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da S Senra Filho AC, Murta Junior LO, Monteiro Paschoal A. Assessing biological self-organization patterns using statistical complexity characteristics: a tool for diffusion tensor imaging analysis. MAGMA (NEW YORK, N.Y.) 2024:10.1007/s10334-024-01185-4. [PMID: 39068635 DOI: 10.1007/s10334-024-01185-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/24/2024] [Accepted: 06/28/2024] [Indexed: 07/30/2024]
Abstract
OBJECT Diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) are well-known and powerful imaging techniques for MRI. Although DTI evaluation has evolved continually in recent years, there are still struggles regarding quantitative measurements that can benefit brain areas that are consistently difficult to measure via diffusion-based methods, e.g., gray matter (GM). The present study proposes a new image processing technique based on diffusion distribution evaluation of López-Ruiz, Mancini and Calbet (LMC) complexity called diffusion complexity (DC). MATERIALS AND METHODS The OASIS-3 and TractoInferno open-science databases for healthy individuals were used, and all the codes are provided as open-source materials. RESULTS The DC map showed relevant signal characterization in brain tissues and structures, achieving contrast-to-noise ratio (CNR) gains of approximately 39% and 93%, respectively, compared to those of the FA and ADC maps. DISCUSSION In the special case of GM tissue, the DC map obtains its maximum signal level, showing the possibility of studying cortical and subcortical structures challenging for classical DTI quantitative formalism. The ability to apply the DC technique, which requires the same imaging acquisition for DTI and its potential to provide complementary information to study the brain's GM structures, can be a rich source of information for further neuroscience research and clinical practice.
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Branco P, Bosak N, Bielefeld J, Cong O, Granovsky Y, Kahn I, Yarnitsky D, Apkarian AV. Structural brain connectivity predicts early acute pain after mild traumatic brain injury. Pain 2023; 164:1312-1320. [PMID: 36355048 DOI: 10.1097/j.pain.0000000000002818] [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: 06/08/2022] [Accepted: 10/20/2022] [Indexed: 11/12/2022]
Abstract
ABSTRACT Mild traumatic brain injury (mTBI), is a leading cause of disability worldwide, with acute pain manifesting as one of its most debilitating symptoms. Understanding acute postinjury pain is important because it is a strong predictor of long-term outcomes. In this study, we imaged the brains of 157 patients with mTBI, following a motorized vehicle collision. We extracted white matter structural connectivity networks and used a machine learning approach to predict acute pain. Stronger white matter tracts within the sensorimotor, thalamiccortical, and default-mode systems predicted 20% of the variance in pain severity within 72 hours of the injury. This result generalized in 2 independent groups: 39 mTBI patients and 13 mTBI patients without whiplash symptoms. White matter measures collected at 6 months after the collision still predicted mTBI pain at that timepoint (n = 36). These white matter connections were associated with 2 nociceptive psychophysical outcomes tested at a remote body site-namely, conditioned pain modulation and magnitude of suprathreshold pain-and with pain sensitivity questionnaire scores. Our findings demonstrate a stable white matter network, the properties of which determine an important amount of pain experienced after acute injury, pinpointing a circuitry engaged in the transformation and amplification of nociceptive inputs to pain perception.
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Affiliation(s)
- Paulo Branco
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Noam Bosak
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Jannis Bielefeld
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Olivia Cong
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Yelena Granovsky
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Itamar Kahn
- Department of Neuroscience and Zuckerman Mind Brain Behavior Institute, Columbia University, New York, NY, United States
| | - David Yarnitsky
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - A Vania Apkarian
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Diffusion-Weighted Imaging in Mild Traumatic Brain Injury: A Systematic Review of the Literature. Neuropsychol Rev 2023; 33:42-121. [PMID: 33721207 DOI: 10.1007/s11065-021-09485-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/09/2021] [Indexed: 12/14/2022]
Abstract
There is evidence that diffusion-weighted imaging (DWI) is able to detect tissue alterations following mild traumatic brain injury (mTBI) that may not be observed on conventional neuroimaging; however, findings are often inconsistent between studies. This systematic review assesses patterns of differences in DWI metrics between those with and without a history of mTBI. A PubMed literature search was performed using relevant indexing terms for articles published prior to May 14, 2020. Findings were limited to human studies using DWI in mTBI. Articles were excluded if they were not full-length, did not contain original data, if they were case studies, pertained to military populations, had inadequate injury severity classification, or did not report post-injury interval. Findings were reported independently for four subgroups: acute/subacute pediatric mTBI, acute/subacute adult mTBI, chronic adult mTBI, and sport-related concussion, and all DWI acquisition and analysis methods used were included. Patterns of findings between studies were reported, along with strengths and weaknesses of the current state of the literature. Although heterogeneity of sample characteristics and study methods limited the consistency of findings, alterations in DWI metrics were most commonly reported in the corpus callosum, corona radiata, internal capsule, and long association pathways. Many acute/subacute pediatric studies reported higher FA and lower ADC or MD in various regions. In contrast, acute/subacute adult studies most commonly indicate lower FA within the context of higher MD and RD. In the chronic phase of recovery, FA may remain low, possibly indicating overall demyelination or Wallerian degeneration over time. Longitudinal studies, though limited, generally indicate at least a partial normalization of DWI metrics over time, which is often associated with functional improvement. We conclude that DWI is able to detect structural mTBI-related abnormalities that may persist over time, although future DWI research will benefit from larger samples, improved data analysis methods, standardized reporting, and increasing transparency.
