain injury.
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Affiliation(s)
- Albert Leung
- 1 Division of Pain Medicine, Department of Anesthesiology, The University of California, San Diego, CA, USA.,2 Veteran Affairs San Diego Healthcare System, CA, USA
| | - Eric Yang
- 3 The University of California, San Diego, CA, USA
| | - Michael Lim
- 3 The University of California, San Diego, CA, USA
| | | | - Rebecca Theilmann
- 4 Department of Radiology, The University of California, San Diego, CA, USA
| | - David Song
- 2 Veteran Affairs San Diego Healthcare System, CA, USA.,5 Department of Neuroscience, The University of California, San Diego, CA, USA
| | - Lisa Lin
- 2 Veteran Affairs San Diego Healthcare System, CA, USA
| | - Alice Tsai
- 2 Veteran Affairs San Diego Healthcare System, CA, USA
| | - Roland Lee
- 2 Veteran Affairs San Diego Healthcare System, CA, USA.,4 Department of Radiology, The University of California, San Diego, CA, USA
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6
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Leddy JJ, Baker JG, Willer B. Active Rehabilitation of Concussion and Post-concussion Syndrome. Phys Med Rehabil Clin N Am 2018; 27:437-54. [PMID: 27154855 DOI: 10.1016/j.pmr.2015.12.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Concussion is a physiological brain injury with physical, cognitive, and emotional sequelae. The macrophysiological insult to the brain affects the autonomic nervous system and its control of cerebral blood flow. Most patients recover within 2 weeks, but some do not. Persistence of symptoms beyond the generally accepted time frame for recovery is called post-concussion syndrome (PCS). PCS is not a single entity; it is a group of disorders that requires specific forms of therapy. Rest has been the mainstay of the treatment for concussion and PCS. This article discusses the rationale for the active treatment of concussion and PCS.
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Affiliation(s)
- John J Leddy
- UBMD Department of Orthopaedics and Sports Medicine, SUNY Buffalo, 160 Farber Hall, Buffalo, NY 14214, USA.
| | - John G Baker
- UBMD Department of Orthopaedics and Sports Medicine and Nuclear Medicine, Jacobs School of Medicine and Biomedical Sciences, School of Social Work, University at Buffalo, Buffalo, NY, USA
| | - Barry Willer
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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7
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Cerebral Hemodynamic Influences in Task-Related Functional Magnetic Resonance Imaging and Near-Infrared Spectroscopy in Acute Sport-Related Concussion: A Review. J Imaging 2018. [DOI: 10.3390/jimaging4040059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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8
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Shetty VS, Reis MN, Aulino JM, Berger KL, Broder J, Choudhri AF, Kendi AT, Kessler MM, Kirsch CF, Luttrull MD, Mechtler LL, Prall JA, Raksin PB, Roth CJ, Sharma A, West OC, Wintermark M, Cornelius RS, Bykowski J. ACR Appropriateness Criteria Head Trauma. J Am Coll Radiol 2017; 13:668-79. [PMID: 27262056 DOI: 10.1016/j.jacr.2016.02.023] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 10/21/2022]
Abstract
Neuroimaging plays an important role in the management of head trauma. Several guidelines have been published for identifying which patients can avoid neuroimaging. Noncontrast head CT is the most appropriate initial examination in patients with minor or mild acute closed head injury who require neuroimaging as well as patients with moderate to severe acute closed head injury. In short-term follow-up neuroimaging of acute traumatic brain injury, CT and MRI may have complementary roles. In subacute to chronic traumatic brain injury, MRI is the most appropriate initial examination, though CT may have a complementary role in select circumstances. Advanced neuroimaging techniques are areas of active research but are not considered routine clinical practice at this time. In suspected intracranial vascular injury, CT angiography or venography or MR angiography or venography is the most appropriate imaging study. In suspected posttraumatic cerebrospinal fluid leak, high-resolution noncontrast skull base CT is the most appropriate initial imaging study to identify the source, with cisternography reserved for problem solving. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Affiliation(s)
| | - Martin N Reis
- St Louis University School of Medicine, St Louis, Missouri
| | | | | | - Joshua Broder
- Duke University Division of Emergency Medicine, Cary, North Carolina, American College of Emergency Physicians
| | - Asim F Choudhri
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Marcus M Kessler
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | | | - Laszlo L Mechtler
