Browsing by Subject "Traumatic axonal injury"

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    Prognostic Value of Hemorrhagic Brainstem Injury on Early Computed Tomography: A TRACK-TBI Study
    (Springer, 2021) Williams, John R.; Nieblas-Bedolla, Edwin; Feroze, Abdullah; Young, Christopher; Temkin, Nancy R.; Giacino, Joseph T.; Okonkwo, David O.; Manley, Geoffrey T.; Barber, Jason; Durfy, Sharon; Markowitz, Amy J.; Yu, Esther L.; Mukherjee, Pratik; Mac Donald, Christine L.; The Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Investigators; Psychiatry, School of Medicine
    Background: Traumatic brainstem injury has yet to be incorporated into widely used imaging classification systems for traumatic brain injury (TBI), and questions remain regarding prognostic implications for this TBI subgroup. To address this, retrospective data on patients from the multicenter prospective Transforming Research and Clinical Knowledge in TBI study were studied. Methods: Patients with brainstem and cerebrum injury (BSI+) were matched by age, sex, and admission Glasgow Coma Scale (GCS) score to patients with cerebrum injuries only. All patients had an interpretable head computed tomography (CT) scan from the first 48 hours after injury and a 6-month Glasgow Outcome Scale Extended (GOSE) score. CT scans were reviewed for brainstem lesions and, when present, characterized by location, size, and type (traumatic axonal injury, contusion, or Duret hemorrhage). Clinical, demographic, and outcome data were then compared between the two groups. Results: Mann-Whitney U-tests showed no significant difference in 6-month GOSE scores in patients with BSI+ (mean 2.7) compared with patients with similar but only cerebrum injuries (mean 3.9), although there is a trend (p = 0.10). However, subclassification by brainstem lesion type, traumatic axonal injury (mean 4.0) versus Duret hemorrhage or contusion (mean 1.4), did identify a proportion of BSI+ with significantly less favorable outcome (p = 0.002). The incorporation of brainstem lesion type (traumatic axonal injury vs. contusion/Duret), along with GCS into a multivariate logistic regression model of favorable outcome (GOSE score 4-8) did show a significant contribution to the prognostication of this brainstem injury subgroup (odds ratio 0.08, 95% confidence interval 0.00-0.67, p = 0.01). Conclusions: These findings suggest two groups of patients with brainstem injuries may exist with divergent recovery potential after TBI. These data support the notion that newer CT imaging classification systems may augment traditional clinical measures, such as GCS in identifying those patients with TBI and brainstem injuries that stand a higher chance of favorable outcome.
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    Tractography-Pathology Correlations in Traumatic Brain Injury: A TRACK-TBI Study
    (Mary Ann Liebert, 2021) Nolan, Amber L.; Petersen, Cathrine; Iacono, Diego; Mac Donald, Christine L.; Mukherjee, Pratik; van der Kouwe, Andre; Jain, Sonia; Stevens, Allison; Diamond, Bram R.; Wang, Ruopeng; Markowitz, Amy J.; Fischl, Bruce; Perl, Daniel P.; Manley, Geoffrey T.; Keene, C. Dirk; Diaz-Arrastia, Ramon; Edlow, Brian L.; TRACK-TBI Investigators; Psychiatry, School of Medicine
    Diffusion tractography magnetic resonance imaging (MRI) can infer changes in network connectivity in patients with traumatic brain injury (TBI), but the pathological substrates of disconnected tracts have not been well defined because of a lack of high-resolution imaging with histopathological validation. We developed an ex vivo MRI protocol to analyze tract terminations at 750-μm isotropic resolution, followed by histopathological evaluation of white matter pathology, and applied these methods to a 60-year-old man who died 26 days after TBI. Analysis of 74 cerebral hemispheric white matter regions revealed a heterogeneous distribution of tract disruptions. Associated histopathology identified variable white matter injury with patchy deposition of amyloid precursor protein (APP), loss of neurofilament-positive axonal processes, myelin dissolution, astrogliosis, microgliosis, and perivascular hemosiderin-laden macrophages. Multiple linear regression revealed that tract disruption strongly correlated with the density of APP-positive axonal swellings and neurofilament loss. Ex vivo diffusion MRI can detect tract disruptions in the human brain that reflect axonal injury.