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

Radiology. 2013 Oct;269(1):249-57

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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