Microbleeds may expand acutely after traumatic brain injury

Tóth, Arnold; Kovács, Noémi; Tamás, Viktória; Kornyei, Balint; Nagy, Mária; Horváth, Adrienn; Rostás, Tamás; Bogner, Péter; Janszky, József; Dóczi, Tamás; Büki, András; Schwarcz, Attila

doi:10.1016/j.neulet.2016.02.028

Cited by 32 publications

(32 citation statements)

References 31 publications

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“…Here, we report diffuse cortical microhemorrhages on SWI 1 week post‐rmCHI, confirmed histopathologically with positive Prussian blue reaction products in the cortical neuropil of injured animals. Clinically, the number, localization, type, and magnitude of microhemorrhage are associated with severity of injury and prognostication of functional outcome at 6–12 months (L. Liu et al, ; S. Liu et al, ; Toth et al, ). The number and extent of microbleeds is dynamic, however (Toth et al, ), emphasizing the importance of longitudinal and noninvasive SWI assessment of hemorrhage concomitant with clinical signs.…”

Section: Discussionmentioning

confidence: 99%

“…Clinically, the number, localization, type, and magnitude of microhemorrhage are associated with severity of injury and prognostication of functional outcome at 6–12 months (L. Liu et al, ; S. Liu et al, ; Toth et al, ). The number and extent of microbleeds is dynamic, however (Toth et al, ), emphasizing the importance of longitudinal and noninvasive SWI assessment of hemorrhage concomitant with clinical signs. Prussian blue detects hemosiderin deposits at a cellular level in sections 4–6‐μm thin, allowing for much greater resolution of reactive blood products.…”

Section: Discussionmentioning

confidence: 99%

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Microstructural and microglial changes after repetitive mild traumatic brain injury in mice

Robinson

Berglass

Denson

et al. 2016

J of Neuroscience Research

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Traumatic brain injury (TBI) is a major public health issue, with recent increased awareness of the potential long-term sequelae of repetitive injury. While TBI is common, objective diagnostic tools with sound neurobiological predictors of outcome are lacking. Indeed, such tools could help identify those at risk for more severe outcomes after repetitive injury and improve understanding of biological underpinnings to provide important mechanistic insights. We tested the hypothesis that acute and subacute pathological injury, including the microgliosis that results from repeated, mild closed head injury, is reflected in susceptibility-weighted magnetic resonance imaging (SWI) and diffusion-tensor imaging (DTI) microstructural abnormalities. Using a combination of high-resolution magnetic resonance imaging (MRI), stereology and qPCR, we studied the pathophysiology of male mice that sustained 7 consecutive mild traumatic brain injuries over 9 days in acute (24 hour) and subacute (1 week) time periods. Repetitive mild closed head injury induced focal cortical microhemorrhages and impaired axial diffusivity at one week post-injury. These microstructural abnormalities were associated with a significant increase in microglia. Notably, microgliosis was accompanied by a change in inflammatory microenvironment, defined by robust spatiotemporal alterations in tumor necrosis factor alpha (TNFα) receptor mRNA. Together, these data contribute novel insight on the fundamental biological processes associated with repeated mild brain injury concomitant with subacute imaging abnormalities in a clinically relevant animal model of repeated mild TBI. These findings suggest new diagnostic techniques can be used as biomarkers to guide the use of future protective or reparative interventions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Microstructural and microglial changes after repetitive mild traumatic brain injury in mice

Robinson

Berglass

Denson

et al. 2016

J of Neuroscience Research

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“…[21] While CT remains the gold standard for the initial evaluation in fast detecting hemorrhages,[22] SWI enhances contrast in hemorrhagic foci and helps depict localization, volume and number of injuries. [22, 23] Size of lesions might appear larger on SWI than on T1 or T2 weighted images because of the susceptibility effect of hemoglobin degradation. SWI has been shown to be more sensitive for evaluation of microhemorrhages in the brainstem and corpus callosum than CT, T2, T2* and FLAIR imaging.…”

Section: Clinical Applicationsmentioning

confidence: 99%

“…[6, 24–26] SWI may be considered as a valuable tool for patient follow-up because imaging methods, like CT and conventional MRI, are less sensitive for evaluating evolving and small hemorrhagic lesions. [23, 27] The number and volume of hemorrhagic lesions have been noted to correlate with Glasgow Coma Scale (GCS) scores, with brainstem lesions correlating especially well with GCS. [25, 26, 28]…”

Section: Clinical Applicationsmentioning

confidence: 99%

Susceptibility-Based Neuroimaging: Standard Methods, Clinical Applications, and Future Directions

et al. 2017

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The evaluation of neuropathologies using MRI methods that leverage tissue susceptibility have become standard practice, especially to detect blood products or mineralization. Additionally, emerging MRI techniques have the ability to provide new information based on tissue susceptibility properties in a robust and quantitative manner. This paper discusses these advanced susceptibility imaging techniques and their clinical applications.

