The Relationship between Age, Injury Severity, and MRI Findings after Traumatic Brain Injury

Background: Pediatric traumatic brain injury (TBI) is a leading cause of death and disability. Polymorphisms in the apolipoprotein E ( APOE) gene have been linked to cerebral vasospasm (CV) and poor outcomes in adults with TBI, yet these associations remain poorly defined in children. Objective: We examined the effect of the relationship between APOE polymorphisms and CV on functional outcomes in children with a TBI. Method: This prospective, descriptive study examined 60 children (aged 10 days to 15 years) with a TBI. Data included demographic information, genetic sampling for the APOE gene and single-nucleotide polymorphisms (SNPs; rs405509, rs429358, rs7412), and daily transcranial Doppler ultrasounds to evaluate for CV. We examined Glasgow Outcome Scale–Extended Pediatrics (GOS-E Peds) scores at the time of discharge and 4–6 weeks after discharge. Results: More than half (56.7%) of the 60 children ( Mage = 5.9 years) were male. Twenty-six participants (43.3%) experienced an occurrence of CV. There were significant differences in injury mechanism (unadjusted p = .048) and age (unadjusted p = .02) between those with and without CV. Also, the noncoding promoter SNP rs405509 T/T, when considered with injury severity, appeared to modify the relationship of APOE genotype to CV. The relationship between APOE and CV had no significant effect on GOS-E Peds scores. Conclusion: Injury severity and the APOE noncoding promoter SNP rs405509 may modify the relationship between APOE and CV in children with TBI. More studies are needed to understand the role of APOE polymorphisms in outcomes in children with TBI.

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Predicting Behavioral Deficits in Pediatric Traumatic Brain Injury Through Uncinate Fasciculus Integrity

Journal of the International Neuropsychological Society ◽

10.1017/s1355617711000464 ◽

2011 ◽

Vol 17 (4) ◽

pp. 663-673 ◽

Cited By ~ 25

Author(s):

Chad P. Johnson ◽

Jenifer Juranek ◽

Larry A. Kramer ◽

Mary R. Prasad ◽

Paul R. Swank ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Behavioral Problems ◽

Injury Severity ◽

Diffusion Tensor ◽

Uncinate Fasciculus ◽

Post Injury ◽

Orthopedic Injury ◽

Behavioral Dysregulation ◽

The Relationship

AbstractBehavioral dysregulation is a common and detrimental consequence of traumatic brain injury (TBI) in children that contributes to poor academic achievement and deficits in social development. Unfortunately, behavioral dysregulation is difficult to predict from either injury severity or early neuropsychological evaluation. The uncinate fasciculus (UF) connects orbitofrontal and anterior temporal lobes, which are commonly implicated in emotional and behavioral regulation. Using probabilistic diffusion tensor tractography (DTT), we examined the relationship between the integrity of the UF 3 months post-injury and ratings of executive functions 12 months post-injury in children with moderate to severe TBI and a comparison group with orthopedic injuries. As expected, fractional anisotropy of the UF was lower in the TBI group relative to the orthopedic injury group. DTT metrics from the UF served as a biomarker and predicted ratings of emotional and behavior regulation, but not metacognition. In contrast, the Glasgow Coma Scale score was not related to either UF integrity or to executive function outcomes. Neuroanatomical biomarkers like the uncinate fasciculus may allow for early identification of behavioral problems and allow for investigation into the relationship of frontotemporal networks to brain-behavior relationships. (JINS, 2011, 17, 663–673)

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B-72 The Relationship between Anxiety and Postconcussive Symptomology in patients with Mild Traumatic Brain Injury

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz034.155 ◽

2019 ◽

Vol 34 (6) ◽

pp. 1020-1020

Author(s):

K Cornett

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Injury Severity ◽

Small Sample ◽

Future Research ◽

Control Group ◽

Patient Report ◽

The Relationship ◽

Report Measure

Abstract Objective Research literature has demonstrated the role that pre-morbid anxiety has in prolonging recovery from mild traumatic brain injury (mTBI). The aim of this investigation is to clarify the degree of the relationship between anxiety and postconcussive symptomology in patients with mTBI. Method This study compared scores from a patient-report measure of anxiety, the General Anxiety Disorder-7 (GAD-7), to scores from a patient-report measure of postconcussion symptom severity, the Neurobehavioral Symptom Inventory (NSI). Participants were recruited from September 2018 to December 2019 who had been referred for clinical evaluation to Rehabilitation Institute of Washington’s Brain Injury Services (a privately-run, interdisciplinary, outpatient clinic). 39 adult participants (30 males and nine females) completed both the GAD-7 and NSI. No control group was used. Injury severity level was ascertained via review of the medical records. Patients underwent an abbreviated evaluation with a clinical neuropsychologist. As a part of this initial evaluation, patients completed an intake packet, which included the NSI and GAD-7. Results The relationship between the ordinal variables (i.e., anxiety and postconscussive symptomology) was assessed using spearman’s rho. Anxiety had a strong, statistically significant relationship with postconcussive symptomology (rho = 0.670, p = 0.000). Conclusions Anxiety and postconcussive symptomology severity are associated in this population of patients with mTBI. Limitations of this current investigation include a small sample size and no control group. This study indicates the need for controlled studies in future research to address the above-encountered limitations. Nevertheless, this study lends support to the prevalence of anxiety in those with elevated postconcussive symptomology and the need to monitor this in assessment and treatment.

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