Research Reports - Longitudinal and prognostic evaluation of mild traumatic brain injury

J Neurotrauma. 2014 Jan 27

George EO, Roys SR, Sours C, Rosenberg J, Zhuo J, Shanmuganathan K, Gullapalli RP

In the majority of mild traumatic brain injury (mTBI) cases, brain tissue
impairment is undetectable by computed tomography and/or structural magnetic
resonance imaging (MRI). Even in confirmed cases of head injury, conventional
neuroimaging methods lack sensitivity in predicting neuropsychological outcomes
of patients. The objectives of this study were to (i) cross-sectionally determine
deviations in the neurometabolic profile of mTBI patients from healthy controls
at different stages of mTBI using tightly controlled examination windows (ii)
determine associations between acute neurometabolic markers of mTBI and chronic
neurocognitive performance. Patients were examined at the early sub-acute (n=43;
5.44+3.15 days post injury (DPI)), late sub-acute (n=33; 37.00+12.26 DPI) and
chronic (n=27; 195.30+19.60 DPI) stages of mTBI. Twenty-one neurologically intact
subjects were used as controls. Proton magnetic resonance spectroscopy imaging
(1H-MRSI) was used to obtain metabolic measurements from different brain regions.
The Automated Neuropsychological Assessment Metrics (ANAM) was used for cognitive
evaluation of patients at the chronic stage of mTBI. Measurements in the thalamus
and centrum semiovale (CSV) emerged as the most indicative of injury and were
used to predict neurocognitive outcome. The major findings of this study are (i)
decreases in Cho/Cre (choline-to-creatine ratio) measured in the thalamus
(p=0.042) and CSV (p=0.017) at the late sub-acute stage of mTBI (ii) positive
associations of early sub-acute Cre measurements in the CSV with chronic ANAM
scores measuring performance in delayed (r=0.497, p=0.019) and immediate
(r=0.391, p=0.072) code substitution. These findings show that metabolic
measurements in the thalamus and CSV can potentially serve as diagnostic and
prognostic markers of mTBI.

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