Research Reports - Symptomatic white matter changes in mild traumatic brain injury resemble pathologic features of early alzheimer dementia

Radiology. 2013 Jun 18

Fakhran S, Yaeger K, Alhilali L

Purpose:To evaluate white matter integrity in patients with mild traumatic brain
injury (TBI) who did not have morphologic abnormalities at conventional magnetic
resonance (MR) imaging with diffusion-tensor imaging to determine any
relationship between patterns of white matter injury and severity of
postconcussion symptoms.Materials and Methods:The institutional review board
approved this study, with waiver of informed consent. Diffusion-tensor images
from 64 consecutive patients with mild TBI obtained with conventional MR imaging
were evaluated retrospectively. Fractional anisotropy (FA) maps were generated as
a measure of white matter integrity. All patients underwent a neurocognitive
evaluation. Correlations between skeletonized FA values in white matter, total
concussion symptom score, and findings of sleep and wake disturbances were
analyzed with regression analysis that used tract-based spatial
statistics.Results:Total concussion symptom scores varied from 2 to 97 (mean ±
standard deviation, 32.7 ± 24.4), with 34 patients demonstrating sleep and wake
disturbances. Tract-based spatial statistics showed a significant correlation
between high total concussion symptom score and reduced FA at the gray
matter-white matter junction (P < .05), most prominently in the auditory cortex
(P < .05). FA in the parahippocampal gyri was significantly decreased in patients
with sleep and wake disturbances relative to patients without such disturbances
(0.26 and 0.37, respectively; P < .05).Conclusion:The distribution of white
matter abnormalities in patients with symptomatic mild TBI is strikingly similar
to the distribution of pathologic abnormalities in patients with early Alzheimer
dementia, a finding that may help direct research strategies.

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