Microstructural brain injury in post-concussion syndrome after minor head injury

Marion Smits, Gavin C Houston, Diederik W J Dippel, Piotr A Wielopolski, Meike W Vernooij, Peter J Koudstaal, M G Myriam Hunink, Aad van der Lugt, Marion Smits, Gavin C Houston, Diederik W J Dippel, Piotr A Wielopolski, Meike W Vernooij, Peter J Koudstaal, M G Myriam Hunink, Aad van der Lugt

Abstract

Introduction: After minor head injury (MHI), post-concussive symptoms commonly occur. The purpose of this study was to correlate the severity of post-concussive symptoms in MHI patients with MRI measures of microstructural brain injury, namely mean diffusivity (MD) and fractional anisotropy (FA), as well as the presence of microhaemorrhages.

Methods: Twenty MHI patients and 12 healthy controls were scanned at 3 T using diffusion tensor imaging (DTI) and high-resolution gradient recalled echo (HRGRE) T2*-weighted sequences. One patient was excluded from the analysis because of bilateral subdural haematomas. DTI data were preprocessed using Tract Based Spatial Statistics. The resulting MD and FA images were correlated with the severity of post-concussive symptoms evaluated with the Rivermead Postconcussion Symptoms Questionnaire. The number and location of microhaemorrhages were assessed on the HRGRE T2*-weighted images.

Results: Comparing patients with controls, there were no differences in MD. FA was decreased in the right temporal subcortical white matter. MD was increased in association with the severity of post-concussive symptoms in the inferior fronto-occipital fasciculus (IFO), the inferior longitudinal fasciculus and the superior longitudinal fasciculus. FA was reduced in association with the severity of post-concussive symptoms in the uncinate fasciculus, the IFO, the internal capsule and the corpus callosum, as well as in the parietal and frontal subcortical white matter. Microhaemorrhages were observed in one patient only.

Conclusions: The severity of post-concussive symptoms after MHI was significantly correlated with a reduction of white matter integrity, providing evidence of microstructural brain injury as a neuropathological substrate of the post-concussion syndrome.

Figures

Fig. 1
Fig. 1
Mean FA images in axial, coronal and sagittal view showing significantly reduced FA in patients compared with controls in the right temporal lobe subcortical fibres of the inferior fronto-occipital fasciculus
Fig. 2
Fig. 2
Mean fractional anisotropy images in axial, coronal and sagittal view showing significantly increased mean diffusivity in association with the severity of post-concussive symptoms (patient group regression analysis) in the left superior longitudinal fasciculus (a) and inferior fronto-occipital/inferior longitudinal fasciculus (b)
Fig. 3
Fig. 3
Mean FA images in axial, coronal and sagittal view showing areas of significantly reduced FA in association with the severity of post-concussive symptoms (patient group regression analysis) in the peripheral white matter consisting of fibres originating from the corpus callosum in the right frontal lobe (a), the right uncinate and inferior fronto-occipital fasciculus and left internal capsule (b), the posterior limb of the internal capsule bilaterally (c), the corpus callosum (d), and the peripheral white matter consisting of fibres originating from the corpus callosum in the left parietal lobe (e)
Fig. 4
Fig. 4
Three-dimensional, high-resolution gradient recalled echo T2*-weighted images from one patient showing two microhaemorrhages (arrows) in the right frontal lobe

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