- Dent Neurologic Institute, Amherst, New York, American Academy of Neurology
| | | | | | | | - Aseem Sharma
- Mallinckrodt Institute of Radiology, St Louis, Missouri
| | | | | | | | - Julie Bykowski
- University of California, San Diego, Health Center, San Diego, California
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9
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Scheibel RS. Functional Magnetic Resonance Imaging of Cognitive Control following Traumatic Brain Injury. Front Neurol 2017; 8:352. [PMID: 28824524 PMCID: PMC5543081 DOI: 10.3389/fneur.2017.00352] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 07/05/2017] [Indexed: 11/13/2022] Open
Abstract
Novel and non-routine tasks often require information processing and behavior to adapt from moment to moment depending on task requirements and current performance. This ability to adapt is an executive function that is referred to as cognitive control. Patients with moderate-to-severe traumatic brain injury (TBI) have been reported to exhibit impairments in cognitive control and functional magnetic resonance imaging (fMRI) has provided evidence for TBI-related alterations in brain activation using various fMRI cognitive control paradigms. There is some support for greater and more extensive cognitive control-related brain activation in patients with moderate-to-severe TBI, relative to comparison subjects without TBI. In addition, some studies have reported a correlation between these activation increases and measures of injury severity. Explanations that have been proposed for increased activation within structures that are thought to be directly involved in cognitive control, as well as the extension of this over-activation into other brain structures, have included compensatory mechanisms, increased demand upon normal processes required to maintain adequate performance, less efficient utilization of neural resources, and greater vulnerability to cognitive fatigue. Recent findings are also consistent with the possibility that activation increases within some structures, such as the posterior cingulate gyrus, may reflect a failure to deactivate components of the default mode network (DMN) and that some cognitive control impairment may result from ineffective coordination between the DMN and components of the salience network. Functional neuroimaging studies examining cognitive control-related activation following mild TBI (mTBI) have yielded more variable results, with reports of increases, decreases, and no significant change. These discrepancies may reflect differences among the various mTBI samples under study, recovery of function in some patients, different task characteristics, and the presence of comorbid conditions such as depression and posttraumatic stress disorder that also alter brain activation. There may be mTBI populations with activation changes that overlap with those found following more severe injuries, including symptomatic mTBI patients and those with acute injuries, but future research to address such dysfunction will require well-defined samples with adequate controls for injury characteristics, comorbid disorders, and severity of post-concussive symptoms.
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Affiliation(s)
- Randall S Scheibel
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States.,Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States
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10
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Leung A, Metzger-Smith V, He Y, Cordero J, Ehlert B, Song D, Lin L, Shahrokh G, Tsai A, Vaninetti M, Rutledge T, Polston G, Sheu R, Lee R. Left Dorsolateral Prefrontal Cortex rTMS in Alleviating MTBI Related Headaches and Depressive Symptoms. Neuromodulation 2017; 21:390-401. [DOI: 10.1111/ner.12615] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/22/2017] [Accepted: 04/10/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Albert Leung
- Department of Anesthesiology; The University of California; San Diego, La Jolla, CA, USA
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | | | - Yifan He
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | - James Cordero
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | - Brandon Ehlert
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | - David Song
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
- Department of Neuroscience; The University of California; San Diego, La Jolla, CA, USA
| | - Lisa Lin
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | | | - Alice Tsai
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | - Michael Vaninetti
- Department of Anesthesiology; The University of California; San Diego, La Jolla, CA, USA
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | - Thomas Rutledge
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