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Ogren JA, Allen LA, Roy B, Diehl B, Stern JM, Eliashiv DS, Lhatoo SD, Harper RM, Kumar R. Regional variation in brain tissue texture in patients with tonic-clonic seizures. PLoS One 2022; 17:e0274514. [PMID: 36137154 PMCID: PMC9499268 DOI: 10.1371/journal.pone.0274514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/28/2022] [Indexed: 11/19/2022] Open
Abstract
Patients with epilepsy, who later succumb to sudden unexpected death, show altered brain tissue volumes in selected regions. It is unclear whether the alterations in brain tissue volume represent changes in neurons or glial properties, since volumetric procedures have limited sensitivity to assess the source of volume changes (e.g., neuronal loss or glial cell swelling). We assessed a measure, entropy, which can determine tissue homogeneity by evaluating tissue randomness, and thus, shows tissue integrity; the measure is easily calculated from T1-weighted images. T1-weighted images were collected with a 3.0-Tesla MRI from 53 patients with tonic-clonic (TC) seizures and 53 healthy controls; images were bias-corrected, entropy maps calculated, normalized to a common space, smoothed, and compared between groups (TC patients and controls using ANCOVA; covariates, age and sex; SPM12, family-wise error correction for multiple comparisons, p<0.01). Decreased entropy, indicative of increased tissue homogeneity, appeared in major autonomic (ventromedial prefrontal cortex, hippocampus, dorsal and ventral medulla, deep cerebellar nuclei), motor (sensory and motor cortex), or both motor and autonomic regulatory sites (basal-ganglia, ventral-basal cerebellum), and external surfaces of the pons. The anterior and posterior thalamus and midbrain also showed entropy declines. Only a few isolated regions showed increased entropy. Among the spared autonomic regions was the anterior cingulate and anterior insula; the posterior insula and cingulate were, however, affected. The entropy alterations overlapped areas of tissue changes found earlier with volumetric measures, but were more extensive, and indicate widespread injury to tissue within critical autonomic and breathing regulatory areas, as well as prominent damage to more-rostral sites that exert influences on both breathing and cardiovascular regulation. The entropy measures provide easily-collected supplementary information using only T1-weighted images, showing aspects of tissue integrity other than volume change that are important for assessing function.
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Affiliation(s)
- Jennifer A. Ogren
- Department of Neurobiology, University of California at Los Angeles, Los Angeles, California, United States of America
| | - Luke A. Allen
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, United Kingdom
| | - Bhaswati Roy
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, United Kingdom
| | - John M. Stern
- Department of Neurology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Dawn S. Eliashiv
- Department of Neurology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Samden D. Lhatoo
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Ronald M. Harper
- Department of Neurobiology, University of California at Los Angeles, Los Angeles, California, United States of America
- Brain Research Institute, University of California Los Angeles, Los Angeles, California, United States of America
| | - Rajesh Kumar
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Brain Research Institute, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Bioengineering, University of California Los Angeles, Los Angeles, California, United States of America
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Microstructural white matter alterations associated with migraine headaches: a systematic review of diffusion tensor imaging studies. Brain Imaging Behav 2022; 16:2375-2401. [PMID: 35710680 PMCID: PMC9581876 DOI: 10.1007/s11682-022-00690-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 11/04/2022]
Abstract
The pathophysiology of migraine as a headache disorder is still undetermined. Diffusion tensor imaging (DTI) has significantly improved our knowledge about brain microstructure in this disease. Here, we aimed to systematically review DTI studies in migraine and survey the sources of heterogeneity by investigating diffusion parameter changes associated with clinical characteristics and migraine subtypes. Microstructural changes, as revealed by widespread alteration of diffusion metrics in white matter (WM) tracts, subcortical and cortical regions, were reported by several migraine DTI studies. Specifically, we reported changes in the corpus callosum, thalamic radiations, corona radiata, and brain stem. These alterations showed high variability across migraine cycle phases. Additionally, migraine associated with depressive/anxiety symptoms revealed significant changes in the corpus callosum, internal capsule, and superior longitudinal fasciculus. No significant WM microstructural differences were observed between migraine patients with and without aura. Overall, differences between chronic and episodic migraine showed inconsistency across studies. Migraine is associated with microstructural changes in widespread regions including thalamic radiations, corpus callosum, and brain stem. These alterations can highlight neuronal damage and neuronal plasticity mechanisms either following pain stimulations occurring in migraine cycle or as a compensatory response to pain in chronic migraine. Longitudinal studies applying advanced modalities may shed new light on the underlying microstructural changes in migraine subtypes.
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Examining brain white matter after pediatric mild traumatic brain injury using neurite orientation dispersion and density imaging: An A-CAP study. Neuroimage Clin 2021; 32:102887. [PMID: 34911193 PMCID: PMC8633364 DOI: 10.1016/j.nicl.2021.102887] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/26/2021] [Accepted: 11/16/2021] [Indexed: 12/04/2022]
Abstract
We examined white matter microstructure after pediatric mTBI using NODDI and DTI. Children with mTBI did not significantly differ from those with OI on any metrics. Minor alterations, if any, may be present in children at the post-acute stage after mTBI. Large longitudinal studies are needed to understand long-term brain changes post injury.
Background Pediatric mild traumatic brain injury (mTBI) affects millions of children annually. Diffusion tensor imaging (DTI) is sensitive to axonal injuries and white matter microstructure and has been used to characterize the brain changes associated with mild traumatic brain injury (mTBI). Neurite orientation dispersion and density imaging (NODDI) is a diffusion model that can provide additional insight beyond traditional DTI metrics, but has not been examined in pediatric mTBI. The goal of this study was to employ DTI and NODDI to gain added insight into white matter alterations in children with mTBI compared to children with mild orthopedic injury (OI). Methods Children (mTBI n = 320, OI n = 176) aged 8–16.99 years (12.39 ± 2.32 years) were recruited from emergency departments at five hospitals across Canada and underwent 3 T MRI on average 11 days post-injury. DTI and NODDI metrics were calculated for seven major white matter tracts and compared between groups using univariate analysis of covariance controlling for age, sex, and scanner type. False discovery rate (FDR) was used to correct for multiple comparisons. Results Univariate analysis revealed no significant group main effects or interactions in DTI or NODDI metrics. Fractional anisotropy and neurite density index in all tracts exhibited a significant positive association with age and mean diffusivity in all tracts exhibited a significant negative association with age in the whole sample. Conclusions Overall, there were no significant differences between mTBI and OI groups in brain white matter microstructure from either DTI or NODDI in the seven tracts. This indicates that mTBI is associated with relatively minor white matter differences, if any, at the post-acute stage. Brain differences may evolve at later stages of injury, so longitudinal studies with long-term follow-up are needed.
