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Abstract

Background: Despite normal CT imaging and neurologic functioning, many individuals report postconcussion symptoms following mild traumatic brain injury (MTBI). This dissociation has been enigmatic for clinicians and investigators.
Methods: Diffusion tensor imaging tractography of the corpus callosum was performed in 10 adolescents (14 to 19 years of age) with MTBI 1 to 6 days postinjury with Glasgow Coma Scale score of 15 and negative CT, and 10 age- and gender-equivalent uninjured controls. Subjects were administered the Rivermead Post Concussion Symptoms Questionnaire and the Brief Symptom Inventory to assess self-reported cognitive, affective, and somatic symptoms.
Results: The MTBI group demonstrated increased fractional anisotropy and decreased apparent diffusion coefficient and radial diffusivity, and more intense postconcussion symptoms and emotional distress compared to the control group. Increased fractional anisotropy and decreased radial diffusivity were correlated with severity of postconcussion symptoms in the MTBI group, but not in the control group.
Conclusions: In adolescents with mild traumatic brain injury (MTBI) with Glasgow Coma Scale score of 15 and negative CT, diffusion tensor imaging (DTI) performed within 6 days postinjury showed increased fractional anisotropy and decreased diffusivity suggestive of cytotoxic edema. Advanced MRI-based DTI methods may enhance our understanding of the neuropathology of TBI, including MTBI. Additionally, DTI may prove more sensitive than conventional imaging methods in detecting subtle, but clinically meaningful, changes following MTBI and may be critical in refining MTBI diagnosis, prognosis, and management.

