This is the first study to demonstrate and quantify attenuation of non-haemorrhagic TAI lesions on structural MRI during the first 3 months after TBI; most importantly, the disappearance of brainstem lesions. Haemorrhagic TAI lesions attenuate first after 3 months. Only early MRI findings predicted clinical outcome after adjustment for other prognostic factors. Hence valuable clinical information may be missed if MRI is performed too late after TBI.
The aim of this study was to explore the prognostic value of visible traumatic axonal injury (TAI) loads in different MRI sequences from the early phase after adjusting for established prognostic factors. Likewise, we sought to explore the prognostic role of early apparent diffusion coefficient (ADC) values in normal-appearing corpus callosum. In this prospective study, 128 patients (mean age, 33.9 years; range, 11-69) with moderate (n = 64) and severe traumatic brain injury (TBI) were examined with MRI at a median of 8 days (range, 0-28) postinjury. TAI lesions in fluid-attenuated inversion recovery (FLAIR), diffusion-weighted imaging (DWI), and T2*-weighted gradient echo (T2*GRE) sequences were counted and FLAIR lesion volumes estimated. In patients and 47 healthy controls, mean ADC values were computed in 10 regions of interests in the normal-appearing corpus callosum. Outcome measure was the Glasgow Outcome Scale-Extended (GOS-E) at 12 months. In patients with severe TBI, number of DWI lesions and volume of FLAIR lesions in the corpus callosum, brain stem, and thalamus predicted outcome in analyses with adjustment for age, Glasgow Coma Scale score, and pupillary dilation (odds ratio, 1.3-6.9; p = <0.001-0.017). The addition of Rotterdam CT score and DWI lesions in the corpus callosum yielded the highest R2 (0.24), compared to all other MRI variables, including brain stem lesions. For patients with moderate TBI only the number of cortical contusions (p = 0.089) and Rotterdam CT score (p = 0.065) tended to predict outcome. Numbers of T2*GRE lesions did not affect outcome. Mean ADC values in the normal-appearing corpus callosum did not differ from controls. In conclusion, the loads of visible TAI lesions in the corpus callosum, brain stem, and thalamus in DWI and FLAIR were independent prognostic factors in patients with severe TBI. DWI lesions in the corpus callosum were the most important predictive MRI variable. Interestingly, number of cortical contusions in MRI and CT findings seemed more important for patients with moderate TBI.
The objectives of this prospective study in 62 moderate–severe TBI patients were to investigate volume change in cortical gray matter (GM), hippocampus, lenticular nucleus, lobar white matter (WM), brainstem and ventricles using a within subject design and repeated MRI in the early phase (1–26 days) and 3 and 12 months postinjury and to assess changes in GM apparent diffusion coefficient (ADC) in normal appearing tissue in the cortex, hippocampus and brainstem. The impact of Glasgow Coma Scale (GCS) score at admission, duration of post-traumatic amnesia (PTA), and diffusion axonal injury (DAI) grade on brain volumes and ADC values over time was assessed. Lastly, we determined if MRI-derived brain volumes from the 3-month scans provided additional, significant predictive value to 12-month outcome classified with the Glasgow Outcome Scale—Extended after adjusting for GCS, PTA and age.Cortical GM loss was rapid, largely finished by 3 months, but the volume reduction was unrelated to GCS score, PTA, or presence of DAI. However, cortical GM volume at 3 months was a significant independent predictor of 12-month outcome. Volume loss in the hippocampus and lenticular nucleus was protracted and statistically significant first at 12 months. Slopes of volume reduction over time for the cortical and subcortical GGM were significantly different. Hippocampal volume loss was most pronounced and rapid in individuals with PTA > 2 weeks. The 3-month volumes of the hippocampus and lentiform nucleus were the best independent predictors of 12-month outcome after adjusting for GCS, PTA and age. In the brainstem, volume loss was significant at both 3 and 12 months. Brainstem volume reduction was associated with lower GCS score and the presence of DAI. Lobar WM volume was significantly decreased first after 12 months. Surprisingly DAI grade had no impact on lobar WM volume. Ventricular dilation developed predominantly during the first 3 months, and was strongly associated with volume changes in the brainstem and cortical GM, but not lobar WM volume.Higher ADC values were detected in the cortex in individuals with severe TBI, DAI and PTA > 2 weeks, from 3 months. There were no associations between ADC values and brain volumes, and ADC values did not predict outcome.