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Abusamak M, Alrawashdeh HM. Post-concussion Syndrome Light Sensitivity: A Case Report and Review of the Literature. Neuroophthalmology 2021; 46:85-90. [DOI: 10.1080/01658107.2021.1983612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Mohammad Abusamak
- Ophthalmology Department, Faculty of Medicine, Al-Balqa Applied University, AlSalt, Jordan
- Department of Ophthalmology, Amman Eye Clinic, Amman, Jordan
| | - Hamzeh Mohammad Alrawashdeh
- Department of Ophthalmology, Amman Eye Clinic, Amman, Jordan
- Department of Ophthalmology, Sharif Eye Centers, Irbid, Jordan
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Shan Y, Li Y, Xu X, Feng J, Wu X, Gao G. Evaluation of Intracranial Hypertension in Traumatic Brain Injury Patient: A Noninvasive Approach Based on Cranial Computed Tomography Features. J Clin Med 2021; 10:jcm10112524. [PMID: 34200228 PMCID: PMC8200948 DOI: 10.3390/jcm10112524] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/20/2021] [Accepted: 05/27/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Our purpose was to establish a noninvasive quantitative method for assessing intracranial pressure (ICP) levels in patients with traumatic brain injury (TBI) through investigating the Hounsfield unit (HU) features of computed tomography (CT) images. METHODS In this retrospective study, 47 patients with a closed TBI were recruited. Hounsfield unit features from the last cranial CT and the initial ICP value were collected. Three models were established to predict intracranial hypertension with Hounsfield unit (HU model), midline shift (MLS model), and clinical expertise (CE model) features. RESULTS The HU model had the highest ability to predict intracranial hypertension. In 34 patients with unilateral injury, the HU model displayed the highest performance. In three classifications of intracranial hypertension (ICP ≤ 22, 23-29, and ≥30 mmHg), the HU model achieved the highest F1 score. CONCLUSIONS This radiological feature-based noninvasive quantitative approach showed better performance compared with conventional methods, such as the degree of midline shift and clinical expertise. The results show its potential in clinical practice and further research.
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Affiliation(s)
- Yingchi Shan
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China; (Y.S.); (Y.L.); (X.W.)
| | - Yihua Li
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China; (Y.S.); (Y.L.); (X.W.)
| | - Xuxu Xu
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China; (X.X.); (J.F.)
| | - Junfeng Feng
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China; (X.X.); (J.F.)
| | - Xiang Wu
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China; (Y.S.); (Y.L.); (X.W.)
| | - Guoyi Gao
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China; (Y.S.); (Y.L.); (X.W.)
- Correspondence:
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Mayor D, Panday D, Kandel HK, Steffert T, Banks D. CEPS: An Open Access MATLAB Graphical User Interface (GUI) for the Analysis of Complexity and Entropy in Physiological Signals. ENTROPY 2021; 23:e23030321. [PMID: 33800469 PMCID: PMC7998823 DOI: 10.3390/e23030321] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/28/2021] [Accepted: 03/03/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND We developed CEPS as an open access MATLAB® GUI (graphical user interface) for the analysis of Complexity and Entropy in Physiological Signals (CEPS), and demonstrate its use with an example data set that shows the effects of paced breathing (PB) on variability of heart, pulse and respiration rates. CEPS is also sufficiently adaptable to be used for other time series physiological data such as EEG (electroencephalography), postural sway or temperature measurements. METHODS Data were collected from a convenience sample of nine healthy adults in a pilot for a larger study investigating the effects on vagal tone of breathing paced at various different rates, part of a development programme for a home training stress reduction system. RESULTS The current version of CEPS focuses on those complexity and entropy measures that appear most frequently in the literature, together with some recently introduced entropy measures which may have advantages over those that are more established. Ten methods of estimating data complexity are currently included, and some 28 entropy measures. The GUI also includes a section for data pre-processing and standard ancillary methods to enable parameter estimation of embedding dimension m and time delay τ ('tau') where required. The software is freely available under version 3 of the GNU Lesser General Public License (LGPLv3) for non-commercial users. CEPS can be downloaded from Bitbucket. In our illustration on PB, most complexity and entropy measures decreased significantly in response to breathing at 7 breaths per minute, differentiating more clearly than conventional linear, time- and frequency-domain measures between breathing states. In contrast, Higuchi fractal dimension increased during paced breathing. CONCLUSIONS We have developed CEPS software as a physiological data visualiser able to integrate state of the art techniques. The interface is designed for clinical research and has a structure designed for integrating new tools. The aim is to strengthen collaboration between clinicians and the biomedical community, as demonstrated here by using CEPS to analyse various physiological responses to paced breathing.
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Affiliation(s)
- David Mayor
- School of Health and Social Work, University of Hertfordshire, Hatfield AL10 9AB, UK
- Correspondence:
| | - Deepak Panday
- School of Engineering and Computer Science, University of Hertfordshire, Hatfield AL10 9AB, UK;
| | - Hari Kala Kandel
- Department of Computing, Goldsmiths College, University of London, New Cross, London SE14 6NW, UK;
| | - Tony Steffert
- MindSpire, Napier House, 14-16 Mount Ephraim Rd, Tunbridge Wells TN1 1EE, UK;
- School of Life, Health and Chemical Sciences, Walton Hall, The Open University, Milton Keynes MK7 6AA, UK;
| | - Duncan Banks
- School of Life, Health and Chemical Sciences, Walton Hall, The Open University, Milton Keynes MK7 6AA, UK;
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Schwedt TJ. Post-traumatic headache due to mild traumatic brain injury: Current knowledge and future directions. Cephalalgia 2020; 41:464-471. [PMID: 33210546 DOI: 10.1177/0333102420970188] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND/OBJECTIVE Post-traumatic headache is one of the most common and persistent symptoms following mild traumatic brain injury. The objective of this narrative review is to provide an update on the diagnostic criteria, clinical presentation, epidemiology, pathophysiology, and treatment of post-traumatic headache, and to identify future research priorities. METHODS This is a narrative review of the literature regarding post-traumatic headache attributed to mild traumatic brain injury. RESULTS Onset of post-traumatic headache within 7 days of injury is the only evidence for a causal relationship between the injury and the headache included in the diagnostic criteria. Post-traumatic headache often resolves within the first few days of onset, whereas it persists for at least 3 months in 30-50%. The majority of insights into post-traumatic headache pathophysiology come from pre-clinical animal studies and human imaging studies, which implicate structural, functional, metabolic, and neuroinflammatory mechanisms for post-traumatic headache. There is a paucity of quality evidence for how to best treat post-traumatic headache. CONCLUSIONS Although meaningful progress has been made in the post-traumatic headache field, priorities for future research are numerous, including the optimization of diagnostic criteria, a greater understanding of post-traumatic headache pathophysiology, identifying mechanisms and predictors for post-traumatic headache persistence, and identifying safe, well-tolerated, effective therapies.