- Department of Psychiatric; The University of California; San Diego, La Jolla, CA, USA
| | - Greg Polston
- Department of Anesthesiology; The University of California; San Diego, La Jolla, CA, USA
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | - Robert Sheu
- Naval Medical Center San Diego; San Diego, CA, USA
| | - Roland Lee
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
- Department of Radiology; The University of California; San Diego, La Jolla, CA, USA
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11
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Zhou Y. Abnormal structural and functional hypothalamic connectivity in mild traumatic brain injury. J Magn Reson Imaging 2016; 45:1105-1112. [PMID: 27467114 DOI: 10.1002/jmri.25413] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 07/19/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To investigate whether there is imaging evidence of hypothalamic injury in patients with mild traumatic brain injury (MTBI), which is a major public health problem due to the high prevalence and difficulty in diagnosis and treatment. MATERIALS AND METHODS Twenty-four patients (mean age 34.2, range, 18-56 years) with symptomatic MTBI and 22 age-matched healthy controls (mean age 37.0, range 20-61 years) participated in the study. Diffusion kurtosis imaging was performed with diffusion-weighted images acquired along 30 gradient directions and three b-values (b = 0, 1000, 2000 s/mm2 ) based on a twice-refocused spin-echo sequence with a 3T magnetic resonance imaging (MRI) scanner. Resting-state functional (f)MRI with standard echo planar imaging (EPI) were performed to localize the resting-state networks (RSN) and hypothalamic functional connectivity. RESULTS There were significantly reduced mean kurtosis (P = 0.0092) and radial kurtosis (P = 0.0078) in patients as compared to controls in the hypothalamus. Furthermore, there was a significant negative correlation (r = -0.675, P = 0.0007) between radial kurtosis in the hypothalamus and fatigue severity scale in patients. The MTBI group also showed disrupted hypothalamic RSNs, with significantly decreased positive connectivity in medial prefrontal cortex, inferior posterior parietal, and cingulate regions but increased connectivity in the peri-hypothalamic regions and cerebellum, together with significantly decreased negative RSNs in visual and bilateral premotor areas (cluster corrected P < 0.05). CONCLUSION Our results show disruption of functional and structural hypothalamic connectivity in patients with MTBI, and might further the understanding of an array of clinical symptoms in MTBI such as sleep disturbance and fatigue. LEVEL OF EVIDENCE 2 J. Magn. Reson. Imaging 2017;45:1105-1112.
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Affiliation(s)
- Yongxia Zhou
- Department of Radiology / Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
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12
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Wang X, Xie H, Cotton AS, Brickman KR, Lewis TJ, Wall JT, Tamburrino MB, Bauer WR, Law K, McLean SA, Liberzon I. Early Changes in Cortical Emotion Processing Circuits after Mild Traumatic Brain Injury from Motor Vehicle Collision. J Neurotrauma 2016; 34:273-280. [PMID: 27169480 DOI: 10.1089/neu.2015.4392] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Mild traumatic brain injury (mTBI) patients frequently experience emotion dysregulation symptoms, including post-traumatic stress. Although mTBI likely affects cortical activation and structure, resulting in cognitive symptoms after mTBI, early effects of mTBI on cortical emotion processing circuits have rarely been examined. To assess early mTBI effects on cortical functional and structural components of emotion processing, we assessed cortical activation to fearful faces within the first 2 weeks after motor vehicle collision (MVC) in survivors who did and did not experience mTBI. We also examined the thicknesses of cortical regions with altered activation. MVC survivors with mTBI (n = 21) had significantly less activation in left superior parietal gyrus (SPG) (-5.9, -81.8, 33.8; p = 10-3.623), left medial orbitofrontal gyrus (mOFG) (-4.7, 36.1, -19.3; p = 10-3.231), and left and right lateral orbitofrontal gyri (lOFG) (left: -16.0, 41.4, -16.6; p = 10-2.573; right: 18.7, 22.7, -17.7; p = 10-2.764) than MVC survivors without mTBI (n = 23). SPG activation in mTBI survivors within 2 weeks after MVC was negatively correlated with subsequent post-traumatic stress symptom severity at 3 months (r = -0.68, p = 0.03). Finally, the SPG region was thinner in the mTBI survivors than in the non-mTBI survivors (F = 11.07, p = 0.002). These results suggest that early differences in activation and structure in cortical emotion processing circuits in trauma survivors who sustain mTBI may contribute to the development of emotion-related symptoms.