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“…For example, it was believed that trauma‐related microbleeds (also known as hemorrhagic diffuse axonal injuries or shearing injuries) remain more or less constant over years. However, recent evidence suggests that such lesions may decrease overtime (Liu et al ., ), grow (Toth et al ., ) or (temporarily) disappear (Watanabe et al ., ). Moreover, we can assume that some regions might show white matter Wallerian‐type degeneration after brain trauma, while other areas might develop compensatory increasing connectivity.…”

Section: Progressive or Regressive Brain Abnormalities?mentioning

confidence: 99%

Advance MR imaging in sports‐related concussion and mild traumatic brain injury – ready for clinical use? (Commentary on Tremblay et al. 2017)

Haller

2017

Eur J of Neuroscience

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Sports-related concussion -including chronic traumatic encephalopathy in adult professional American football players -has recently attracted considerable interest, even in the general media. The Hollywood movie entitled 'Concussion' is one recent example. Furthermore, discussion about brain abnormalities as a consequence of sports injuries should also include younger players (Bahrami et al., 2016). It remains to be explored how traumatic brain injury in the youth may alter the normal trajectory of brain development. In Europe, more attention is paid to sports-related concussion in the commonly played game of soccer (Koerte et al., 2012;Lipton et al., 2013). Likewise, there is growing interest in brain abnormalities related to mild traumatic brain injury (MTBI) resulting from minor accidents (e.g. whip-lash injury), particularly with respect to medico-legal and insurance-related issues. In both sports-related concussion and MTBI, conventional CT and MR imaging results generally do not reveal clear abnormalities. However, advanced imaging techniques, including diffusion tensor imaging (DTI) (Bahrami et al., 2016) In 'Defining a multimodal signature of remote sports concussions ', Tremblay et al. (2017) used DTI and MRS to characterize white matter changes in aging, retired athletes with a history of sports-related MTBI. Using machine learning approaches, the authors achieved up to 90% accuracy in identifying former athletes on the basis of their white matter profiles. While this research is certainly promising, there are several concerns that require strict and careful consideration before such automated classification techniques can be used clinically. Regional specific pattern of brain abnormalities?Advanced imaging techniques have been used in the domain of neurodegeneration, particularly in Alzheimer's dementia and its prodromal stages, with the same basic aim -to detect subtle brain abnormalities not evident using standard imaging techniques. There is, however, a fundamental difference between trauma-related and neurodegenerative abnormalities. Neurodegenerative diseases typically share common, disease-specific patterns of brain changes. For example, Alzheimer's dementia is characterized by atrophy particularly within the hippocampal and parietal regions, while behavioral variant fronto-temporal dementia is typically associated with a predominantly fronto-temporal atrophy (Haller et al., 2013). For post-traumatic changes, we may assume that some traumatic mechanisms are more common than others, and that trauma-related changes are more or less widespread in the brain. Therefore, trauma-related changes will overlap to a certain degree. However, the individual trauma-related changes are variable depending on the site, direction and velocity of the impact, and consequently trauma-related variability is larger than the more stereotypical neurodegeneration-related brain alterations. This implies that several patterns of trauma-related brain abnormalities should be defined, and the best-suited reference dataset for...

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Microbleeds may expand acutely after traumatic brain injury

Cited by 32 publications

References 31 publications

Microstructural and microglial changes after repetitive mild traumatic brain injury in mice

Microstructural and microglial changes after repetitive mild traumatic brain injury in mice

Susceptibility-Based Neuroimaging: Standard Methods, Clinical Applications, and Future Directions

Advance MR imaging in sports‐related concussion and mild traumatic brain injury – ready for clinical use? (Commentary on Tremblay et al. 2017)

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