(339) Cerebral grey matter changes associated with posttraumatic headache in mild traumatic brain injury patients: a longitudinal MRI study

ObjectiveTo determine the utility of fractional amplitude of low frequency fluctuations (fALFF) during resting state fMRI (rs-fMRI) as an advanced neuroimaging biomarker for Mild Traumatic Brain Injury (mTBI).BackgroundmTBI is defined by a constellation of functional rather than structural deficits. As a measure of functional connectivity, fALFF has been implicated in long-term outcomes post-mTBI. It is unclear however, how longitudinal changes in fALFF may relate to the clinical presentation of mTBI.Design/Methods111 patients and 32 controls (15–50 years old) were enrolled acutely after mTBI and followed with up to 4 standardized serial assessments. Patients were enrolled at either Encounter 1 (E1), within 72 hours, or Encounter 2 (E2), 5–10 days post-injury, and returned for Encounter 3 (E3) at 15–29 days and Encounter 4 (E4) at 83–97 days. Each encounter included a clinical exam, neuropsychological assessment, as well as rs-fMRI imaging. fALFF was analyzed independently in 14 functional networks and, in grey and white matter as a function of symptom severity. Symptom severity scores (SSS) ranged from 0–132 as defined by the SCAT2 symptom evaluation.ResultsIn mTBI patients, fALFF scores across 5 functional brain networks (language, sensorimotor, visuospatial, higher-order visual, and posterior salience) differed between mTBI patients with low versus high SSS (SSS <5 and >30, respectively). Overall, greater SSS were indexed by reduced connectivity (p < 0.03, Bonferroni corrected). Further analysis also identified corresponding network pairs which were most predictive of increased SSS. White matter fALFF was not correlated with symptom severity, however, decreased grey matter fALFF was significantly correlated with greater SSS (r = −0.25, p = 0.002).ConclusionsGrey matter fALFF was correlated with mTBI symptom burden suggesting that patterns of neural connectivity relate directly to the clinical presentation of mTBI. Furthermore, differences in functional network connectivity as a function of SSS may reflect which networks are implicated in recovery of mTBI.

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Photophobia symptoms and visual pain thresholds in posttraumatic headache after mild traumatic brain injury

Neurology ◽

10.1212/01.wnl.0000550668.55103.10 ◽

2018 ◽

Vol 91 (23 Supplement 1) ◽

pp. S11.2-S11

Author(s):

Nicholas Jarvis ◽

Amaal J. Starling ◽

Todd J. Schwedt

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Pilot Study ◽

Mild Traumatic Brain Injury ◽

Light Sensitivity ◽

Fisher Exact Test ◽

Pain Thresholds ◽

Posttraumatic Headache ◽

Exact Test ◽

Wilcoxon Rank Sum Test

BackgroundLight sensitivity can be a disabling symptom in posttraumatic headache (PTH). The objective of this pilot study was to characterize photophobia symptoms and visual pain thresholds in PTH compared to healthy controls (HC).MethodsIndividuals with PTH attributed to mild traumatic brain injury (mTBI) (N = 18) and HC (N = 20), aged 18–65, were prospectively assessed using the Photosensitivity Assessment Questionnaire (PAQ), State Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI). A progressive light stimulation device was used to quantify visual pain thresholds. Visual pain thresholds were determined by the intensity of light at which subjects first noted pain. The mean of 3 trials was considered the visual pain threshold. Two sample t-test, Wilcoxon rank sum test, χ2 test and Fisher exact test was used to compare the 2 groups for their demographics, clinical characteristics, and outcomes measures.ResultsThere were no differences in demographics including age, gender, or race. The average time since onset of PTH was 50.7 (73.6) months. Those with PTH had 15.8 (9.2) headache days per month. BDI and STAI scores were significantly higher in PTH compared to HC. Photophobia was higher in PTH compared to HC, 0.64 (0.25) vs 0.24 (0.24), p < 0.0001. Visual pain thresholds were lower in PTH (median 50.1 lux; quartiles 15.3 to 300.0) compared to HC (median 863.5 lux; quartiles 519.9 to 4,906.5; p = 0.0002).ConclusionPhotophobia symptoms are higher and visual pain thresholds are lower in PTH compared to HC. Light sensitivity is a well-known disabling symptom in PTH and this pilot study provides objective data through a validated photophobia scale and visual pain thresholds to characterize light sensitivity. Additional studies are needed to confirm this data, to compare acute to persistent PTH, to compare PTH to other headache disorders, and to determine if photophobia and visual pain thresholds will improve with intervention.

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Multiparametric and Longitudinal MRI Characterization of Mild Traumatic Brain Injury in Rats

Journal of Neurotrauma ◽

10.1089/neu.2014.3563 ◽

2015 ◽

Vol 32 (8) ◽

pp. 598-607 ◽

Cited By ~ 30

Author(s):

Justin Alexander Long ◽

Lora Talley Watts ◽

Jonathan Chemello ◽

Shiliang Huang ◽

Qiang Shen ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Longitudinal Mri

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Staying in service with posttraumatic headache

Neurology ◽

10.1212/wnl.0000000000004358 ◽

2017 ◽

Vol 89 (11) ◽

pp. 1186-1194 ◽

Cited By ~ 1

Author(s):

Alan G. Finkel ◽

John S. Klaric ◽

Juanita A. Yerry ◽

Young S. Choi

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Regression Coefficient ◽

Medical Center ◽

Clinical Analysis ◽

Posttraumatic Headache ◽

Logistic Regressions ◽

Return To Duty ◽

The Brain

Objective:To predict the probability of a military outcome (medical discharge/retirement) in patients with mild traumatic brain injury from a clinical analysis of predetermined patient and headache characteristics.Methods:This retrospective cohort study sampled all new patients referred for headache evaluation at the Brain Injury Clinic of the Womack Army Medical Center, Ft. Bragg, NC (August 2008–January 2010). Headache characteristics were extracted and analyzed. Multivariable binary logistic regressions were conducted to predict probability of medical discharge/retirement.Results:Ninety-five soldiers (age 31.3 ± 7.4 years, male 93.7%) reported 166 headaches. The most common injury cited was a blast (53.7%). Patients with a continuous headache have almost 4 times the odds of a medically related discharge/retirement compared to patients without such a headache (continuous headache regression coefficient estimate: p < 0.042, odds ratio 3.98, 95% Wald confidence interval 1.05–15.07). Results suggest that, compared to service members who did not have a continuous headache, patients with headache histories with severe holocephalic pain who medicate to keep functioning had the highest probability of medical discharge/retirement.Conclusions:Certain headache characteristics may be predictive of military outcomes after mild traumatic brain injury, and we propose a profile that may be useful in that prediction. These data could be useful in future attempts to assess and treat patients with posttraumatic headache and to advise longer-term planning for return to duty or discharge.

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