Differences in Corticoreticulospinal Tract Injuries According to Whiplash in Mild Traumatic Brain Injury Patients

Abstract

Background: This study investigated differences in postural control ability (PCA) and corticoreticulospinal tract (CRT) injury severity according to whiplash in patients with mild traumatic brain injury (mTBI).Methods: Thirty-one patients with mTBI and 21 healthy control subjects were recruited for this study. The balance error scoring system (BESS) was used for PCA assessment. Based on their whiplash history, the patients were classified into two groups: group A—mTBI with whiplash injury; group B—mTBI without whiplash injury. Fractional anisotropy (FA), apparent diffusion coefficient (ADC), and tract volume (TV) values were estimated for the reconstructed CRTs in all subjects.Results: Significant differences were observed among the total BESS scores of patient groups A and B and the control group (p < 0.05). The patient group A BESS score was significantly higher than that of patient group B, and that of the patient group B was significantly higher than that of the control group. No significant differences were detected among the FA and ADC values of the CRTs of the two patient groups and the control group (p > 0.05). However, the TV values of the CRT did reveal significant differences; the TV of patient group A was significantly lower than those of patient group B and the control group, and that of patient group B was significantly lower than that of the control group (p < 0.05).Conclusions: We observed greater CRT injury severity and PCA impairment in mTBI patients with whiplash than in mTBI patients without whiplash. The results indicate that whiplash might lead to a greater level of severity in axonal injuries in mTBI patients.

Injury of the Spinothalamic Tract Following Whiplash Injury: A Diffusion Tensor Tractography Study

“…In 1998, Shannon et al [20] reported that axonal injury was detected on post-mortem brain dissection in 14 children with shaken baby syndrome. After introduction of DTI, several studies using DTT demonstrated TAI following whiplash injury in patients with mild TBI [21][22][23][24][25][26][27]. In 2019, Jang and Seo reported on two patient with mild TBI who showed injury of STT with central pain following whiplash injury [23].…”

“…In 2019, Jang and Seo reported on two patient with mild TBI who showed injury of STT with central pain following whiplash injury [23]. From 2015 to 2019, Jang et al [21][22][23][24][25][26][27] reported several manuscripts of TAI using DTT in the patient (suffering tremor, ataxia, hypersomnia, impaired motor function, tinnitus and neural pain) with neural tract injury such as DRTT, ARAS, Corticospinal tract (CST), CRT, AR and STT after whiplash injury. Therefore, to the best of our knowledge, this is the first original study to demonstrate the STT injury in large number of patients after whiplash injury.…”

“…Since development of diffusion tensor imaging (DTI), a few studies using diffusion tensor tractography (DTT), reported injuries of the corticospinal tract, corticoreticulospinal tract (CRT), dentatorubrothalamic tract (DRTT), ascending reticular activating system (ARAS), auditory radiation (AR), and spinothalamic tract (STT) following whiplash injury [21][22][23][24][25][26][27]. However, all of these studies were case reports, and only one case study reported specifically an injury of the STT [21][22][23][24][25][26][27].…”