Kjelvik G, Evensmoen HR, Brezova V, Håberg AK. The human brain representation of odor identification.
BACKGROUND AND PURPOSE:The intracranial volume is commonly used for correcting regional brain volume measurements for variations in head size. Accurate intracranial volume measurements are important because errors will be propagated to the corrected regional brain volume measurements, possibly leading to biased data or decreased power. Our aims were to describe a fully automatic SPM-based method for estimating the intracranial volume and to explore the practical implications of different methods for obtaining the intracranial volume and normalization methods on statistical power.
We did not find any association between the clinical neurovascular conflict (NVC) and the size of the posterior fossa and its substructures. MRI volumetry may show the atrophy of the affected trigeminal nerve in clinical NVC.
587Mengden diffus aksonal skade innen første måned etter hodetraume samt volum av enkelte hjernestrukturer predikerer utfallet.Målet for studien var å undersøke hvordan traumatisk hodeskade påvirker volumet av ulike hjernestrukturer i løpet av et år og hvordan diffus aksonal skade utvikles i samme periode. Vi ville dessuten undersøke hvilke tidlige MR-avbildningsfunn som predikerer utfallet av hjerneskaden.Mitt doktorgradsarbeid er basert på 125 pasienter med moderat til alvorlig hodeskade innlagt i nevrokirurgisk avdeling ved St. Olavs hospital .Vi fant signifikante volumforskjeller for alle analyserte hjernestrukturer i løpet av de første 12 måneder etter hodeskaden, men effekten av skaden var forskjellig i de ulike strukturene. Hos pasienter med posttraumatisk amnesi over to uker var det hippocampus og ventrikler som tapte mest volum. Tap av hjernestammevolum var assosiert med grad av diffus aksonal skade. Det var større atrofi ved alvorlig hodeskade enn ved moderat hodeskade i lobaer hvit substans og hjernestamme, mens for de øvrige hjernestrukturer var det ingen forskjell mellom alvorlig og moderat skade.I pasienter med diffus aksonal skade viste vi at ikke-hemoragiske lesjoner forsvinner innen tre måneder. Signifikante utfallsprediktorer var volum av kortikal grå substans, hippocampus og nucleus lenticularis tre måneder etter skaden og volum samt antall områder med diffus aksonal skade i corpus callosum, hjernestamme og thalamus tidlig etter skaden.Det anbefales at MR-undersøkelse gjøres tidlig etter hodeskaden fordi MR-forandringer har stor betydning for å predikere utfallet. Veronika Brezova Depresjon og migrene hos personer med diabetes 587Personer med diabetes har økt forekomst av depresjon, men redusert forekomst av medikamentelt behandlet migrene. Forekomsten av begge sykdommene hos diabetikere varierer betydelig med alder.Diabetes kan gi komplikasjoner i de fleste organsystem, som for eksempel hjerte-og karsystemet, men vi vet mindre om forekomsten av psykiatriske og nevrologiske tilstander hos personer med diabetes.I mitt doktorgradsarbeid brukte vi data fra Helseundersøkelsen i Hordaland (HUSK) og Reseptregisteret (NorPD). Sammenliknet med personer uten diabetes har personer med diabetes økt forekomst av depresjon, målt ved symptomer og bruk av antidepressiver, men redusert forekomst av medikamentelt behandlet migrene. Saerlig høy forekomst av depresjon ble funnet hos middelaldrende med diabetes. Etter justering for kjønn, kroppsmasseindeks, fysisk aktivitet, alkoholbruk og utdanning hadde personer som brukte orale antidiabetika opp mot tre ganger så høy forekomst av depresjon sammenliknet med personer uten diabetes. Siden depresjon hos personer med diabetes er assosiert med økt mortalitet, og depresjon ofte kan behandles effektivt, er det viktig at helsepersonell er oppmerksomme på grupper med økt forekomst.Yngre personer med diabetes har økt forekomst av medikamentelt behandlet migrene, mens middelaldrende og eldre med diabetes har omtrent halvert forekomst sammenliknet med personer uten diabet...
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