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Abstract
After traumatic brain injury (TBI), a host of symptoms of varying severity and associated functional impairment may occur. One of the most commonly encountered and challenging to treat are the post-traumatic cephalalgias. Post-traumatic cephalalgia (PTC) or headache is often conceptualized as a single entity as currently classified using the ICHD-3. Yet, the terminology applicable to the major primary, non-traumatic, headache disorders such as migraine, tension headache, and cervicogenic headache are often used to specify the specific type of headache the patients experiences seemingly disparate from the unitary definition of post-traumatic headache adopted by ICHD-3. More complex post-traumatic presentations attributable to brain injury as well as other headache conditions are important to consider as well as other causes such as medication overuse headache and medication induced headache. Treatment of any post-traumatic cephalalgia must be optimized by understanding that there may be more than one headache pain generator, that comorbid traumatic problems may contribute to the pain presentation and that pre-existing conditions could impact both symptom complaint, clinical presentation and recovery. Any treatment for PTC must harmonize with ongoing medical and psychosocial aspects of recovery.
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Affiliation(s)
- Brigid Dwyer
- Department of Neurology, Boston University, Boston, Massachusetts, USA
| | - Nathan Zasler
- Concussion Care Centre of Virginia Ltd. and Tree of Life Services, Inc., Richmond, Virginia, USA.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, Virginia, USA
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Guglielmetti M, Serafini G, Amore M, Martelletti P. The Relation between Persistent Post-Traumatic Headache and PTSD: Similarities and Possible Differences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114024. [PMID: 32516965 PMCID: PMC7313050 DOI: 10.3390/ijerph17114024] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/11/2020] [Accepted: 05/26/2020] [Indexed: 12/27/2022]
Abstract
Post-traumatic headache (PTH) may be considered a secondary headache, which is linked to severe disability and psychosocial impairment. Interestingly, nearly 30% of subjects with persistent post-traumatic headache (PPTH) also suffer from post-traumatic stress disorder (PTSD). Although existing studies demonstrated the existence of common pathophysiological characteristics in subjects with migraine and PPTH, the differences and similarities between these complex diseases are currently poorly understood and are yet to be comprehensively elucidated. Thus, the present review aimed to systematically investigate the nature of PPTH in the effort to better identify both the neurobiological and clinical aspects underlying this condition. Overall, the included studies reported that: (1) the predictors for persistent acute traumatic injury to the head were female gender, persistent symptoms related to mild post-traumatic brain injury (mTBI), PTSD, elevated inflammatory markers, prior mild traumatic brain injury, being injured while suffering from alcohol abuse; (2) static/dynamic functional connectivity differences, white matter tract abnormalities, and morphology changes were found between PPTH and migraine in brain regions involved in pain processing; and (3) clinical differences which were most prominent at early time points when they were linked to the increased risk of PPTH. Based on the selected reports, the relation between migraine and PPTH needs to be considered bidirectionally, but PTSD may play a critical role in this relation. The main implications of these findings, with a specific focus on PTSD, are discussed. Further longitudinal studies are needed to reveal the exact nature of this relation, as well as to clarify the distinct clinical characteristics of migraine, PPTH, and PTSD.
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Affiliation(s)
- Martina Guglielmetti
- Sant’Andrea Hospital, Regional Referral Headache Centre, 00181 Rome, Italy; (M.G.); (P.M.)
- Department of Clinical and Molecular Medicine, Sapienza University, 00181 Rome, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics and Maternal Childhood Sciences, Psychiatry Unit, University of Genoa, 16132 Genoa, Italy;
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Correspondence: ; Tel.: +39-010-353-7668 (office); +39-347-537-2316 (mobile); Fax: +39-010-353-7669
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics and Maternal Childhood Sciences, Psychiatry Unit, University of Genoa, 16132 Genoa, Italy;
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Paolo Martelletti
- Sant’Andrea Hospital, Regional Referral Headache Centre, 00181 Rome, Italy; (M.G.); (P.M.)
- Department of Clinical and Molecular Medicine, Sapienza University, 00181 Rome, Italy
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Labastida-Ramírez A, Benemei S, Albanese M, D’Amico A, Grillo G, Grosu O, Ertem DH, Mecklenburg J, Fedorova EP, Řehulka P, di Cola FS, Lopez JT, Vashchenko N, MaassenVanDenBrink A, Martelletti P. Persistent post-traumatic headache: a migrainous loop or not? The clinical evidence. J Headache Pain 2020; 21:55. [PMID: 32448142 PMCID: PMC7245945 DOI: 10.1186/s10194-020-01122-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/05/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Headache is a common complication of traumatic brain injury. The International Headache Society defines post-traumatic headache as a secondary headache attributed to trauma or injury to the head that develops within seven days following trauma. Acute post-traumatic headache resolves after 3 months, but persistent post-traumatic headache usually lasts much longer and accounts for 4% of all secondary headache disorders. MAIN BODY The clinical features of post-traumatic headache after traumatic brain injury resemble various types of primary headaches and the most frequent are migraine-like or tension-type-like phenotypes. The neuroimaging studies that have compared persistent post-traumatic headache and migraine found different structural and functional brain changes, although migraine and post-traumatic headache may be clinically similar. Therapy of various clinical phenotypes of post-traumatic headache almost entirely mirrors the therapy of the corresponding primary headache and are currently based on expert opinion rather than scientific evidence. Pharmacologic therapies include both abortive and prophylactic agents with prophylaxis targeting comorbidities, especially impaired sleep and post-traumatic disorder. There are also effective options for non-pharmacologic therapy of post-traumatic headache, including cognitive-behavioral approaches, onabotulinum toxin injections, life-style considerations, etc. CONCLUSION: Notwithstanding some phenotypic similarities, persistent post-traumatic headache after traumatic brain injury, is considered a separate phenomenon from migraine but available data is inconclusive. High-quality studies are further required to investigate the pathophysiological mechanisms of this secondary headache, in order to identify new targets for treatment and to prevent disability.