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Affiliation(s)
- Xin Wang
- 1 Department of Psychiatry, University of Toledo , Toledo, Ohio.,2 Department of Neurosciences, University of Toledo , Toledo, Ohio.,3 Department of Radiology, University of Toledo , Toledo, Ohio
| | - Hong Xie
- 2 Department of Neurosciences, University of Toledo , Toledo, Ohio
| | - Andrew S Cotton
- 1 Department of Psychiatry, University of Toledo , Toledo, Ohio
| | | | | | - John T Wall
- 2 Department of Neurosciences, University of Toledo , Toledo, Ohio
| | | | - William R Bauer
- 2 Department of Neurosciences, University of Toledo , Toledo, Ohio
| | - Kenny Law
- 1 Department of Psychiatry, University of Toledo , Toledo, Ohio
| | - Samuel A McLean
- 5 Department of Anesthesiology, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Israel Liberzon
- 6 Department of Psychiatry, University of Michigan , Ann Arbor, Michigan
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13
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Henry LC, Tremblay S, De Beaumont L. Long-Term Effects of Sports Concussions: Bridging the Neurocognitive Repercussions of the Injury with the Newest Neuroimaging Data. Neuroscientist 2016; 23:567-578. [PMID: 27188455 DOI: 10.1177/1073858416651034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Little is known of the long-term effects of sports-related concussion. Within the scientific literature, conclusions vary substantially where some work suggests there are no long-term consequences at all and other studies show rampant neurodegeneration thought to be caused by sometimes even a single concussive blow to the head. There is growing evidence that supports multiple long-term outcomes, showing both subclinical and clinically relevant changes in the brains of athletes, young and old alike. This article reviews the pathohistology of cerebral concussions and examines the extant literature with a focus on electrophysiological and neuroimaging findings. Neurobehavioral and neurocognitive changes are also reviewed, particularly as they are related to chronic traumatic encephalopathy. Lacunae within the literature are explored, and future research directions are proposed.
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Affiliation(s)
- Luke C Henry
- 1 Department of Neurological Surgery, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sebastien Tremblay
- 2 Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Louis De Beaumont
- 3 Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,4 Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
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14
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Abstract
Imaging is an indispensable part of the initial assessment and subsequent management of patients with head trauma. Initially, it is important for diagnosing the extent of injury and the prompt recognition of treatable injuries to reduce mortality. Subsequently, imaging is useful in following the sequelae of trauma. In this chapter, we review indications for neuroimaging and typical computed tomography (CT) and magnetic resonance imaging (MRI) protocols used in the evaluation of a patient with head trauma. We review the role of CT), the imaging modality of choice in the acute setting, and the role of MRI in the evaluation of patients with head trauma. We describe an organized and consistent approach to the interpretation of imaging of these patients. Important topics in head trauma, including fundamental concepts related to skull fractures, intracranial hemorrhage, parenchymal injury, penetrating trauma, cerebrovascular injuries, and secondary effects of trauma, are reviewed. The chapter concludes with advanced neuroimaging techniques for the evaluation of traumatic brain injury, including use of diffusion tensor imaging (DTI), functional MRI (fMRI), and MR spectroscopy (MRS), techniques which are still under development.
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Affiliation(s)
- Sandra Rincon
- Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, USA.
| | - Rajiv Gupta
- Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, USA; Division of Neuroradiology and Cardiac Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas Ptak
- Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, USA; Division of Emergency Radiology, Massachusetts General Hospital, Boston, MA, USA
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15
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Michael AP, Stout J, Roskos PT, Bolzenius J, Gfeller J, Mogul D, Bucholz R. Evaluation of Cortical Thickness after Traumatic Brain Injury in Military Veterans. J Neurotrauma 2015; 32:1751-8. [DOI: 10.1089/neu.2015.3918] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alex P. Michael
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Jeffrey Stout
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois
| | - P. Tyler Roskos
- Department of Physical Medicine and Rehabilitation, Oakwood, Wayne State University, School of Medicine, Dearborn, Michigan
| | | | - Jeffrey Gfeller
- Department of Psychology, Saint Louis University School of Medicine, St. Louis, Missouri
| | - David Mogul
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois
| | - Richard Bucholz
- Department of Neurosurgery, Saint Louis University School of Medicine, St. Louis, Missouri
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16
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Shetty T, Raince A, Manning E, Tsiouris AJ. Imaging in Chronic Traumatic Encephalopathy and Traumatic Brain Injury. Sports Health 2015; 8:26-36. [PMID: 26733590 PMCID: PMC4702153 DOI: 10.1177/1941738115588745] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Context: The diagnosis of chronic traumatic encephalopathy (CTE) can only be made pathologically, and there is no concordance of defined clinical criteria for premorbid diagnosis. The absence of established criteria and the insufficient imaging findings to detect this disease in a living athlete are of growing concern. Evidence Acquisition: The article is a review of the current literature on CTE. Databases searched include Medline, PubMed, JAMA evidence, and evidence-based medicine guidelines Cochrane Library, Hospital for Special Surgery, and Cornell Library databases. Study Design: Clinical review. Level of Evidence: Level 4. Results: Chronic traumatic encephalopathy cannot be diagnosed on imaging. Examples of imaging findings in common types of head trauma are discussed. Conclusion: Further study is necessary to correlate the clinical and imaging findings of repetitive head injuries with the pathologic diagnosis of CTE.
