Research Reports - Evaluation of white matter injury patterns underlying neuropsychiatric symptoms after mild traumatic brain injury

Radiology. 2015 Jun 16:142974

Alhilali LM(1), Delic JA(1), Gumus S(1), Fakhran S(1)

Purpose To determine if a central axonal injury underlies neuropsychiatric
symptoms after mild traumatic brain injury (mTBI) by using tract-based spatial
statistics analysis of diffusion-tensor images. Materials and Methods The
institutional review board approved this study, with waiver of informed consent.
Diffusion-tensor imaging and serial neurocognitive testing with the Immediate
Post-Concussion Assessment and Cognitive Testing evaluation were performed in 45
patients with mTBI (38 with irritability, 32 with depression, and 18 with
anxiety). Control subjects consisted of 29 patients with mTBI without
neuropsychiatric symptoms. Fractional anisotropy and diffusivity maps were
analyzed by using tract-based spatial statistics with a multivariate general
linear model. Diffusion-tensor imaging findings were correlated with symptom
severity, neurocognitive test scores, and time to recovery with the Pearson
correlation coefficient. Results Compared with control subjects, patients with
mTBI and depression had decreased fractional anisotropy in the superior
longitudinal fasciculus (P = .006), white matter around the nucleus accumbens (P
= .03), and anterior limb of the internal capsule (P = .02). Patients with
anxiety had diminished fractional anisotropy in the vermis (P = .04). No regions
of significantly decreased fractional anisotropy were seen in patients with
irritability relative to control subjects. Injury in the region of the nucleus
accumbens inversely correlated with recovery time in patients with depression (r
= -0.480, P = .005). Conclusion Unique white matter injury patterns were seen for
two major posttraumatic neuropsychiatric symptoms. Injury to the cerebellar
vermis in patients with mTBI and anxiety may indicate underlying dysfunction in
primitive fear conditioning circuits in the cerebellum. Involvement of the
nucleus accumbens in depression after mTBI may suggest an underlying
dysfunctional reward circuit that affects the prognosis in these patients.

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