Traumatic brain injury and the post-concussion syndrome: A diffusion tensor tractography study

D’Souza, Maria; Trivedi, Richa; Singh, Kavita; Grover, Hemal; Choudhury, Arup; Kaur, Prabhjot; Kumar, Pawan; Tripathi, Renu

doi:10.4103/0971-3026.169445

Cited by 38 publications

(29 citation statements)

References 37 publications

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“…34 Although relationships between headache characteristics and cortical thickness were not specifically assessed, results did indicate that more post-traumatic symptoms (including headache) related to thinner cortex in a variety of frontal, temporal, and parietal areas in a cohort of male concussed hockey players. Similarily, D'Souza et al 36 found white matter changes in patients with mild to moderate head trauma using diffusion tensor imaging. Results showed a correlation between white matter integrity loss and postconcussion symptom severity using the Rivermead Postconcussion Symptom Questionnaire, which is a questionnaire that assesses a variety of self-reported symptoms including headache, mood, physical problems, and cognitive problems.…”

Section: Discussionmentioning

confidence: 61%

Less Cortical Thickness in Patients With Persistent Post‐Traumatic Headache Compared With Healthy Controls: An MRI Study

et al. 2017

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Objective.-To investigate differences in cortical thickness in patients with persistent post-traumatic headache (PPTH) relative to healthy controls and to interrogate whether cortical morphology relates to headache burden (headache frequency, years with post-traumatic headache, PTH) in patients with PPTH.Background.-PTHs are one of the most common symptoms following concussion. In some patients, PTHs continue for longer than three months and are classified as PPTH. This study has two main goals: (1) To delineate the neuropathology of PPTH, by interrogating differences in cortical thickness in patients with PPTH relative to healthy controls. (2) To interrogate potential associations between brain morphology and headache burden in patients with PPTH by examining whether cortical thickness relates to frequency of headaches or years lived with PTH.Methods.-Adults with PPTH diagnosed according to ICHD 3 beta diagnostic criteria and healthy controls underwent brain MRI on a 3 Tesla scanner. Vertex-by-vertex whole brain estimates of cortical thickness were automatically calculated using FreeSurfer v5.3. Differences in cortical thickness in patients with PPTH relative to healthy controls were determined using a general linear model design. Associations were explored between regional clusters where patients with PPTH showed cortical thickness differences compared with healthy controls with headache frequency and years lived with PPTH.Results.-This study included 33 patients with PPTH and 33 healthy control subjects (healthy controls: median age 5 33.0, IQR 5 15.5; patients with PPTH: median age 5 36.0, IQR 5 20.5; P 5 .56). Patients with PPTH had less cortical thickness relative to healthy controls in the left and right superior frontal, caudal middle frontal, and precentral cortex as well as less cortical thickness in the right supramarginal, right superior and inferior parietal, and right precuneus region (P < .05, Monte Carlo corrected for multiple comparisons). There were no regions where patients with PPTH had more cortical thickness relative to healthy controls. A correlation analysis of regions that showed less cortical thickness in patients with PPTH demonstrated a negative correlation between left and right superior frontal thickness with headache frequency (P < .05). There was no association between regional cortical thickness and years lived with PPTH.Conclusion.-Compared with healthy controls, patients with PPTH had less cortical thickness in bilateral frontal regions and right hemisphere parietal regions. For patients with PPTH, more frequent headaches were related to less thickness in the left and right superior frontal regions, potentially indicating that brain morphology changes in the superior frontal regions in patients with PPTH are modified by headache frequency.

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Section: Discussionmentioning

confidence: 61%

Less Cortical Thickness in Patients With Persistent Post‐Traumatic Headache Compared With Healthy Controls: An MRI Study

et al. 2017

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“…However, due to a shortage of scientific evidence supporting the use of the 6-hour LOC criterion to distinguish between concussion and DAI, and the low sensitivity of conventional brain MRI in the detection of DAI lesions, the accuracy of a DAI diagnosis is limited [4,11,12]. In addition, axonal injuries have been detected in many concussion cases with less than 6-hour LOC, and there are opposing opinions regarding the applicability of the term diffuse in DAI [7,11,[13][14][15][16][17][18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Problems in Diffuse Axonal Injury