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Affiliation(s)
- Alejandro Labastida-Ramírez
- Division of Vascular Medicine and Pharmacology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Silvia Benemei
- Health Sciences Department, University of Florence, and Headache Centre, Careggi University Hospital, Florence, Italy
| | - Maria Albanese
- Department of Systems Medicine, Neurology Unit, University of Rome “Tor Vergata”, “Tor Vergata” Hospital, Rome, Italy
| | - Antonina D’Amico
- Department of Child Neuropsychiatry, University of Palermo, Palermo, Italy
| | - Giovanni Grillo
- Department of Child Neuropsychiatry, A.R.N.A.S. Civico, P.O. Giovanni di Cristina Ospedale dei Bambini, Palermo, Italy
| | - Oxana Grosu
- Diomid Gherman Institute of Neurology and Neurosurgery, Headache Centre and Nicolae Testemițanu State University of Medicine and Pharmacy, Chișinău, Republic of Moldova
| | - Devrimsel Harika Ertem
- Department of Neurology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Jasper Mecklenburg
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Pavel Řehulka
- Department of Neurology, St. Anne’s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Francesca Schiano di Cola
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Javier Trigo Lopez
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Nina Vashchenko
- University Clinic of Nervous Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | | | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - On behalf of the European Headache Federation School of Advanced Studies (EHF-SAS)
- Division of Vascular Medicine and Pharmacology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Health Sciences Department, University of Florence, and Headache Centre, Careggi University Hospital, Florence, Italy
- Department of Systems Medicine, Neurology Unit, University of Rome “Tor Vergata”, “Tor Vergata” Hospital, Rome, Italy
- Department of Child Neuropsychiatry, University of Palermo, Palermo, Italy
- Department of Child Neuropsychiatry, A.R.N.A.S. Civico, P.O. Giovanni di Cristina Ospedale dei Bambini, Palermo, Italy
- Diomid Gherman Institute of Neurology and Neurosurgery, Headache Centre and Nicolae Testemițanu State University of Medicine and Pharmacy, Chișinău, Republic of Moldova
- Department of Neurology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Zdorovie Clinic, Tomsk, Russia
- Department of Neurology, St. Anne’s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- University Clinic of Nervous Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
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Abstract
PURPOSE OF REVIEW Posttraumatic headache (PTH) attributed to mild traumatic brain injury is common and debilitating. In up to one-half of those with acute PTH, the PTH becomes persistent (PTH), enduring for longer than 3 months. The high incidence and persistence of PTH necessitate research into PTH pathophysiology and treatment. In this review, recent developments regarding the diagnostic criteria for PTH, the pathophysiology of PTH, and PTH treatment are discussed. RECENT FINDINGS International Classification of Headache Disorders 3 diagnostic criteria for PTH attributed to head trauma require that 'a headache of any type' starts within 7 days of a head injury. PTH is considered 'persistent' when it endures for more than 3 months. Preclinical and human PTH research suggest multiple pathophysiologic mechanisms including genetic influences, neuroinflammation, increased release and inadequate clearance of neuropeptides and neurotransmitters, mast cell degranulation, and brain structural and functional remodeling. Even when it has a phenotype similar to a primary headache, data suggest that PTH is distinct from primary headaches. There is a lack of high-quality evidence for the acute or preventive treatment of PTH. However, results from published studies of conventional headache therapies and newer therapies, such as calcitonin gene-related peptide mAbs and transcranial magnetic stimulation, justify the current and future randomized controlled trials. SUMMARY Evidence points towards a complex pathophysiology for PTH that is at least partially distinct from the primary headaches. Although properly conducted clinical trials of PTH treatment are needed, existing work has provided important data that help to plan these clinical trials. Current and future investigations will help to identify PTH mechanisms, predictors for PTH persistence, therapeutic targets, and evidence-based treatment options.
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15
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Ofoghi Z, Dewey D, Barlow KM. A Systematic Review of Structural and Functional Imaging Correlates of Headache or Pain after Mild Traumatic Brain Injury. J Neurotrauma 2020; 37:907-923. [DOI: 10.1089/neu.2019.6750] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Zahra Ofoghi
- Department of Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Deborah Dewey
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Karen M. Barlow
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Paediatric Neurology Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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16
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Schwedt TJ. Structural and Functional Brain Alterations in Post-traumatic Headache Attributed to Mild Traumatic Brain Injury: A Narrative Review. Front Neurol 2019; 10:615. [PMID: 31258507 PMCID: PMC6587675 DOI: 10.3389/fneur.2019.00615] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/24/2019] [Indexed: 12/28/2022] Open
Abstract
Introduction: By definition, post-traumatic headache (PTH) attributed to mild traumatic brain injury (mTBI) is not associated with brain structural abnormalities that are seen on routine clinical inspection of brain images. However, subtle brain structural abnormalities, as well as functional abnormalities, detected via research imaging techniques yield insights into the pathophysiology of PTH. The objective of this manuscript is to summarize published findings regarding research imaging of the brain in PTH attributed to mTBI. Methods:For this narrative review, PubMed was searched using the terms “post-traumatic headache” or “post-concussion headache” and “imaging” or “magnetic resonance imaging” or “research imaging” or “positron emission tomography”. Articles were chosen for inclusion based on their relevance to the topic. Results: Ten articles were ultimately included within this review. The studies investigated white matter tract integrity and functional connectivity in acute PTH, structural measures, white matter tract integrity, cerebral blood flow, and functional connectivity in persistent PTH (PPTH), and proton spectroscopy in both acute and persistent PTH. The articles demonstrate that acute and persistent PTH are associated with abnormalities in brain structure, that acute and persistent PTH are also associated with abnormalities in brain function, that it might be possible to predict the persistence of PTH using brain imaging findings, and that there are differences in imaging findings when comparing PTH to healthy controls and when comparing PTH to migraine. Although it is not entirely clear if the imaging findings are directly attributable to PTH as opposed to the underlying TBI or other post-TBI symptoms, correlations between the imaging findings with headache frequency and headache resolution suggest a true relationship between the imaging findings and PTH. Conclusions: PTH attributed to mTBI is associated with abnormalities in brain structure and function that can be detected via research imaging. Additional studies are needed to determine the specificity of the findings for PTH, to differentiate findings attributed to PTH from those attributed to the underlying TBI and coexistent post-TBI symptoms, and to determine the accuracy of imaging findings for predicting the development of PPTH.