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REFERENCES

1.
The Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine. Definition of mild traumatic brain injury. J Head Trauma Rehabil 1993;8:86–87.
2.
Langlois JA, Kegler SR, Butler JA, et al. Traumatic brain injury-related hospital discharges: results from a 14-state surveillance system, 1997. MMWR Surveill Summ 2003;52:1–20.
3.
Carroll LJ, Cassidy JD, Peloso PM, et al. Prognosis for mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Journal of Rehabilitation Medicine 2004;36:84–105.
4.
Iverson GL. Outcome from mild traumatic brain injury. Curr Opin Psychiatry 2005;18:301–317.
5.
McCauley SR, Boake C, Levin HS, Contant CF, Song JX. Postconcussional disorder following mild to moderate traumatic brain injury: anxiety, depression, and social support as risk factors and comorbidities. J Clin Exp Neuropsychol 2001;23:792–808.
6.
Alexander MP. Neuropsychiatric correlates of persistent postconcussive syndrome. J Head Trauma Rehabil 1992;7:60–69.
7.
Oppenheimer DR. Microscopic lesions in the brain following head injury. J Neurol Neurosurg Psychiatry 1968;31:299–306.
8.
Blumbergs PC, Scott G, Manavis J, Wainwright H, Simpson DA, McLean AJ. Topography of axonal injury as defined by amyloid precursor protein and the sector scoring method in mild and severe closed head injury. J Neurotrauma 1995;12:565–572.
9.
Mathias JL, Beall JA, Bigler ED. Neuropsychological and information processing deficits following mild traumatic brain injury. J Int Neuropsychol Soc 2004;10:286–297.
10.
Arfanakis K, Haughton VM, Carew JD, Rogers BP, Dempsey RJ, Meyerand ME. Diffusion tensor MR imaging in diffuse axonal injury. AJNR Am J Neuroradiol 2002;23:794–802.
11.
Xu J, Rasmussen IA, Lagopoulos J, Haberg A. Diffuse axonal injury in severe traumatic brain injury visualized using high-resolution diffusion tensor imaging. J Neurotrauma 2007;24:753–765.
12.
Alexander AL, Lee JE, Lazar M, Field AS. Diffusion Tensor Imaging of the Brain. Neurotherapeutics 2007;4:316–329.
13.
Povlishock JT, Katz DI. Update of neuropathology and neurological recovery after traumatic brain injury. J Head Trauma Rehabil 2005;20:76–94.
14.
Inglese M, Makani S, Johnson G, et al. Diffuse axonal injury in mild traumatic brain injury: a diffusion tensor imaging study. J Neurosurg 2005;103:298–303.
15.
Rugg-Gunn FJ, Symms MR, Barker GJ, Greenwood R, Duncan JS. Diffusion imaging shows abnormalities after blunt head trauma when conventional magnetic resonance imaging is normal. J Neurol Neurosurg Psychiatry 2001;70:530–533.
16.
Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet 1974;2:81–84.
17.
Huisman TA, Schwamm LH, Schaefer PW, et al. Diffusion tensor imaging as potential biomarker of white matter injury in diffuse axonal injury. AJNR Am J Neuroradiol 2004;25:370–376.
18.
Levin HS, O'Donnell VM, Grossman RG. The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis 1979;167:675–684.
19.
Barona A, Reynolds CR, Chastain R. A demographically based index of premorbid intelligence for the WAIS–R. J Consult Clin Psychol 1984;52:885–887.
20.
Jones DK, Horsfield MA, Simmons A. Optimal strategies for measuring diffusion in anisotropic systems by magnetic resonance imaging. Magn Reson Med 1999;42:515–525.
21.
Netsch T, van Muiswinkel A. Quantitative evaluation of image-based distortion correction in diffusion tensor imaging. IEEE Trans Med Imaging 2004;23:789–798.
22.
Haacke EM, Xu Y, Cheng YC, Reichenbach JR. Susceptibility weighted imaging (SWI). Magn Reson Med 2004;52:612–618.
23.
