Microvascular and large vein abnormalities in young patients after mild head trauma and associated fatigue: A brain SPECT evaluation and posture dependence modeling

Crider, Tiffany; Eng, Derrick; Sarkar, Prakash; Cordero, Janet; Krusz, J.; Sarkar, Subhendra N.

doi:10.1016/j.clineuro.2018.05.019

Cited by 10 publications

(13 citation statements)

References 28 publications

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“…These findings are consistent with a recent systematic review by Kamins et al. 60 which suggested that full recovery of physiological biomarkers may require from months up to more than a year after the resolution of clinical symptoms. Importantly, while differences in both maximal fit and latency to maximal fit were predictive of group membership in a binary logistic regression (90.8%; pmTBI vs. HC), these differences were not associated with persistent processing speed or attention deficits in pmTBI.…”

Section: Discussionsupporting

confidence: 92%

“…This finding potentially emphasizes the further need for a conservative return-to-play/study timeline following pediatric injury. 60 As previous studies have shown hemodynamic changes in response to hypercapnia between pmTBI and HC “upstream” (i.e., middle cerebral artery), 61 it may be difficult to fully disambiguate if any component of the timing of CVR and our observed differences between pmTBI and HC are due to changes within the brain versus leading to the brain.…”

Section: Discussionmentioning

confidence: 86%

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Persistent alterations in cerebrovascular reactivity in response to hypercapnia following pediatric mild traumatic brain injury

Dodd

Wertz

et al. 2020

J Cereb Blood Flow Metab

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Much attention has been paid to the effects of mild traumatic brain injury (mTBI) on cerebrovascular reactivity in adult populations, yet it remains understudied in pediatric injury. In this study, 30 adolescents (12–18 years old) with pediatric mTBI (pmTBI) and 35 age- and sex-matched healthy controls (HC) underwent clinical and neuroimaging assessments during sub-acute (6.9 ± 2.2 days) and early chronic (120.4 ± 11.7 days) phases of injury. Relative to controls, pmTBI reported greater initial post-concussion symptoms, headache, pain, and anxiety, resolving by four months post-injury. Patients reported increased sleep issues and exhibited deficits in processing speed and attention across both visits. In grey-white matter interface areas throughout the brain, pmTBI displayed increased maximal fit/amplitude of a time-shifted end-tidal CO2 regressor to blood oxygen-level dependent response relative to HC, as well as increased latency to maximal fit. The alterations persisted through the early chronic phase of injury, with maximal fit being associated with complaints of ongoing sleep disturbances during post hoc analyses but not cognitive measures of processing speed or attention. Collectively, these findings suggest that deficits in the speed and degree of cerebrovascular reactivity may persist longer than current conceptualizations about clinical recovery within 30 days.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 86%

Persistent alterations in cerebrovascular reactivity in response to hypercapnia following pediatric mild traumatic brain injury

Dodd

Wertz

et al. 2020

J Cereb Blood Flow Metab

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“…Endothelial junctional (tight junction, TJ) proteins play important roles in vascular permeability, and toward in-vitro stretch model of TJ proteins for mild-blast brain trauma [29]. We think the TJ stretch model can be applied to the increased permeability of microvasculature in the frontal and temporal lobes to explain the reduced esterase activity for ECD tracer in mTBI just because there may be greater Red-ox activity post mTBI in this region) [18]. The effects of biaxial stretch were characterized at 5, 10, 15, 25, and 50% deformation (mild to moderate in trauma scale in the stretch model) that induced a deformation-dependent increase in LDH release, cell death, and activation of caspase 3/7, suggesting the induction of apoptosis.…”

Section: Oxidative Stress and Effects Of Mtbi On Endothelial Tight Junctionsmentioning

confidence: 99%

“…The conversion from acute to chronic symptoms in TBI that accompanies fatigue among young patients [15] requires further study. Similarly, the local blood-brain barrier (BBB) disruption in the microvasculature [16] and the distal spread of injury due to the cerebral vulnerability as demonstrated in minor blast-induced TBI [17] are inadequate to create a mechanistic model as claimed by radiotracer imaging [18].…”

Section: Introductionmentioning

confidence: 99%

Suitability of Neuroimaging in Diagnosis of Sleep, Fatigue, Perfusion and Metabolite Deficits after Mild Traumatic Brain Injury

Sarkar

2020

ANN

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“…Furthermore, there are also indications that alterations of the CBF are associated with persistent symptoms and impaired cognitive functioning [ 7 ]. Meanwhile, several resting-state CBF alterations have been associated with the core clinical cognitive impairments symptoms of mTBI [ 8 , 9 ]. Although SPECT, PET, and arterial spin labeling (ASL) can all evaluate brain hemodynamics, SPECT and PET are nuclear medicine techniques that require using invasive radioactive tracers, which limit repeated testing.…”

Section: Introductionmentioning

confidence: 99%

Cerebral Blood Flow and Its Connectivity Deficits in Mild Traumatic Brain Injury at the Acute Stage

Shang

et al. 2020

Neural Plasticity

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Objective. The influence of cognitive impairment after mild traumatic brain injury (mTBI) on cerebral vascular perfusion has been widely concerned, yet the resting-state cerebral blood flow (CBF) connectivity alterations based on arterial spin labeling (ASL) in mild traumatic brain injury (mTBI) remain unclear. This study investigated region CBF and CBF connectivity features in acute mTBI patients, as well as the associations between CBF changes and cognitive impairment. Materials and Methods. Forty-five acute mTBI patients and 42 health controls underwent pseudocontinuous arterial spin labeling (pCASL) perfusion magnetic resonance imaging (MRI). The alterations in regional CBF and relationship between the CBF changes and cognitive impairment were detected. The ASL-CBF connectivity of the brain regions with regional CBF significant differences was also compared between two groups. Neuropsychological tests covered seven cognitive domains. Associations between the CBF changes and cognitive impairment were further investigated. Results. Compared with the healthy controls, the acute mTBI patients exhibited increased CBF in the bilateral inferior temporal gyrus (ITG) and decreased CBF in the right middle frontal gyrus (MFG), the bilateral superior frontal gyrus (SFG), and the right cerebellum posterior lobe (CPL). In the mTBI patients, significant correlations were identified between the CBF changes and cognitive impairment. Importantly, the acute mTBI patients exhibited CBF disconnections between the right CPL and right fusiform gyrus (FG) as well as bilateral ITG, between the left SFG and left middle occipital gyrus (MOG), and between the right SFG and right FG as well as right parahippocampal gyrus. Conclusion. Our results suggest that acute mTBI patients exhibit both regional CBF abnormalities and CBF connectivity deficits, which may underlie the cognitive impairment of the acute mTBI patients.

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Microvascular and large vein abnormalities in young patients after mild head trauma and associated fatigue: A brain SPECT evaluation and posture dependence modeling

Cited by 10 publications

References 28 publications

Persistent alterations in cerebrovascular reactivity in response to hypercapnia following pediatric mild traumatic brain injury

Persistent alterations in cerebrovascular reactivity in response to hypercapnia following pediatric mild traumatic brain injury

Suitability of Neuroimaging in Diagnosis of Sleep, Fatigue, Perfusion and Metabolite Deficits after Mild Traumatic Brain Injury

Cerebral Blood Flow and Its Connectivity Deficits in Mild Traumatic Brain Injury at the Acute Stage

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