The neuropathology of intimate partner violence

Abstract

Lifelong brain health consequences of traumatic brain injury (TBI) include the risk of neurodegenerative disease. Up to one-third of women experience intimate partner violence (IPV) in their lifetime, often with TBI, yet remarkably little is known about the range of autopsy neuropathologies encountered in IPV. We report a prospectively accrued case series from a single institution, the New York City Office of Chief Medical Examiner, evaluated in partnership with the Brain Injury Research Center of Mount Sinai, using a multimodal protocol comprising clinical history review, ex vivo imaging in a small subset, and comprehensive neuropathological assessment by established consensus protocols. Fourteen brains were obtained over 2 years from women with documented IPV (aged 3rd–8th decade; median, 4th) and complex histories including prior TBI in 6, nonfatal strangulation in 4, cerebrovascular, neurological, and/or psychiatric conditions in 13, and epilepsy in 7. At autopsy, all had TBI stigmata (old and/or recent). In addition, white matter regions vulnerable to diffuse axonal injury showed perivascular and parenchymal iron deposition and microgliosis in some subjects. Six cases had evidence of cerebrovascular disease (lacunes and/or chronic infarcts). Regarding neurodegenerative disease pathologies, Alzheimer disease neuropathologic change was present in a single case (8th decade), with no chronic traumatic encephalopathy neuropathologic change (CTE-NC) identified in any. Findings from this initial series then prompted similar exploration in an expanded case series of 70 archival IPV cases (aged 2nd–9th decade; median, 4th) accrued from multiple international institutions. In this secondary case series, we again found evidence of vascular and white matter pathologies. However, only limited neurodegenerative proteinopathies were encountered in the oldest subjects, none meeting consensus criteria for CTE-NC. These observations from this descriptive exploratory study reinforce a need to consider broad co-morbid and neuropathological substrates contributing to brain health outcomes in the context of IPV, some of which may be potentially modifiable.

Longitudinal Lesion Expansion in Chronic Traumatic Brain Injury

“…Traumatic brain injury (TBI) is a well-established risk factor for neurodegenerative diseases (Dams-O’Connor et al, 2020). The pathophysiologic mechanisms that link TBI to post-traumatic neurodegeneration (PTND) are not fully understood, though emerging evidence implicates a “polypathology” (Kenney et al, 2018) that includes axonal injury (Johnson et al, 2013), tau deposition (McKee et al, 2013), vascular injury (Dams-O’Connor et al, 2023; Sandsmark, Bashir, Wellington, & Diaz-Arrastia, 2019), and neuroinflammation (Johnson et al, 2013). An underexplored factor in the pathogenesis of PTND is the potential impact of focal lesions, such as cerebral contusions, which are amongst the most common lesions in individuals with TBI (Vande Vyvere et al, 2024).…”

Chronic traumatic encephalopathy (CTE) in the context of longstanding intimate partner violence

“…In common with almost all other cases of CTE, the cases presented here had a long history of RHI. In contrast, a recent study of IPV neuropathology failed to identify CTE in a series of prospective and retrospective cases [ 4 ]. Evidence of longstanding RHI was lacking in this detailed study but has been present in all cases of CTE identified in IPV to date, underscoring the importance of chronic RHI exposure in CTE pathogenesis.…”