Wilde EA, Chu Z, Bigler ED, et al. Diffusion tensor imaging in the corpus callosum in children after moderate to severe traumatic brain injury. J Neurotrauma 2006;23:1412–1426.
24.
King NS, Crawford S, Wenden FJ, Moss NE, Wade DT. The Rivermead Post Concussion Symptoms Questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. J Neurol 1995;242:587–592.
25.
Derogatis LR. Brief Symptom Inventory (BSI): Administration, Scoring, and Procedures Manual. Minneapolis: NCS Pearson, Inc., 1993.
26.
Smith-Seemiller L, Fow NR, Kant R, Franzen MD. Presence of post-concussion syndrome symptoms in patients with chronic pain vs mild traumatic brain injury. Brain Injury 2003;17:199–206.
27.
Barzo P, Marmarou A, Fatouros P, Hayasaki K, Corwin F. Contribution of vasogenic and cellular edema to traumatic brain swelling measured by diffusion-weighted imaging. J Neurosurg 1997;87:900–907.
28.
Marmarou A, Signoretti S, Fatouros PP, Portella G, Aygok GA, Bullock MR. Predominance of cellular edema in traumatic brain swelling in patients with severe head injuries. J Neurosurg 2006;104:720–730.
29.
Liu AY, Maldjian JA, Bagley LJ, Sinson GP, Grossman RI. Traumatic brain injury: diffusion-weighted MR imaging findings. AJNR Am J Neuroradiol 1999;20:1636–1641.
30.
Gallucci M, Limbucci N, Paonessa A, Caranci F. Reversible focal splenial lesions. Neuroradiol 2007;49:541–544.
31.
Kallenberg K, Bailey DM, Christ S, et al. Magnetic resonance imaging evidence of cytotoxic cerebral edema in acute mountain sickness. J Cereb Blood Flow Metab 2007;27:1064–1071.
32.
Benson RR, Meda SA, Vasudevan S, et al. Global white matter analysis of diffusion tensor images is predictive of injury severity in traumatic brain injury. J Neurotrauma 2007;24:446–459.
33.
Newcombe VF, Williams GB, Nortje J, et al. Analysis of acute traumatic axonal injury using diffusion tensor imaging. Br J Neurosurg 2007;21:340–348.
34.
Field AS, Hasan K, Jellison BJ, Arfanakis K, Alexander AL. Diffusion tensor imaging in an infant with traumatic brain swelling. AJNR Am J Neuroradiol 2003;24:1461–1464.
35.
Green HA, Pena A, Price CJ, et al. Increased anisotropy in acute stroke: a possible explanation. Stroke 2002;33:1517–1521.
36.
Bhagat YA, Emery DJ, Shuaib A, et al. The relationship between diffusion anisotropy and time of onset after stroke. J Cereb Blood Flow Metab 2006;26:1442–1450.
37.
Ito J, Marmarou A, Barzo P, Fatouros P, Corwin F. Characterization of edema by diffusion-weighted imaging in experimental traumatic brain injury. J Neurosurg 1996;84:97–103.
38.
Marmarou A. Traumatic brain edema: an overview. Acta Neurochir Suppl (Wien) 1994;60:421–424.
39.
Adams JH, Graham DI, Murray LS, Scott G. Diffuse axonal injury due to nonmissile head injury in humans: an analysis of 45 cases. Ann Neurol 1982;12:557–563.
40.
Viano DC, Casson IR, Pellman EJ, Zhang L, King AI, Yang KH. Concussion in professional football: brain responses by finite element analysis: part 9. Neurosurgery 57:891–916, 2005; discussion 891–916.
41.
Mendelsohn DB, Levin HS, Harward H, Bruce D. Corpus callosum lesions after closed head injury in children: MRI, clinical features and outcome. Neuroradiol 1992;34:384–388.
42.
Hortobagyi T, Wise S, Hunt N, et al. Traumatic axonal damage in the brain can be detected using beta-APP immunohistochemistry within 35 min after head injury to human adults. Neuropathol Appl Neurobiol 2007;33:226–237.
43.
Kochanek PM, Clark RS, Ruppel RA, et al. Biochemical, cellular, and molecular mechanisms in the evolution of secondary damage after severe traumatic brain injury in infants and children: Lessons learned from the bedside. Pediatr Crit Care Med 2000;1:4–19.

