Longitudinal changes in brain volumetry and cognitive functions after moderate and severe diffuse axonal injury

Feltrin, Fabrício Stewan; Zaninotto, Ana Luiza; Guirado, Vinícius Monteiro de Paula; Macruz, Fabíola Bezerra de Carvalho; Sakuno, Daniel; Dalaqua, Mariana; Magalhaes, Luiz Gustavo Antunes; Paiva, Wellingson Silva; Andrade, Almir Ferreira de; Otaduy, Maria Concepción García; Leite, Cláudia C.

doi:10.1080/02699052.2018.1494852

Cited by 17 publications

(16 citation statements)

References 69 publications

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“…[17] SWI was utilized to document an association between total DAI lesion burden and white matter atrophy at 1 year in patients with moderate to severe DAI, although these patients were able to improve their cognitive functioning with rehabilitation. [18] As imaging techniques continue to be refined and the data they generate are analyzed with regard to prognosis, MRI may play a larger role in the clinical management of comatose patients with severe TBI and DAI. The blanket description of Grade 3 for brainstem DAI lesions was of concern in this study as several patients initially assessed as Grade 3 DAI regained consciousness with GCS of 15 before hospital discharge.…”

Section: Discussionmentioning

confidence: 99%

Brainstem Diffuse Axonal Injury and Consciousness

Sandhu

Soule

Fiester

et al. 2019

JCIS

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Background: Severe traumatic brain injuries (TBI), commonly due to motor vehicle accidents may cause death and long-term disability especially when the acceleration-deceleration force on the brain is massive. This may cause shearing of the axonal connections within the cerebral cortex and brainstem in a process referred to as diffuse axonal injury (DAI). Extensive DAI has been postulated to be a poor prognostic indicator for neurological recovery. In our institution, several patients with Grade 3 DAI were observed to recover and achieve neurological outcomes greater than expected given the presence of brainstem injury. Methods: MRI studies from 100 patients admitted to a large tertiary trauma center for TBI were retrospectively analyzed by two fellowship-trained neuroradiologists. The size of DAI lesions, location of injury within the brainstem, and the number of discrete DAI lesions were measured and recorded. Glasgow Coma Scale (GCS) on arrival and at discharge was noted, as well as the presence of other neurological injuries. Results: Of 20 patients initially noted to have DAI with lesions of the brainstem, eight of them were discharged with Glasgow Coma Scale (GCS) of 14–15. The 12 patients discharged with reduced consciousness (average GC 7.1) demonstrated a greater number of larger lesions, with a predilection for the dorsal pons. Conclusion: These results suggest that large, numerous pontine lesions may indicate worse neurological outcomes in patients with these findings.

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Section: Discussionmentioning

confidence: 99%

Brainstem Diffuse Axonal Injury and Consciousness

Sandhu

Soule

Fiester

et al. 2019

JCIS

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“…Recent evidence suggests that traumatic brain injury (TBI)—one of the leading causes of death and disability worldwide—leads to greater ‘brain age’ ( Cole et al, 2015 , Gan et al, 2021 ). Atrophy of grey and white matter, alongside other pathological processes, may drive elevated ‘brain age’ in TBI ( Savjani et al, 2017 , Feltrin et al, 2018 , Graham and Sharp, 2019 , Harris et al, 2019 ). Establishing whether TBI leads to a ‘one-off’ loss in cellular volume, progressive, or accelerated ‘brain age’ is of considerable importance to the field and has significant ramifications for patient management.…”

Section: Introductionmentioning

confidence: 99%

“…Traumatic brain injury results in loss of grey and white brain matter ( Raz et al, 1997 , Fjell et al, 2009 , Douaud et al, 2014 ). However, given that some studies have found progressive loss of brain volume, it has been postulated that TBI may also lead to ongoing, accelerated, ‘brain age’ ( Sidaros et al, 2009 , Cole et al, 2018 , Feltrin et al, 2018 , Harris et al, 2019 ). Progressive changes in brain structure following TBI may be further exacerbated over time through interaction with the neurobiological processes of ageing.…”

Section: Introductionmentioning

confidence: 99%

Brain age in chronic traumatic brain injury

Spitz

Hicks

Roberts

et al. 2022

NeuroImage: Clinical

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“…The present study is the first randomized clinical trial to investigate anxiety outcomes after 10 consecutive sessions of high-frequency rTMS in patients with chronic moderate to severe TBI. Due to the high incidence of diffuse lesions in moderate to severe TBI and the widespread non-specific brain lesion damage location (9,67,68), this is an excellent population to investigate the efficacy of rTMS intervention on anxiety symptoms. This study is the result of a post-hoc analysis of a clinical trial that evaluated the effects of rTMS on attention and executive functions (66).…”

Section: Introductionmentioning

confidence: 99%

The Effects of Repetitive Transcranial Magnetic Stimulation on Anxiety in Patients With Moderate to Severe Traumatic Brain Injury: A Post-hoc Analysis of a Randomized Clinical Trial

et al. 2020

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Background: Traumatic brain injury (TBI) is one of the leading causes of neuropsychiatric disorders in young adults. Repetitive Transcranial Magnetic Stimulation (rTMS) has been shown to improve psychiatric symptoms in other neurologic disorders, such as focal epilepsy, Parkinson's disease, and fibromyalgia. However, the efficacy of rTMS as a treatment for anxiety in persons with TBI has never been investigated. This exploratory post-hoc analyzes the effects of rTMS on anxiety, depression and executive function in participants with moderate to severe chronic TBI.Methods: Thirty-six participants with moderate to severe TBI and anxiety symptoms were randomly assigned to an active or sham rTMS condition in a 1:1 ratio. A 10-session protocol was used with 10-Hz rTMS stimulation over the left dorsolateral prefrontal cortex (DLPFC) for 20 min each session, a total of 2,000 pulses were applied at each daily session (40 stimuli/train, 50 trains). Anxiety symptoms; depression and executive function were analyzed at baseline, after the last rTMS session, and 90 days post intervention.Results: Twenty-seven participants completed the entire protocol and were included in the post-hoc analysis. Statistical analysis showed no interaction of group and time (p > 0.05) on anxiety scores. Both groups improved depressive and executive functions over time, without time and group interaction (ps < 0.05). No adverse effects were reported in either intervention group.Conclusion: rTMS did not improve anxiety symptoms following high frequency rTMS in persons with moderate to severe TBI.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02167971.

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Longitudinal changes in brain volumetry and cognitive functions after moderate and severe diffuse axonal injury

Abstract: Our findings suggest that MHL may be a predictor of WMV reduction but cannot predict EF or EVM in DAI. Brain atrophy progresses over time, but patients showed better EF and EVM in some of the tests, which could be due to neuroplasticity.

Cited by 17 publications

References 69 publications

Brainstem Diffuse Axonal Injury and Consciousness

Brainstem Diffuse Axonal Injury and Consciousness

Brain age in chronic traumatic brain injury

The Effects of Repetitive Transcranial Magnetic Stimulation on Anxiety in Patients With Moderate to Severe Traumatic Brain Injury: A Post-hoc Analysis of a Randomized Clinical Trial

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