Clinical Findings in a Multicenter MRI Study of Mild TBI

Abstract

Background: Uncertainty continues to surround mild traumatic brain injury (mTBI) diagnosis, symptoms, prognosis, and outcome due in part to a lack of objective biomarkers of injury and recovery. As mTBI gains recognition as a serious public health epidemic, there is need to identify risk factors, diagnostic tools, and imaging biomarkers to help guide diagnosis and management.Methods: One hundred and eleven patients (15–50 years old) were enrolled acutely after mTBI and followed with up to four standardized serial assessments over 3 months. Each encounter included a clinical exam, neuropsychological assessment, and magnetic resonance imaging (MRI). Chi-square and linear mixed models were used to assess changes over time and determine potential biomarkers of mTBI severity and outcome.Results: The symptoms most frequently endorsed after mTBI were headache (91%), not feeling right (89%), fatigue (86%), and feeling slowed down (84%). Of the 104 mTBI patients with a processed MRI scan, 28 (27%) subjects had white matter changes which were deemed unrelated to age, and 26 of these findings were deemed unrelated to acute trauma. Of the neuropsychological assessments tested, 5- and 6-Digit Backward Recall, the modified Balance Error Scoring System (BESS), and Immediate 5-Word Recall significantly improved longitudinally in mTBI subjects and differentiated between mTBI subjects and controls. Female sex was found to increase symptom severity scores (SSS) at every time point. Age ≥ 25 years was correlated with increased SSS. Subjects aged ≥ 25 also did not improve longitudinally on 5-Digit Backward Recall, Immediate 5-Word Recall, or Single-Leg Stance of the BESS, whereas subjects < 25 years improved significantly. Patients who reported personal history of depression, anxiety, or other psychiatric disorder had higher SSS at each time point.Conclusions: The results of this study show that 5- and 6-Digit Backward Recall, the modified BESS, and Immediate 5-Word Recall should be considered useful in demonstrating cognitive and vestibular improvement during the mTBI recovery process. Clinicians should take female sex, older age, and history of psychiatric disorder into account when managing mTBI patients. Further study is necessary to determine the true prevalence of white matter changes in people with mTBI.

Patients with Mild Traumatic Brain Injury Recruited from Both Hospital and Primary Care Settings: A Controlled Longitudinal Magnetic Resonance Imaging Study

“…WMH were defined as hyperintense lesions on FLAIR, without hypointense lesions on SWI, which persisted unchanged across all time points on MRI. First, in line with another study, 44 we found no difference in the frequency of non-traumatic WMH between the mTBI group and the controls, as expected based on these lesions considered not to be of traumatic origin.…”

Letter to the Editor. Pupillometry and neurotrauma: point-of-care technologies versus point-of-care techniques

“…In addition, pupil dilation velocity, percentage change in pupil size, and maximum constriction velocity parameters showed statically significant alterations after a mild traumatic brain injury (mTBI), findings that have already been confirmed by Ciuffreda et al 3 However, the changes of these parameters could not be interpreted to be due only to anatomical changes or neuron pathway dysfunction. As already described by Shetty et al, 4 about 27% of the patients after an mTBI develop white matter changes. Of the neuropsychological assessments used, the 5-and 6-Digit Backward Recall, the modified Balance Error Scoring System (BESS), and the Immediate 5-Word Recall significantly improved longitudinally in mTBI subjects and facilitated differentiation between the mTBI subjects and controls.…”

Magnetic Resonance Spectroscopy following Mild Traumatic Brain Injury: A Systematic Review and Meta-Analysis on the Potential to Detect Posttraumatic Neurodegeneration

“…We chose strict inclusion criteria investigating mTBI patients with negative routine brain scans that are often underdiagnosed yet still exhibit posttraumatic symptoms [37]. Early diagnosis of those presumably mildly braininjured patients at risk for long-term consequences is critically relevant as longitudinal follow-up studies underline continued symptoms, including chronic fatigue, psychiatric disorders, and unsatisfied quality of life in one third of patients [38][39][40][41]. A recent meta-analysis revealed that MRS might have limitations for use in mTBI patients [21], which is contradictory to our findings possibly due to a greater heterogeneity of their study population.…”