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Affiliation(s)
- Todd J Schwedt
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, United States
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17
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Chong CD, Peplinski J, Berisha V, Ross K, Schwedt TJ. Differences in fibertract profiles between patients with migraine and those with persistent post-traumatic headache. Cephalalgia 2019; 39:1121-1133. [DOI: 10.1177/0333102418815650] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objectives Often, persistent post-traumatic headache and migraine are phenotypically similar. However, the similarities and differences in the neuropathological underpinnings of persistent post-traumatic headache and migraine require further understanding. We used diffusion tensor imaging (DTI) and a novel method for detecting subtle changes in fibertract integrity by measuring node-by-node parameters along each tract to compare fibertract profiles between those with migraine and those with persistent post-traumatic headache, and compared both cohorts to a group of controls. Methods Eighteen fibertracts were reconstructed for 131 subjects, including 49 patients with persistent post-traumatic headache attributed to mild traumatic brain injury, 41 with migraine, and 41 controls. Node-by-node diffusion parameters of mean diffusivity and radial diffusivity were calculated along each tract. Mean diffusivity and radial diffusivity measurements were averaged along quartiles of each tract for statistical interpretation and group comparison. Using a post-hoc analysis, correlations between tract quartile measurements and headache frequency were calculated. Results There were significant differences between migraine and persistent post-traumatic headache cohorts for quartile measurements of mean diffusivity or radial diffusivity in the bilateral anterior thalamic radiations, cingulum (angular bundles and cingulate gyri), inferior longitudinal fasciculi, and uncinate fasciculi, the left corticospinal tract, and the right superior longitudinal fasciculi-parietal portion. For migraine patients, there was a significant positive correlation between headache frequency and forceps major mean diffusivity, whereas for persistent post-traumatic headache there was a positive correlation between headache frequency and cingulum angular bundle mean diffusivity and radial diffusivity. Conclusions Quartile measurements of radial diffusivity and mean diffusivity indicate unique differences in fibertract profiles between those with migraine vs. persistent post-traumatic headache. Although for both migraine and persistent post-traumatic headache there was a positive relationship between fibertract alterations and headache frequency, there were disease-specific differences between headache frequency and fibertract injury patterns. These findings might suggest potential differences in the neuropathological mechanisms underlying migraine and persistent post-traumatic headache.
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Affiliation(s)
| | - Jacob Peplinski
- School of Electrical, Computer and Energy Engineering and Department of Speech and Hearing Science, Arizona State University, Phoenix, AZ, USA
| | - Visar Berisha
- School of Electrical, Computer and Energy Engineering and Department of Speech and Hearing Science, Arizona State University, Phoenix, AZ, USA
| | - Katherine Ross
- Phoenix VA Health Care System, Audiology and Speech Pathology Service, Phoenix, AZ, USA
| | - Todd J Schwedt
- Mayo Clinic Department of Neurology, Mayo Clinic, Phoenix, AZ, USA
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18
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Classification of amyloid PET images using novel features for early diagnosis of Alzheimer's disease and mild cognitive impairment conversion. Nucl Med Commun 2019; 40:242-248. [PMID: 30507747 DOI: 10.1097/mnm.0000000000000953] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND New PET tracers could have a substantial impact on the early diagnosis of Alzheimer's disease (AD), particularly if they are accompanied by optimised image analysis and machine learning methods. Fractal dimension (FD) analysis, a measure of shape complexity, has been proven useful in MRI but its application to fluorine-18 amyloid PET has not yet been demonstrated. Shannon entropy (SE) has also been proposed as a measure of image complexity in DTI imaging, but it is not yet widely used in radiology. MATERIALS AND METHODS In this study, one volumetric FD method and one volumetric SE method were applied to fluorine-18-flutemetamol and fluorine-18-florbetapir 3D amyloid images from 65 and 281 participants, respectively, including healthy volunteers, and patients with probable Alzheimer's disease (pAD) or mild cognitive impairment (MCI). RESULTS The group average FD of white matter surface and SE of white matter volume for healthy volunteers were higher than for pAD patients. Both FD and SE are effective in the identification of MCI patients who progress to pAD during the 2-year follow-up (ground truth). Finally, we developed a support vector machine multimodal classification framework using both PET and MRI features, which showed higher accuracy compared to traditional standard uptake value ratio or using PET alone. The classification accuracy for flutemetamol and florbetapir is 88.9 and 83.3%, respectively, for MCI progression, which is competitive with existing literature. CONCLUSION The results presented in this study demonstrate the potential of FD and SE methods for the analysis of brain PET scans in early AD diagnosis and in the prediction of MCI-AD conversion.
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19
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Narrative Review of the Pathophysiology of Headaches and Photosensitivity in Mild Traumatic Brain Injury and Concussion. Can J Neurol Sci 2018; 46:14-22. [PMID: 30509333 DOI: 10.1017/cjn.2018.361] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The most common symptom of post-concussive syndrome (PCS) is post-traumatic headache (PTH) accompanied by photophobia. Post-traumatic headache is currently categorized as a secondary headache disorder with a clinical phenotype described by its main features and resembling one of the primary headache disorders: tension, migraine, migraine-like cluster. Although PTH is often treated with medication used for primary headache disorders, the underlying mechanism for PTH has yet to be elucidated. The goal of this narrative literature review is to determine the current level of knowledge of these PTHs and photophobia in mild traumatic brain injury (mTBI) in order to guide further research and attempt to discover the underlying mechanism to both symptoms. The ultimate purpose is to better understand the pathophysiology of these symptoms in order to provide better and more targeted care to afflicted patients. A review of the literature was conducted using the databases CINAHL, EMBASE, PubMed. All papers were screened for sections on pathophysiology of PTH or photophobia in mTBI patients. Our paper summarizes current hypotheses. Although the exact pathophysiology of PTH and photophobia in mTBI remains to be determined, we highlight several interesting findings and avenues for future research, including central and peripheral explanations for PTH, neuroinflammation, cortical spreading depolarization and the role of glutamate excitotoxicity. We discuss the possible neuroanatomical pathways for photophobia and hypothesize a possible common pathophysiological basis between PTH and photophobia.