Jang

2020

Diagnostics

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In this study, three problems associated with diagnosing diffuse axonal injury (DAI) in patients with traumatic brain injury are reviewed: the shortage of scientific evidence supporting the 6-hour loss of consciousness (LOC) diagnostic criterion to discriminate concussion and DAI, the low sensitivity of conventional brain MRI in the detection of DAI lesions, and the inappropriateness of the term diffuse in DAI. Pathological study by brain biopsy is required to confirm DAI; however, performing a brain biopsy for the diagnosis of DAI in a living patient is impossible. Therefore, the diagnosis of DAI in a living patient is clinically determined based on the duration of LOC, clinical manifestations, and the results of conventional brain MRI. There is a shortage of scientific evidence supporting the use of the 6-hour LOC criterion to distinguish DAI from concussion, and axonal injuries have been detected in many concussion cases with a less than 6-hour LOC. Moreover, due to the low sensitivity of conventional brain MRI, which can only detect DAI lesions in approximately half of DAI patients, diagnostic MRI criteria for DAI are not well established. In contrast, diffusion tensor imaging (DTI) has been shown to have high sensitivity for the detection of DAI lesions. As DTI is a relatively new method, further studies aimed at the establishment of diagnostic criteria for DAI detection using DTI are needed. On the other hand, because DAI distribution is not diffuse but multifocal, and because axonal injury lesions have been detected in concussion patients, steps to standardize the use of terms related to axonal injury in both concussion and DAI are necessary.

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“…Similar trends are observed in DTI studies on mTBI. For instance, two additional studies (D'souza et al, ; Toth et al, ) report increased MD and decreased FA during the acute phase of mTBI as compared to age‐ and sex‐matched healthy controls with FA decreases persisting at 1 month (Toth et al, ). An additional TBSS study reports increased RD and decreased FA in the subacute phase of mTBI without post‐concussion syndrome as compared to healthy controls with FA decreases persisting at 6 months (Messé et al, ).…”

Section: Introductionmentioning

confidence: 99%

“…Similar trends are observed in DTI studies on mTBI. For instance, two additional studies (D'souza et al, 2015;Toth et al, 2013) report increased MD and decreased FA during the acute phase of mTBI as compared to age-and sex-matched healthy controls with FA decreases persisting at 1 month (Toth et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Preliminary evidence from a prospective DTI study suggests a posterior‐to‐anterior pattern of recovery in college athletes with sports‐related concussion

et al. 2018

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ObjectivesWe compared the integrity of white matter (WM) microstructure to the course of recovery in athletes who sustained one sports‐related concussion (SRC), assessing individual longitudinal changes in WM fiber tracts following SRC using pre‐ and post‐injury measurements.Materials and MethodsBaseline diffusion tensor imaging (DTI) scans and neuropsychological tests were collected on 53 varsity contact‐sport college athletes. Participants (n = 13) who subsequently sustained an SRC underwent DTI scans and neuropsychological testing at 2 days, 2 weeks, and 2 months following injury.ResultsRelying on tract‐based spatial statistics (TBSS) analyses, we found that radial diffusivity (RD) and mean diffusivity (MD) were significantly increased at 2 days post‐injury compared to the same‐subject baseline (corrected p < 0.02). These alterations were visible in anterior/posterior WM regions spanning both hemispheres, demonstrating a diffuse pattern of injury after concussion. Implicated WM fiber tracts at 2 days include the following: right superior/inferior longitudinal fasciculus; right/left inferior fronto‐occipital fasciculus; right corticospinal tract; right acoustic radiation; right/left anterior thalamic radiations; right/left uncinate fasciculus; and forceps major/minor. At 2 weeks post‐injury, persistently elevated RD and MD were observed solely in prefrontal portions of WM fiber tracts (using same‐subject contrasts). No significant differences were found for FA in any of the post‐injury comparisons to baseline. Plots of individual subject RD and MD in prefrontal WM demonstrated homogenous increases from baseline to just after SRC; thereafter, trajectories became more variable. Most subjects’ diffusivity values remained elevated at 2 months post‐injury relative to their own baseline. Over the 2‐month period after SRC, recovery of WM fiber tracts appeared to follow a posterior‐to‐anterior trend, paralleling the posterior–anterior pattern of WM maturation previously identified in the normal population.ConclusionThese results suggest greater vulnerability of prefrontal regions to SRC, underline the importance of an individualized approach to concussion management, and show promise for using RD and MD for imaging‐based diagnosis of SRC.

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Traumatic brain injury and the post-concussion syndrome: A diffusion tensor tractography study

Cited by 38 publications

References 37 publications

Less Cortical Thickness in Patients With Persistent Post‐Traumatic Headache Compared With Healthy Controls: An MRI Study

Less Cortical Thickness in Patients With Persistent Post‐Traumatic Headache Compared With Healthy Controls: An MRI Study

Diagnostic Problems in Diffuse Axonal Injury

Preliminary evidence from a prospective DTI study suggests a posterior‐to‐anterior pattern of recovery in college athletes with sports‐related concussion

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