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Affiliation(s)
- Teena Shetty
- Hospital for Special Surgery, New York, New York
| | | | - Erin Manning
- Hospital for Special Surgery, New York, New York
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17
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Buki A, Kovacs N, Czeiter E, Schmid K, Berger RP, Kobeissy F, Italiano D, Hayes RL, Tortella FC, Mezosi E, Schwarcz A, Toth A, Nemes O, Mondello S. Minor and repetitive head injury. Adv Tech Stand Neurosurg 2015; 42:147-92. [PMID: 25411149 DOI: 10.1007/978-3-319-09066-5_8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Traumatic brain injury (TBI) is the leading cause of death and disability in the young, active population and expected to be the third leading cause of death in the whole world until 2020. The disease is frequently referred to as the silent epidemic, and many authors highlight the "unmet medical need" associated with TBI.The term traumatically evoked brain injury covers a heterogeneous group ranging from mild/minor/minimal to severe/non-salvageable damages. Severe TBI has long been recognized to be a major socioeconomical health-care issue as saving young lives and sometimes entirely restituting health with a timely intervention can indeed be extremely cost efficient.Recently it has been recognized that mild or minor TBI should be considered similarly important because of the magnitude of the patient population affected. Other reasons behind this recognition are the association of mild head injury with transient cognitive disturbances as well as long-term sequelae primarily linked to repeat (sport-related) injuries.The incidence of TBI in developed countries can be as high as 2-300/100,000 inhabitants; however, if we consider the injury pyramid, it turns out that severe and moderate TBI represents only 25-30 % of all cases, while the overwhelming majority of TBI cases consists of mild head injury. On top of that, or at the base of the pyramid, are the cases that never show up at the ER - the unreported injuries.Special attention is turned to mild TBI as in recent military conflicts it is recognized as "signature injury."This chapter aims to summarize the most important features of mild and repetitive traumatic brain injury providing definitions, stratifications, and triage options while also focusing on contemporary knowledge gathered by imaging and biomarker research.Mild traumatic brain injury is an enigmatic lesion; the classification, significance, and its consequences are all far less defined and explored than in more severe forms of brain injury.Understanding the pathobiology and pathomechanisms may aid a more targeted approach in triage as well as selection of cases with possible late complications while also identifying the target patient population where preventive measures and therapeutic tools should be applied in an attempt to avoid secondary brain injury and late complications.
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Affiliation(s)
- Andras Buki
- MTA-PTE Clinical Neuroscience MR Research Group, Pecs, Hungary,
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18
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Wintermark M, Sanelli PC, Anzai Y, Tsiouris AJ, Whitlow CT. Imaging evidence and recommendations for traumatic brain injury: advanced neuro- and neurovascular imaging techniques. AJNR Am J Neuroradiol 2014; 36:E1-E11. [PMID: 25424870 DOI: 10.3174/ajnr.a4181] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
SUMMARY Neuroimaging plays a critical role in the evaluation of patients with traumatic brain injury, with NCCT as the first-line of imaging for patients with traumatic brain injury and MR imaging being recommended in specific settings. Advanced neuroimaging techniques, including MR imaging DTI, blood oxygen level-dependent fMRI, MR spectroscopy, perfusion imaging, PET/SPECT, and magnetoencephalography, are of particular interest in identifying further injury in patients with traumatic brain injury when conventional NCCT and MR imaging findings are normal, as well as for prognostication in patients with persistent symptoms. These advanced neuroimaging techniques are currently under investigation in an attempt to optimize them and substantiate their clinical relevance in individual patients. However, the data currently available confine their use to the research arena for group comparisons, and there remains insufficient evidence at the time of this writing to conclude that these advanced techniques can be used for routine clinical use at the individual patient level. TBI imaging is a rapidly evolving field, and a number of the recommendations presented will be updated in the future to reflect the advances in medical knowledge.
