Injury-Specific Correlates of Combat-Related Traumatic Brain Injury in Operation Iraqi Freedom

MacGregor, Andrew J.; Dougherty, Amber L.; Galarneau, Michael R.

doi:10.1097/htr.0b013e3181e94404

Cited by 82 publications

(61 citation statements)

References 19 publications

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“…At present, it is unclear why similar mTBI events can lead to dramatic neurobehavioral decompensation with persistent PCS in some individuals, but not in others (Jeter et al, 2013). Retrospective and prospective studies of combatrelated TBI show that most (<85%) deployment-related TBIs are mild (MacGregor et al, 2011;Yurgil et al, 2014). But diagnoses are based primarily on the characteristics of the acute clinical sequelae following the injury.…”

Section: Clinicalmentioning

confidence: 99%

The role of biomarkers and MEG-based imaging markers in the diagnosis of post-traumatic stress disorder and blast-induced mild traumatic brain injury

Huang

Risling

Baker

2016

Psychoneuroendocrinology

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SummaryBackground: Pervasive use of improvised explosive devices (IEDs), rocket-propelled grenades, and land mines in the recent conflicts in Iraq and Afghanistan has brought traumatic brain injury (TBI) and its impact on health outcomes into public awareness. Blast injuries have been deemed signature wounds of these wars. War-related TBI is not new, having become prevalent during WWI and remaining medically relevant in WWII and beyond. Medicine's past attempts to accurately diagnose and disentangle the pathophysiology of war-related TBI parallels current lines of inquiry and highlights limitations in methodology and attribution of symptom etiology, be it organic, psychological, or behavioral. New approaches and biomarkers are needed. Preclinical: Serological biomarkers and biomarkers of injury obtained with imaging techniques represent cornerstones in the translation between experimental data and clinical observations. Experimental models for blast related TBI and PTSD can generate critical data on injury threshold, for example for white matter injury from acceleration. Carefully verified and validated models can be evaluated with gene expression arrays and proteomics to identify new candidates for serological biomarkers. Such models can also be analyzed with diffusion MRI and microscopy in order to identify criteria for detection of diffuse white matter injuries, such as DAI (diffuse axonal injury). The experimental models can also be analyzed with focus on injury outcome in brain stem regions, such as locus coeruleus or nucleus raphe magnus that can be involved in response to anxiety changes. * Corresponding author at: UCSD Radiology Imaging Laboratory, San Diego, CA 92121, USA. Tel.: +1 858 534 1254; fax: +1 8585346046. E-mail address: mxhuang@ucsd.edu (M. Huang). Clinical: Mild (and some moderate) TBI can be difficult to diagnose because the injuries are often not detectable on conventional MRI or CT. There is accumulating evidence that injured brain tissues in TBI patients generate abnormal low-frequency magnetic activity (ALFMA, peaked at 1-4 Hz) that can be measured and localized by magnetoencephalography (MEG). MEG imaging detects TBI abnormalities at the rates of 87% for the mild TBI, group (blast-induced plus non-blast causes) and 100% for the moderate group. Among the mild TBI patients, the rates of abnormalities are 96% and 77% for the blast and non-blast TBI groups, respectively. There is emerging evidence based on fMRI and MEG studies showing hyper-activity in the amygdala and hypo-activity in prefrontal cortex in individuals with PTSD. MEG signal may serve as a sensitive imaging marker for mTBI, distinguishable from abnormalities generated in association with PTSD. More work is needed to fully describe physiological mechanisms of post-concussive symptoms.Published by Elsevier Ltd. BackgroundBlast injuries are deemed the signature wounds of the first wars (Afghanistan and Iraq) of the 21st century (Lancet, 2007;Galarneau et al., 2008). According to a recent U.S. Department Veterans Affairs (DVA) ...

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Section: Clinicalmentioning

confidence: 99%

The role of biomarkers and MEG-based imaging markers in the diagnosis of post-traumatic stress disorder and blast-induced mild traumatic brain injury

Huang

Risling

Baker

2016

Psychoneuroendocrinology

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“…Of these closed-brain injuries, 56% were considered moderate or severe, and 44% were mild, with no visible lesion on clinical MRI or CT (Okie, 2005). A more recent combat-related TBI study in Operation Iraqi Freedom with 2074 participants showed that 89% of all TBIs were mild (MacGregor et al, 2010). The diagnosis of combat-related mTBI is based primarily on the characteristics of the acute clinical sequelae, following the injury and lesion(s) may be "subtle, scattered, varied,…, not detected on conventional brain CT" (Van Boven et al, 2009).…”

Section: Introductionmentioning

confidence: 96%

An automatic MEG low-frequency source imaging approach for detecting injuries in mild and moderate TBI patients with blast and non-blast causes

et al. 2012

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“…13 The prevalence of TBI is much greater in these operations than in previous modern military conflicts. 14 This initiative is aimed at preventing acute pain problems from progressing to harder-to-manage chronic conditions and to improve function and quality of life. The Task Force recognizes that part of the appeal of complementary and alternative medicine (CAM) is that CAM incorporates all aspects of the individual, family, and community, as well as providing the opportunity for greater patient involvement in individualized health care.…”

Section: A Paradigm Shiftmentioning

confidence: 99%

Treating Veterans’ Chronic Pain and Mental Health Disorders: An Integrative, Patient-Centered Approach

HorowitzSala¹

2013

Alternative and Complementary Therapies

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Injury-Specific Correlates of Combat-Related Traumatic Brain Injury in Operation Iraqi Freedom

Cited by 82 publications

References 19 publications

The role of biomarkers and MEG-based imaging markers in the diagnosis of post-traumatic stress disorder and blast-induced mild traumatic brain injury

The role of biomarkers and MEG-based imaging markers in the diagnosis of post-traumatic stress disorder and blast-induced mild traumatic brain injury

An automatic MEG low-frequency source imaging approach for detecting injuries in mild and moderate TBI patients with blast and non-blast causes

Treating Veterans’ Chronic Pain and Mental Health Disorders: An Integrative, Patient-Centered Approach

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