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Published In

Neurology®
Volume 70Number 12March 18, 2008
Pages: 948-955
PubMed: 18347317

Publication History

Published online: March 17, 2008
Published in print: March 18, 2008

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Authors

Affiliations & Disclosures

E. A. Wilde, PhD
From the Physical Medicine and Rehabilitation Alliance of Baylor College of Medicine and the University of Texas–Houston Medical School (E.A.W., S.R.M., G.R.H., M.T., R.Y., X.L., H.S.L.); Department of Radiology (J.V.H., Z.C., Z.J.W.), Baylor College of Medicine, Houston, TX; E.B. Singleton Department of Diagnostic Imaging (J.V.H.), Texas Children's Hospital, Houston; Departments of Psychology (E.D.B.) and Neuroscience (E.D.B.), Brigham Young University, Provo, UT; Department of Psychiatry (E.D.B.) and the Utah Brain Institute (E.D.B.), University of Utah; and Philips Medical Systems (J.C.), Cleveland, OH.
S. R. McCauley, PhD
From the Physical Medicine and Rehabilitation Alliance of Baylor College of Medicine and the University of Texas–Houston Medical School (E.A.W., S.R.M., G.R.H., M.T., R.Y., X.L., H.S.L.); Department of Radiology (J.V.H., Z.C., Z.J.W.), Baylor College of Medicine, Houston, TX; E.B. Singleton Department of Diagnostic Imaging (J.V.H.), Texas Children's Hospital, Houston; Departments of Psychology (E.D.B.) and Neuroscience (E.D.B.), Brigham Young University, Provo, UT; Department of Psychiatry (E.D.B.) and the Utah Brain Institute (E.D.B.), University of Utah; and Philips Medical Systems (J.C.), Cleveland, OH.
J. V. Hunter, MD
From the Physical Medicine and Rehabilitation Alliance of Baylor College of Medicine and the University of Texas–Houston Medical School (E.A.W., S.R.M., G.R.H., M.T., R.Y., X.L., H.S.L.); Department of Radiology (J.V.H., Z.C., Z.J.W.), Baylor College of Medicine, Houston, TX; E.B. Singleton Department of Diagnostic Imaging (J.V.H.), Texas Children's Hospital, Houston; Departments of Psychology (E.D.B.) and Neuroscience (E.D.B.), Brigham Young University, Provo, UT; Department of Psychiatry (E.D.B.) and the Utah Brain Institute (E.D.B.), University of Utah; and Philips Medical Systems (J.C.), Cleveland, OH.
E. D. Bigler, PhD
From the Physical Medicine and Rehabilitation Alliance of Baylor College of Medicine and the University of Texas–Houston Medical School (E.A.W., S.R.M., G.R.H., M.T., R.Y., X.L., H.S.L.); Department of Radiology (J.V.H., Z.C., Z.J.W.), Baylor College of Medicine, Houston, TX; E.B. Singleton Department of Diagnostic Imaging (J.V.H.), Texas Children's Hospital, Houston; Departments of Psychology (E.D.B.) and Neuroscience (E.D.B.), Brigham Young University, Provo, UT; Department of Psychiatry (E.D.B.) and the Utah Brain Institute (E.D.B.), University of Utah; and Philips Medical Systems (J.C.), Cleveland, OH.
Z. Chu, PhD
From the Physical Medicine and Rehabilitation Alliance of Baylor College of Medicine and the University of Texas–Houston Medical School (E.A.W., S.R.M., G.R.H., M.T., R.Y., X.L., H.S.L.); Department of Radiology (J.V.H., Z.C., Z.J.W.), Baylor College of Medicine, Houston, TX; E.B. Singleton Department of Diagnostic Imaging (J.V.H.), Texas Children's Hospital, Houston; Departments of Psychology (E.D.B.) and Neuroscience (E.D.B.), Brigham Young University, Provo, UT; Department of Psychiatry (E.D.B.) and the Utah Brain Institute (E.D.B.), University of Utah; and Philips Medical Systems (J.C.), Cleveland, OH.
Z. J. Wang, PhD
From the Physical Medicine and Rehabilitation Alliance of Baylor College of Medicine and the University of Texas–Houston Medical School (E.A.W., S.R.M., G.R.H., M.T., R.Y., X.L., H.S.L.); Department of Radiology (J.V.H., Z.C., Z.J.W.), Baylor College of Medicine, Houston, TX; E.B. Singleton Department of Diagnostic Imaging (J.V.H.), Texas Children's Hospital, Houston; Departments of Psychology (E.D.B.) and Neuroscience (E.D.B.), Brigham Young University, Provo, UT; Department of Psychiatry (E.D.B.) and the Utah Brain Institute (E.D.B.), University of Utah; and Philips Medical Systems (J.C.), Cleveland, OH.