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Affiliation(s)
- M Wintermark
- From the Division of Neuroradiology (M.W.), Stanford University, Palo Alto, California
| | - P C Sanelli
- Department of Radiology (P.C.S.), North Shore-LIJ Health System, Manhasset, New York
| | - Y Anzai
- Department of Radiology (Y.A.), University of Washington, Seattle, Washington
| | - A J Tsiouris
- Department of Radiology (A.J.T.), Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - C T Whitlow
- Department of Radiology and Translational Science Institute (C.T.W.), Wake Forest School of Medicine, Winston-Salem, North Carolina
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Bazarian JJ, Zhu T, Zhong J, Janigro D, Rozen E, Roberts A, Javien H, Merchant-Borna K, Abar B, Blackman EG. Persistent, long-term cerebral white matter changes after sports-related repetitive head impacts. PLoS One 2014; 9:e94734. [PMID: 24740265 PMCID: PMC3989251 DOI: 10.1371/journal.pone.0094734] [Citation(s) in RCA: 213] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 03/18/2014] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Repetitive head impacts (RHI) sustained in contact sports are thought to be necessary for the long-term development of chronic traumatic encephalopathy (CTE). Our objectives were to: 1) characterize the magnitude and persistence of RHI-induced white matter (WM) changes; 2) determine their relationship to kinematic measures of RHI; and 3) explore their clinical relevance. METHODS Prospective, observational study of 10 Division III college football players and 5 non-athlete controls during the 2011-12 season. All subjects underwent diffusion tensor imaging (DTI), physiologic, cognitive, and balance testing at pre-season (Time 1), post-season (Time 2), and after 6-months of no-contact rest (Time 3). Head impact measures were recorded using helmet-mounted accelerometers. The percentage of whole-brain WM voxels with significant changes in fractional anisotropy (FA) and mean diffusivity (MD) from Time 1 to 2, and Time 1 to 3 was determined for each subject and correlated to head impacts and clinical measures. RESULTS Total head impacts for the season ranged from 431-1,850. No athlete suffered a clinically evident concussion. Compared to controls, athletes experienced greater changes in FA and MD from Time 1 to 2 as well as Time 1 to 3; most differences at Time 2 persisted to Time 3. Among athletes, the percentage of voxels with decreased FA from Time 1 to 2 was positively correlated with several helmet impact measures. The persistence of WM changes from Time 1 to 3 was also associated with changes in serum ApoA1 and S100B autoantibodies. WM changes were not consistently associated with cognition or balance. CONCLUSIONS A single football season of RHIs without clinically-evident concussion resulted in WM changes that correlated with multiple helmet impact measures and persisted following 6 months of no-contact rest. This lack of WM recovery could potentially contribute to cumulative WM changes with subsequent RHI exposures.
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Affiliation(s)
- Jeffrey J. Bazarian
- Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- * E-mail:
| | - Tong Zhu
- Imaging Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Jianhui Zhong
- Imaging Sciences, Biomedical Engineering, and Physics, University of Rochester, Rochester, New York, United States of America
| | - Damir Janigro
- Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, United States of America
| | - Eric Rozen
- Athletics and Recreation, University of Rochester, Rochester, New York, United States of America
| | - Andrew Roberts
- University of Rochester, Rochester, New York, United States of America
| | - Hannah Javien
- Hamilton College, Clinton, New York, United States of America
| | - Kian Merchant-Borna
- Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Beau Abar
- Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Eric G. Blackman
- Physics and Astronomy, University of Rochester, Rochester, New York, United States of America
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Hutchison MG, Schweizer TA, Tam F, Graham SJ, Comper P. FMRI and brain activation after sport concussion: a tale of two cases. Front Neurol 2014; 5:46. [PMID: 24782819 PMCID: PMC3995073 DOI: 10.3389/fneur.2014.00046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 03/24/2014] [Indexed: 11/26/2022] Open
Abstract
Sport-related concussions are now recognized as a major public health concern: the number of participants in sport and recreation is growing, possibly playing their games faster, and there is heightened public awareness of injuries to some high-profile athletes. However, many clinicians still rely on subjective symptom reports for the clinical determination of recovery. Relying on subjective symptom reports can be problematic, as it has been shown that some concussed athletes may downplay their symptoms. The use of neuropsychological (NP) testing has enabled clinicians to measure the effects and extent of impairment following concussion more precisely, providing more objective metrics for determining recovery. Nevertheless, there is a remaining concern that brain abnormalities may exist beyond the point at which individuals achieve recovery in self-reported symptoms and cognition measured by NP testing. Our understanding of brain recovery after concussion is important, not only from a neuroscience perspective, but also from the perspective of clinical decision-making for safe return-to-play. A number of advanced neuroimaging tools, including blood oxygen level dependent functional magnetic resonance imaging (fMRI), have independently yielded early information on abnormal brain functioning. In the two cases presented in this article, we report contrasting brain activation patterns and recovery profiles using fMRI. Importantly, fMRI was conducted using adapted versions of the most sensitive computerized NP tests administered in our current clinical practice to determine impairments and recovery after sport-related concussion. One of the cases is consistent with the concept of lagging brain recovery.
