Impaired cognitive functions in mild traumatic brain injury patients with normal and pathologic magnetic resonance imaging

Clinic of Neurology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovak Republic.
Neuroradiology (Impact Factor: 2.49). 10/2006; 48(9):661-9. DOI: 10.1007/s00234-006-0109-9
Source: PubMed


Mild traumatic brain injury (MTBI) is a common neurological (neurotraumatological) diagnosis. As well as different subjective symptoms, many patients develop neuropsychological dysfunction with objective impairment of attention, memory and certain executive functions. Magnetic resonance imaging (MRI) is not routinely used in MTBI patients despite its proven greater sensitivity and specificity in comparison with computed tomography (CT).
The patient group consisted of 30 persons with MTBI and the control group consisted of 30 sex- and age-matched healthy volunteers. Both groups underwent neurological examination, neuropsychological testing (including the Postconcussion Symptoms Scale questionnaire, PCSS) and brain MRI (the patient group within 96 h after injury).
The analyzed groups did not differ significantly in terms of sex, age, or level or duration of education. MRI pathological findings (traumatic and nonspecific) were present in nine patients. Traumatic lesions were found in seven patients. Nonspecific white matter lesions were found in five healthy controls. There were significant differences between MTBI patients and controls in terms of subjective symptoms (PCSS) and selected neuropsychological tests. Statistically significant neuropsychological differences were found between MTBI patients with true traumatic lesions and MTBI patients with nonspecific lesions.
There is evidence that MTBI patients with true traumatic MRI lesions are neuropsychologically different from MTBI patients with nonspecific MRI lesions or normal brain MRI. These results support the hypothesis that some acute MTBI signs and symptoms have a real organic basis which can be detected by selected new MRI modalities.

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Available from: Pavol Kucera, Oct 29, 2014
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    • "However, the results from a series of studies are mixed. As a group, patients with complicated MTBIs perform more poorly on neuropsychological tests in the first two months following injury [1] [2] [3] [4] [5] [6]. These differences appear to diminish by six months following injury [7] [8]. "
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    ABSTRACT: Objective . To compare acute outcome following complicated versus uncomplicated mild traumatic brain injury (MTBI) using neurocognitive and self-report measures. Method . Participants were 47 patients who presented to the emergency department of Tampere University Hospital, Finland. All completed MRI scanning, self-report measures, and neurocognitive testing at 3-4 weeks after injury. Participants were classified into the complicated MTBI or uncomplicated MTBI group based on the presence/absence of intracranial abnormality on day-of-injury CT scan or 3-4 week MRI scan. Results . There was a large statistically significant difference in time to return to work between groups. The patients with uncomplicated MTBIs had a median of 6.0 days (IQR = 0.75–14.75, range = 0–77) off work compared to a median of 36 days (IQR = 13.5–53, range = 3–315) for the complicated group. There were no significant differences between groups for any of the neurocognitive or self-report measures. There were no differences in the proportion of patients who (a) met criteria for ICD-10 postconcussional disorder or (b) had multiple low scores on the neurocognitive measures. Conclusion . Patients with complicated MTBIs took considerably longer to return to work. They did not perform more poorly on neurocognitive measures or report more symptoms, at 3-4 weeks after injury compared to patients with uncomplicated MTBIs.
    04/2012; 2012(3):415740. DOI:10.1155/2012/415740
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    • "For a comprehensive review of the neuropathology of TBI the reader is directed to Graham and Lantos (2002). At the mildest end of the TBI spectrum, the term 'concussion' has long been used to describe this injury (Ropper and Gorson 2007) where the majority of concussed individuals show a rapid and what ostensibly appears to be complete recovery, although cognitive and behavioral sequelae persist in some (Kurca et al. 2006; Konrad et al. 2010; Maruta et al. 2010; Ponsford et al. 2011). The mechanisms of how transient deformation of neural tissue in mTBI can induce short-lived changes in axonal physiology yet allow recovery have been discussed by Barkhoudarian et al. (2011), Biasca and Maxwell (2007) and Giza and Hovda (2001). "
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    ABSTRACT: Neuroimaging identified abnormalities associated with traumatic brain injury (TBI) are but gross indicators that reflect underlying trauma-induced neuropathology at the cellular level. This review examines how cellular pathology relates to neuroimaging findings with the objective of more closely relating how neuroimaging findings reveal underlying neuropathology. Throughout this review an attempt will be made to relate what is directly known from post-mortem microscopic and gross anatomical studies of TBI of all severity levels to the types of lesions and abnormalities observed in contemporary neuroimaging of TBI, with an emphasis on mild traumatic brain injury (mTBI). However, it is impossible to discuss the neuropathology of mTBI without discussing what occurs with more severe injury and viewing pathological changes on some continuum from the mildest to the most severe. Historical milestones in understanding the neuropathology of mTBI are reviewed along with implications for future directions in the examination of neuroimaging and neuropathological correlates of TBI.
    Brain Imaging and Behavior 03/2012; 6(2):108-36. DOI:10.1007/s11682-011-9145-0 · 4.60 Impact Factor
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    • "These symptoms comprise the so-called post-concussive syndrome and can affect, to various degrees, everyday life, resolving spontaneously within 7–10 days post-injury in the majority of cases. It is generally believed that the pathobiology of mild TBI in concussed subjects cannot be delineated by classical imaging techniques such as CT scan and MRI (Kurca et al., 2006). This fact, coupled with the faintness and variability of symptoms, mainly assessed by the patient's self-evaluation, is not of help in diagnosing and monitoring concussed patients. "
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    ABSTRACT: Concussive head injury opens a temporary window of brain vulnerability due to the impairment of cellular energetic metabolism. As experimentally demonstrated, a second mild injury occurring during this period can lead to severe brain damage, a condition clinically described as the second impact syndrome. To corroborate the validity of proton magnetic resonance spectroscopy in monitoring cerebral metabolic changes following mild traumatic brain injury, apart from the magnetic field strength (1.5 or 3.0 T) and mode of acquisition, we undertook a multicentre prospective study in which a cohort of 40 athletes suffering from concussion and a group of 30 control healthy subjects were admitted. Athletes (aged 16-35 years) were recruited and examined at three different institutions between September 2007 and June 2009. They underwent assessment of brain metabolism at 3, 15, 22 and 30 days post-injury through proton magnetic resonance spectroscopy for the determination of N-acetylaspartate, creatine and choline-containing compounds. Values of these representative brain metabolites were compared with those observed in the group of non-injured controls. Comparison of spectroscopic data, obtained in controls using different field strength and/or mode of acquisition, did not show any difference in the brain metabolite ratios. Athletes with concussion exhibited the most significant alteration of metabolite ratios at Day 3 post-injury (N-acetylaspartate/creatine: -17.6%, N-acetylaspartate/choline: -21.4%; P < 0.001 with respect to controls). On average, metabolic disturbance gradually recovered, initially in a slow fashion and, following Day 15, more rapidly. At 30 days post-injury, all athletes showed complete recovery, having metabolite ratios returned to values detected in controls. Athletes self-declared symptom clearance between 3 and 15 days after concussion. Results indicate that N-acetylaspartate determination by proton magnetic resonance spectroscopy represents a non-invasive tool to accurately measure changes in cerebral energy metabolism occurring in mild traumatic brain injury. In particular, this metabolic evaluation may significantly improve, along with other clinical assessments, the management of athletes suffering from concussion. Further studies to verify the effects of a second concussive event occurring at different time points of the recovery curve of brain metabolism are needed.
    Brain 11/2010; 133(11):3232-42. DOI:10.1093/brain/awq200 · 9.20 Impact Factor
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