G. R. Hanten, PhD
From the Physical Medicine and Rehabilitation Alliance of Baylor College of Medicine and the University of Texas–Houston Medical School (E.A.W., S.R.M., G.R.H., M.T., R.Y., X.L., H.S.L.); Department of Radiology (J.V.H., Z.C., Z.J.W.), Baylor College of Medicine, Houston, TX; E.B. Singleton Department of Diagnostic Imaging (J.V.H.), Texas Children's Hospital, Houston; Departments of Psychology (E.D.B.) and Neuroscience (E.D.B.), Brigham Young University, Provo, UT; Department of Psychiatry (E.D.B.) and the Utah Brain Institute (E.D.B.), University of Utah; and Philips Medical Systems (J.C.), Cleveland, OH.
M. Troyanskaya, MD
From the Physical Medicine and Rehabilitation Alliance of Baylor College of Medicine and the University of Texas–Houston Medical School (E.A.W., S.R.M., G.R.H., M.T., R.Y., X.L., H.S.L.); Department of Radiology (J.V.H., Z.C., Z.J.W.), Baylor College of Medicine, Houston, TX; E.B. Singleton Department of Diagnostic Imaging (J.V.H.), Texas Children's Hospital, Houston; Departments of Psychology (E.D.B.) and Neuroscience (E.D.B.), Brigham Young University, Provo, UT; Department of Psychiatry (E.D.B.) and the Utah Brain Institute (E.D.B.), University of Utah; and Philips Medical Systems (J.C.), Cleveland, OH.
R. Yallampalli, BS
From the Physical Medicine and Rehabilitation Alliance of Baylor College of Medicine and the University of Texas–Houston Medical School (E.A.W., S.R.M., G.R.H., M.T., R.Y., X.L., H.S.L.); Department of Radiology (J.V.H., Z.C., Z.J.W.), Baylor College of Medicine, Houston, TX; E.B. Singleton Department of Diagnostic Imaging (J.V.H.), Texas Children's Hospital, Houston; Departments of Psychology (E.D.B.) and Neuroscience (E.D.B.), Brigham Young University, Provo, UT; Department of Psychiatry (E.D.B.) and the Utah Brain Institute (E.D.B.), University of Utah; and Philips Medical Systems (J.C.), Cleveland, OH.
X. Li, MS
From the Physical Medicine and Rehabilitation Alliance of Baylor College of Medicine and the University of Texas–Houston Medical School (E.A.W., S.R.M., G.R.H., M.T., R.Y., X.L., H.S.L.); Department of Radiology (J.V.H., Z.C., Z.J.W.), Baylor College of Medicine, Houston, TX; E.B. Singleton Department of Diagnostic Imaging (J.V.H.), Texas Children's Hospital, Houston; Departments of Psychology (E.D.B.) and Neuroscience (E.D.B.), Brigham Young University, Provo, UT; Department of Psychiatry (E.D.B.) and the Utah Brain Institute (E.D.B.), University of Utah; and Philips Medical Systems (J.C.), Cleveland, OH.
J. Chia, MS
From the Physical Medicine and Rehabilitation Alliance of Baylor College of Medicine and the University of Texas–Houston Medical School (E.A.W., S.R.M., G.R.H., M.T., R.Y., X.L., H.S.L.); Department of Radiology (J.V.H., Z.C., Z.J.W.), Baylor College of Medicine, Houston, TX; E.B. Singleton Department of Diagnostic Imaging (J.V.H.), Texas Children's Hospital, Houston; Departments of Psychology (E.D.B.) and Neuroscience (E.D.B.), Brigham Young University, Provo, UT; Department of Psychiatry (E.D.B.) and the Utah Brain Institute (E.D.B.), University of Utah; and Philips Medical Systems (J.C.), Cleveland, OH.
H. S. Levin, PhD
From the Physical Medicine and Rehabilitation Alliance of Baylor College of Medicine and the University of Texas–Houston Medical School (E.A.W., S.R.M., G.R.H., M.T., R.Y., X.L., H.S.L.); Department of Radiology (J.V.H., Z.C., Z.J.W.), Baylor College of Medicine, Houston, TX; E.B. Singleton Department of Diagnostic Imaging (J.V.H.), Texas Children's Hospital, Houston; Departments of Psychology (E.D.B.) and Neuroscience (E.D.B.), Brigham Young University, Provo, UT; Department of Psychiatry (E.D.B.) and the Utah Brain Institute (E.D.B.), University of Utah; and Philips Medical Systems (J.C.), Cleveland, OH.

Notes

Address correspondence and reprint requests to Dr. Elisabeth A. Wilde, Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, 1709 Dryden Rd., Ste. 725, Houston, TX 77025 [email protected]

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