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Affiliation(s)
- Michael G Hutchison
- Faculty of Kinesiology and Physical Education, University of Toronto , Toronto, ON , Canada
| | - Tom A Schweizer
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital , Toronto, ON , Canada ; Faculty of Medicine, University of Toronto , Toronto, ON , Canada
| | - Fred Tam
- Physical Sciences, Sunnybrook Research Institute , Toronto, ON , Canada
| | - Simon J Graham
- Physical Sciences, Sunnybrook Research Institute , Toronto, ON , Canada
| | - Paul Comper
- Faculty of Kinesiology and Physical Education, University of Toronto , Toronto, ON , Canada
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21
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Ford JH, Giovanello KS, Guskiewicz KM. Episodic memory in former professional football players with a history of concussion: an event-related functional neuroimaging study. J Neurotrauma 2013; 30:1683-701. [PMID: 23679098 DOI: 10.1089/neu.2012.2535] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Previous research has demonstrated that sport-related concussions can have short-term effects on cognitive processes, but the long-term consequences are less understood and warrant more research. This study was the first to use event-related functional magnetic resonance imaging (fMRI) to examine long-term differences in neural activity during memory tasks in former athletes who have sustained multiple sport-related concussions. In an event-related fMRI study, former football players reporting multiple sport-related concussions (i.e., three or more) were compared with players who reported fewer than three concussions during a memory paradigm examining item memory (i.e., memory for the particular elements of an event) and relational memory (i.e., memory for the relationships between elements). Behaviorally, we observed that concussion history did not significantly affect behavioral performance, because persons in the low and high concussion groups had equivalent performance on both memory tasks, and in addition, that concussion history was not associated with any behavioral memory measures. Despite demonstrating equivalent behavioral performance, the two groups of former players demonstrated different neural recruitment patterns during relational memory retrieval, suggesting that multiple concussions may be associated with functional inefficiencies in the relational memory network. In addition, the number of previous concussions significantly correlated with functional activity in a number of brain regions, including the medial temporal lobe and inferior parietal lobe. Our results provide important insights in understanding the long-term functional consequences of sustaining multiple sports-related concussions.
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Affiliation(s)
- Jaclyn H Ford
- 1 Department of Psychology, University of North Carolina-Chapel Hill , Chapel Hill, North Carolina
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22
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23
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Slobounov S, Gay M, Johnson B, Zhang K. Concussion in athletics: ongoing clinical and brain imaging research controversies. Brain Imaging Behav 2012; 6:224-43. [PMID: 22669496 DOI: 10.1007/s11682-012-9167-2] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Concussion, the most common form of traumatic brain injury, proves to be increasingly complex and not mild in nature as its synonymous term mild traumatic brain injury (mTBI) would imply. Despite the increasing occurrence and prevalence of mTBI there is no universally accepted definition and conventional brain imaging techniques lack the sensitivity to detect subtle changes it causes. Moreover, clinical management of sports induced mild traumatic brain injury has not changed much over the past decade. Advances in neuroimaging that include electroencephalography (EEG), functional magnetic resonance imaging (fMRI), resting-state functional connectivity, diffusion tensor imaging (DTI) and magnetic resonance spectroscopy (MRS) offer promise in aiding research into understanding the complexities and nuances of mTBI which may ultimately influence clinical management of the condition. In this paper the authors review the major findings from these advanced neuroimaging methods along with current controversy within this field of research. As mTBI is frequently associated with youth and sports injury this review focuses on sports-related mTBI in the younger population.
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Affiliation(s)
- Semyon Slobounov
- Department of Kinesiology, The Pennsylvania State University, University Park, 16802, USA.