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20
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Cuesta-Frau D, Novák D, Burda V, Molina-Picó A, Vargas B, Mraz M, Kavalkova P, Benes M, Haluzik M. Characterization of Artifact Influence on the Classification of Glucose Time Series Using Sample Entropy Statistics. ENTROPY 2018; 20:e20110871. [PMID: 33266595 PMCID: PMC7512430 DOI: 10.3390/e20110871] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/07/2018] [Accepted: 11/09/2018] [Indexed: 01/02/2023]
Abstract
This paper analyses the performance of SampEn and one of its derivatives, Fuzzy Entropy (FuzzyEn), in the context of artifacted blood glucose time series classification. This is a difficult and practically unexplored framework, where the availability of more sensitive and reliable measures could be of great clinical impact. Although the advent of new blood glucose monitoring technologies may reduce the incidence of the problems stated above, incorrect device or sensor manipulation, patient adherence, sensor detachment, time constraints, adoption barriers or affordability can still result in relatively short and artifacted records, as the ones analyzed in this paper or in other similar works. This study is aimed at characterizing the changes induced by such artifacts, enabling the arrangement of countermeasures in advance when possible. Despite the presence of these disturbances, results demonstrate that SampEn and FuzzyEn are sufficiently robust to achieve a significant classification performance, using records obtained from patients with duodenal-jejunal exclusion. The classification results, in terms of area under the ROC of up to 0.9, with several tests yielding AUC values also greater than 0.8, and in terms of a leave-one-out average classification accuracy of 80%, confirm the potential of these measures in this context despite the presence of artifacts, with SampEn having slightly better performance than FuzzyEn.
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Affiliation(s)
- David Cuesta-Frau
- Technological Institute of Informatics, Universitat Politècnica de València, Alcoi Campus, 03801 Alcoi, Spain
- Correspondence: ; Tel.: +34-96-652-85-05
| | - Daniel Novák
- Department of Cybernetics, Czech Technical University in Prague, 16000 Prague, Czech Republic
| | - Vacláv Burda
- Department of Cybernetics, Czech Technical University in Prague, 16000 Prague, Czech Republic
| | - Antonio Molina-Picó
- Technological Institute of Informatics, Universitat Politècnica de València, Alcoi Campus, 03801 Alcoi, Spain
| | - Borja Vargas
- Internal Medicine Department, Teaching Hospital of Móstoles, 28935 Madrid, Spain
| | - Milos Mraz
- Department of Diabetes, Diabetes Centre, Institute for Clinical and Experimental Medicine, 14021 Prague, Czech Republic
- Department of Medical Biochemistry and Laboratory Diagnostics, General University Hospital, Charles University in Prague 1st Faculty of Medicine, 12108 Prague, Czech Republic
| | - Petra Kavalkova
- Department of Medical Biochemistry and Laboratory Diagnostics, General University Hospital, Charles University in Prague 1st Faculty of Medicine, 12108 Prague, Czech Republic
| | - Marek Benes
- Hepatogastroenterology Department, Transplant centre, Institute for Clinical and Experimental Medicine, 14021 Prague, Czech Republic
| | - Martin Haluzik
- Department of Diabetes, Diabetes Centre, Institute for Clinical and Experimental Medicine, 14021 Prague, Czech Republic
- Department of Medical Biochemistry and Laboratory Diagnostics, General University Hospital, Charles University in Prague 1st Faculty of Medicine, 12108 Prague, Czech Republic
- Obesitology Department, Institute of Endocrinology, 11694 Prague, Czech Republic
- Experimental Medicine Centre, Institute for Clinical and Experimental Medicine, 14021 Prague, Czech Republic
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21
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Abstract
PURPOSE OF REVIEW Headache is a frequent and debilitating symptom after mild traumatic brain injury, yet little is known about its pathophysiology and most effective treatments. The goal of this review is to summarize findings from imaging studies used during the clinical evaluation and research investigation of post-traumatic headache (PTH). RECENT FINDINGS There are no published recommendations or guidelines for when to acquire imaging studies of the head or neck in patients with PTH. Clinical acumen is required to determine if imaging is needed to assess for a secondary cause of headache which may have been precipitated or unmasked by the trauma. Several guidelines for when to image the patient with mild traumatic brain injury (mTBI) in the emergency setting consider headache among the deciding factors. In the research arena, imaging techniques including proton spectroscopy magnetic resonance imaging, diffusion tensor imaging, magnetic resonance morphometry, and functional neck x-rays have been employed with the goal of identifying diagnostic and prognostic factors for PTH and to help understand its underlying pathophysiologic mechanisms. Results indicate that changes in regional cortical thickness and damage to specific white matter tracts warrant further research. Future research should interrogate whether these imaging findings contribute to the classification and prognosis of PTH. Current research provides evidence that imaging findings associated with PTH may be distinct from those attributable to mTBI. A variety of imaging techniques have potential to further our understanding of the pathophysiologic processes underlying PTH as well as to provide diagnostic and prognostic indicators. However, considerable work must be undertaken for this to be realized.
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Affiliation(s)
- Jill C Rau
- Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - Gina M Dumkrieger
- Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - Catherine D Chong
- Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - Todd J Schwedt
- Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA.
