Trauma-Specific Brain Abnormalities in Suspected Mild Traumatic Brain Injury Patients Identified in the First 48 Hours after Injury: A Blinded Magnetic Resonance Imaging Comparative Study Including Suspected Acute Minor Stroke Patients

Abstract

We assessed the utility of a brief MRI protocol, appropriate for the acute setting, to detect acute traumatic brain injury (TBI) in patients with suspected mild TBI (mTBI) and distinguish traumatic from nontraumatic brain injury by comparing trauma with nontrauma patients. Twenty-two patients with suspected mTBI were included in this exploratory study over a period of 9 months. Median time from injury to MR scanning was 5.4 h (interquartile range 3.6-15.3). To determine the specificity of certain findings for TBI, 61 patients presenting with suspected minor acute stroke were included as a comparative group using the same MRI methods. A selected series of MRI sequences (diffusion-weighted imaging, fluid attenuated inversion recovery [FLAIR], and T2* weighted) were independently evaluated by two neuroradiologists blinded to clinical diagnosis, for presence of specific findings. In a separate session, all cases in which at least one MRI sequence above was positive were classified as TBI, stroke, or indeterminate. Intracranial MRI abnormalities were observed in 47 (57%) of the 83 studied patients. Based on findings on MRI, 12 (55%) of 22 suspected mTBI patients were classified as having traumatic injury. Nine (47%) of the 19 suspected mTBI patients with a negative CT had findings on MRI. Abnormalities on MRI consistent with trauma were observed most frequently on postcontrast FLAIR (83%) and T2*-weighted (58%) sequences. We demonstrated the ability of a fast MRI protocol to identify trauma-related abnormalities not seen on CT, and differentiate acute trauma from nonspecific chronic disease in a blinded cohort of mTBI patients.

Leptomeningeal gadolinium enhancement across the spectrum of chronic neuroinflammatory diseases

“…Furthermore, the low frequency of LME in controls and in individuals without underlying inflammatory neurologic disease provides additional support to the recent notion that CSF-restricted enhancement on postcontrast T2-FLAIR images, when present, is an expression of breakdown of the blood-meningeal barrier, related directly to ongoing inflammation or post-inflammatory scarring, as might occur in traumatic brain injury. 8 This interpretation is in line with the role of the leptomeninges as a relay and modulatory gate for peripheral immune cells in health and in a variety of immunopathologic processes that lead to focal bloodmeningeal barrier impairment. In viral meningoencephalitis, including that related to HIV, involvement of the leptomeninges is a key pathologic feature.…”

Revisiting Grade 3 Diffuse Axonal Injury: Not All Brainstem Microbleeds are Prognostically Equal

“…To build upon prior efforts to characterize the morphological characteristics of TMBs [38–40], we report our findings on the morphology of brainstem TMBs. Notably, there is no consensus approach to describing TMB morphological characteristics.…”

Phosphodiesterase‐5 inhibition potentiates cerebrovascular reactivity in chronic traumatic brain injury

“…TCVI is a near universal pathologic finding in fatal TBI,12 but has also been detected in mild or moderate TBI cases 13. Vascular injury is detected on MRI in 25–30% of mild TBI cases imaged soon after injury 14, 15. In animal TBI models, TCVI is universally detected,16, 17, 18, 19, 20 and persistent microcirculatory deficits correlate with behavioral and cognitive deficits 18.…”