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24
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Bigler ED, Maxwell WL. Neuropathology of mild traumatic brain injury: relationship to neuroimaging findings. Brain Imaging Behav 2012; 6:108-36. [PMID: 22434552 DOI: 10.1007/s11682-011-9145-0] [Citation(s) in RCA: 207] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Neuroimaging identified abnormalities associated with traumatic brain injury (TBI) are but gross indicators that reflect underlying trauma-induced neuropathology at the cellular level. This review examines how cellular pathology relates to neuroimaging findings with the objective of more closely relating how neuroimaging findings reveal underlying neuropathology. Throughout this review an attempt will be made to relate what is directly known from post-mortem microscopic and gross anatomical studies of TBI of all severity levels to the types of lesions and abnormalities observed in contemporary neuroimaging of TBI, with an emphasis on mild traumatic brain injury (mTBI). However, it is impossible to discuss the neuropathology of mTBI without discussing what occurs with more severe injury and viewing pathological changes on some continuum from the mildest to the most severe. Historical milestones in understanding the neuropathology of mTBI are reviewed along with implications for future directions in the examination of neuroimaging and neuropathological correlates of TBI.
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Affiliation(s)
- Erin D Bigler
- Department of Psychology, Brigham Young University, Provo, UT, USA.
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25
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Fogelman D, Zafonte R. Exercise to Enhance Neurocognitive Function After Traumatic Brain Injury. PM R 2012; 4:908-13. [DOI: 10.1016/j.pmrj.2012.09.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 09/05/2012] [Indexed: 11/25/2022]
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Kan EM, Ling EA, Lu J. Microenvironment changes in mild traumatic brain injury. Brain Res Bull 2012; 87:359-72. [PMID: 22289840 DOI: 10.1016/j.brainresbull.2012.01.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 01/10/2012] [Accepted: 01/12/2012] [Indexed: 02/08/2023]
Abstract
Traumatic brain injury (TBI) is a major public-health problem for which mild TBI (MTBI) makes up majority of the cases. MTBI is a poorly-understood health problem and can persist for years manifesting into neurological and non-neurological problems that can affect functional outcome. Presently, diagnosis of MTBI is based on symptoms reporting with poor understanding of ongoing pathophysiology, hence precluding prognosis and intervention. Other than rehabilitation, there is still no pharmacological treatment for the treatment of secondary injury and prevention of the development of cognitive and behavioural problems. The lack of external injuries and absence of detectable brain abnormalities lend support to MTBI developing at the cellular and biochemical level. However, the paucity of suitable and validated non-invasive methods for accurate diagnosis of MTBI poses as a substantial challenge. Hence, it is crucial that a clinically useful evaluation and management procedure be instituted for MTBI that encompasses both molecular pathophysiology and functional outcome. The acute microenvironment changes post-MTBI presents an attractive target for modulation of MTBI symptoms and the development of cognitive changes later in life.
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Affiliation(s)
- Enci Mary Kan
- Combat Care Laboratory, Defence Medical and Environmental Research Institute, DSO National Laboratories, 27 Medical Drive, Singapore 117510, Singapore
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Abstract
PURPOSE OF REVIEW Concussion produces a brief disruption in mental status and is associated with a variety of physical and cognitive symptoms which typically diminish during the first several days to weeks posttrauma. This review highlights problems in defining and measuring concussion, the mildest form of traumatic brain injury (TBI). Furthermore, the 'natural' course of recovery correlates of postconcussion syndrome (PCS) and guidelines for clinical management are discussed. RECENT FINDINGS Traditional measures of TBI severity (e.g. length of loss of consciousness or period of posttraumatic amnesia) do not correlate with persistent concussion symptoms. Abnormal eye movements, cerebrovascular disturbances, extra-axial injuries, alcohol intoxication at time of injury, and presence of an axis I disorder are associated with persistent symptoms. Early management of physical, cognitive, and emotional symptoms following concussion may reduce long-term morbidity. Techniques used to help concussed athletes return to play appear useful when evaluating and treating concussion in nonathletes. SUMMARY The study of concussion and PCS has increased significantly over the past 10 years, with recent research supporting an underlying biological cause for initial symptomatology. Persistent symptoms may be associated with both neurological and non-neurological variables. Early and serial monitoring and treatment of symptoms appears to result in substantial improvement in the vast majority of concussed patients.
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Akin FW, Murnane OD. Head Injury and Blast Exposure: Vestibular Consequences. Otolaryngol Clin North Am 2011; 44:323-34, viii. [DOI: 10.1016/j.otc.2011.01.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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