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22
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Lepage C, de Pierrefeu A, Koerte IK, Coleman MJ, Pasternak O, Grant G, Marx CE, Morey RA, Flashman LA, George MS, McAllister TW, Andaluz N, Shutter L, Coimbra R, Zafonte RD, Stein MB, Shenton ME, Bouix S. White matter abnormalities in mild traumatic brain injury with and without post-traumatic stress disorder: a subject-specific diffusion tensor imaging study. Brain Imaging Behav 2018; 12:870-881. [PMID: 28676987 PMCID: PMC5756136 DOI: 10.1007/s11682-017-9744-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Mild traumatic brain injuries (mTBIs) are often associated with posttraumatic stress disorder (PTSD). In cases of chronic mTBI, accurate diagnosis can be challenging due to the overlapping symptoms this condition shares with PTSD. Furthermore, mTBIs are heterogeneous and not easily observed using conventional neuroimaging tools, despite the fact that diffuse axonal injuries are the most common injury. Diffusion tensor imaging (DTI) is sensitive to diffuse axonal injuries and is thus more likely to detect mTBIs, especially when analyses account for the inter-individual variability of these injuries. Using a subject-specific approach, we compared fractional anisotropy (FA) abnormalities between groups with a history of mTBI (n = 35), comorbid mTBI and PTSD (mTBI + PTSD; n = 22), and healthy controls (n = 37). We compared all three groups on the number of abnormal FA clusters derived from subject-specific injury profiles (i.e., individual z-score maps) along a common white matter skeleton. The mTBI + PTSD group evinced a greater number of abnormally low FA clusters relative to both the healthy controls and the mTBI group without PTSD (p < .05). Across the groups with a history of mTBI, increased numbers of abnormally low FA clusters were significantly associated with PTSD symptom severity, depression, post-concussion symptoms, and reduced information processing speed (p < .05). These findings highlight the utility of subject-specific microstructural analyses when searching for mTBI-related brain abnormalities, particularly in patients with PTSD. This study also suggests that patients with a history of mTBI and comorbid PTSD, relative to those without PTSD, are at increased risk of FA abnormalities.
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Affiliation(s)
- Christian Lepage
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston St, Boston, MA, 02215, USA
- Department of Psychology, University of Ottawa, Ottawa, Canada
| | - Amicie de Pierrefeu
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston St, Boston, MA, 02215, USA
- School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston St, Boston, MA, 02215, USA
- Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Michael J Coleman
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston St, Boston, MA, 02215, USA
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston St, Boston, MA, 02215, USA
| | - Gerald Grant
- Stanford University Medical Center, Palo Alto, CA, USA
- Duke University, Durham, NC, USA
| | - Christine E Marx
- Duke University Medical Center and VA Mid-Atlantic MIRECC, Durham, NC, USA
| | - Rajendra A Morey
- Duke University Medical Center and VA Mid-Atlantic MIRECC, Durham, NC, USA
| | | | - Mark S George
- Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Thomas W McAllister
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Norberto Andaluz
- Department of Neurosurgery, Mayfield Clinic, University of Cincinnati (UC) College of Medicine, Neurotrauma Center at UC Neuroscience Institute, Cincinnati, OH, USA
| | - Lori Shutter
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- University of Cincinnati, Pittsburgh, PA, USA
| | - Raul Coimbra
- Department of Surgery, University of California, San Diego, CA, USA
| | - Ross D Zafonte
- Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Murray B Stein
- Department of Psychiatry and Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston St, Boston, MA, 02215, USA
- Department of Radiology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, Brockton Division, Brockton, MA, USA
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 1249 Boylston St, Boston, MA, 02215, USA.
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23
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Narayana PA. White matter changes in patients with mild traumatic brain injury: MRI perspective. Concussion 2017; 2:CNC35. [PMID: 30202576 PMCID: PMC6093760 DOI: 10.2217/cnc-2016-0028] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 02/10/2017] [Indexed: 12/20/2022] Open
Abstract
This review focuses on white matter (WM) changes in mild traumatic brain injury (mTBI) as assessed by multimodal MRI. All the peer reviewed publications on WM changes in mTBI from January 2011 through September 2016 are included in this review. This review is organized as follows: introduction to mTBI, the basics of multimodal MRI techniques that are potentially useful for probing the WM integrity, summary and critical evaluation of the published literature on the application of multimodal MRI techniques to assess the changes of WM in mTBI, and correlation of MRI measures with behavioral deficits. The MRI–pathology correlation studies based on preclinical models of mTBI are also reviewed. Finally, the author's perspective of future research directions is described.
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Affiliation(s)
- Ponnada A Narayana
- Department of Diagnostic & Interventional Imaging, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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24
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Wada T, Yasunaga H, Yamana H, Matsui H, Matsubara T, Fushimi K, Nakajima S. Development and validation of a new ICD-10-based trauma mortality prediction scoring system using a Japanese national inpatient database. Inj Prev 2016; 23:263-267. [PMID: 27597403 DOI: 10.1136/injuryprev-2016-042106] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/27/2016] [Accepted: 08/10/2016] [Indexed: 11/03/2022]
Abstract
INTRODUCTION To develop and validate a new trauma mortality prediction scoring system based on International Statistical Classification of Diseases (ICD)-10 codes, using a Japanese administrative claims and discharge abstract database. METHODS This retrospective observational study used the Japanese Diagnosis Procedure Combination database. Injuries were categorised into 33 groups with 5 additional groups based on injury sites and types. A multivariable logistic regression analysis was performed for in-hospital mortality in a derivation cohort after adjusting for the 38 groups, patient's sex, age and Charlson Comorbidity Index score. Each variable was assigned a score that was equal to the value of the regression coefficient. The new severity score was defined as the sum of the scores. The new scoring system was tested in a validation cohort. RESULTS The mortality rates were 2.4% (9270/393 395) and 2.5% (8778/349 285) in the derivation and validation cohorts, respectively. The area under the receiver operating curve (AUROC) of the new scoring system was 0.887 (95% CI 0.884 to 0.890) in the validation cohort. Subgroup analyses showed that the scoring system retained high predictive performance both for patients <65 years (AUROC 0.934, 95% CI 0.928 to 0.939) and for elderly patients at the age of ≥65 years (AUROC 0.825, 95% CI 0.820 to 0.829). CONCLUSIONS A new ICD-10-based injury severity scoring system was developed and validated. Further studies are required to validate the scoring system in other databases.
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Affiliation(s)
- Tomoki Wada
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hayato Yamana
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Takehiro Matsubara
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Susumu Nakajima
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan
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