scholarly journals White Matter Disruption in Pediatric Traumatic Brain Injury: Results from ENIGMA Pediatric msTBI

2020 ◽  
Author(s):  
Emily L Dennis ◽  
Karen Caeyenberghs ◽  
Kristen R Hoskinson ◽  
Tricia L Merkley ◽  
Stacy J Suskauer ◽  
...  
Keyword(s):  
White Matter ◽  
Behavioral Problems ◽  
Child Behavior Checklist ◽  
Injury Severity ◽  
Small Sample ◽  
Brain Maturation ◽  
Post Injury ◽  
Brain White Matter ◽  
Factors Influencing ◽  
The Impact

AbstractAnnually, approximately 3 million children around the world experience traumatic brain injuries (TBIs), of which up to 20% are characterized as moderate to severe (msTBI) and/or have abnormal imaging findings. Affected children are vulnerable to long-term cognitive and behavioral dysfunction, as injury can disrupt or alter ongoing brain maturation. Post-injury outcomes are highly variable, and there is only limited understanding of how inter-individual differences in outcomes arise. Small sample sizes have also complicated efforts to better understand factors influencing the impact of TBI on the developing brain. White matter (WM) disruption is a critical aspect of TBI neuropathology and diffusion MRI (dMRI) is particularly sensitive to microstructural abnormalities. Here we present the results of a coordinated analysis of dMRI data across ten cohorts from three countries. We had three primary aims: (1) to characterize the nature and extent of WM disruption across key post-injury intervals (acute/subacute - within 2 months, post-acute - 2-6 months, chronic - 6+ months); (2) evaluate the impact of age and sex on WM in the context of injury; and (3) to examine associations between WM and neurobehavioral outcomes. Based on data from 507 children and adolescents (244 with complicated mild to severe TBI and 263 control children), we report widespread WM disruption across all post-injury intervals. As expected, injury severity was a significant contributor to the pattern and extent of WM degradation, but explained less variance in dMRI measures with increasing time since injury, supporting other research indicating that other factors contribute increasingly to outcomes over time. The corpus callosum appears to be particularly vulnerable to injury, an effect that persists years post-TBI. We also report sex differences in the effect of TBI on the uncinate fasciculus (UNC), a structure with a key role in emotion regulation. Females with a TBI had significantly lower fractional anisotropy (FA) in the UNC than those with no TBI, and this phenomenon was further associated with more frequent parent-reported behavioral problems as measured by the Child Behavior Checklist (CBCL). These effects were not detected in males. With future harmonization of imaging and neurocognitive data, more complex modeling of factors influencing outcomes will be possible and help to identify clinically-meaningful patient subtypes.

White Matter Disruption in Pediatric Traumatic Brain Injury: Results from ENIGMA Pediatric Moderate to Severe Traumatic Brain Injury

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012222
Author(s):  
Emily L Dennis ◽  
Karen Caeyenberghs ◽  
Kristen R Hoskinson ◽  
Tricia L Merkley ◽  
Stacy J Suskauer ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
White Matter ◽  
Behavioral Problems ◽  
Child Behavior Checklist ◽  
Injury Severity ◽  
Meta Analysis ◽  
Post Injury ◽  
Severe Tbi ◽  
Future Work

Objective:Our study addressed aims: (1) test the hypothesis that moderate-severe TBI in pediatric patients is associated with widespread white matter (WM) disruption; (2) test the hypothesis that age and sex impact WM organization after injury; and (3) examine associations between WM organization and neurobehavioral outcomes.Methods:Data from ten previously enrolled, existing cohorts recruited from local hospitals and clinics were shared with the ENIGMA (Enhancing NeuroImaging Genetics through Meta-Analysis) Pediatric msTBI working group. We conducted a coordinated analysis of diffusion MRI (dMRI) data using the ENIGMA dMRI processing pipeline.Results:Five hundred and seven children and adolescents (244 with complicated mild to severe TBI [msTBI] and 263 controls) were included. Patients were clustered into three post-injury intervals: acute/subacute - <2 months, post-acute - 2-6 months, chronic - 6+ months. Outcomes were dMRI metrics and post-injury behavioral problems as indexed by the Child Behavior Checklist (CBCL). Our analyses revealed altered WM diffusion metrics across multiple tracts and all post-injury intervals (effect sizes ranging between d=-0.5 to -1.3). Injury severity is a significant contributor to the extent of WM alterations but explained less variance in dMRI measures with increasing time post-injury. We observed a sex-by-group interaction: females with TBI had significantly lower fractional anisotropy in the uncinate fasciculus than controls (𝞫=0.043), which coincided with more parent-reported behavioral problems (𝞫=-0.0027).Conclusions:WM disruption after msTBI is widespread, persistent, and influenced by demographic and clinical variables. Future work will test techniques for harmonizing neurocognitive data, enabling more advanced analyses to identify symptom clusters and clinically-meaningful patient subtypes.

scholarly journals Longitudinal Volumetric Changes following Traumatic Brain Injury: A Tensor-Based Morphometry Study

2012 ◽  
Vol 18 (6) ◽  
pp. 1006-1018 ◽  
Author(s):  
Kimberly D.M. Farbota ◽  
Aparna Sodhi ◽  
Barbara B. Bendlin ◽  
Donald G. McLaren ◽  
Guofan Xu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
White Matter ◽  
Degenerative Change ◽  
Extended Period ◽  
Spatiotemporal Pattern ◽  
Volume Loss ◽  
Post Injury ◽  
Cognitive Changes ◽  
Brain White Matter

AbstractAfter traumatic injury, the brain undergoes a prolonged period of degenerative change that is paradoxically accompanied by cognitive recovery. The spatiotemporal pattern of atrophy and the specific relationships of atrophy to cognitive changes are ill understood. The present study used tensor-based morphometry and neuropsychological testing to examine brain volume loss in 17 traumatic brain injury (TBI) patients and 13 controls over a 4-year period. Patients were scanned at 2 months, 1 year, and 4 years post-injury. High-dimensional warping procedures were used to create change maps of each subject's brain for each of the two intervals. TBI patients experienced volume loss in both cortical areas and white matter regions during the first interval. We also observed continuing volume loss in extensive regions of white matter during the second interval. Neuropsychological correlations indicated that cognitive tasks were associated with subsequent volume loss in task-relevant regions. The extensive volume loss in brain white matter observed well beyond the first year post-injury suggests that the injured brain remains malleable for an extended period, and the neuropsychological relationships suggest that this volume loss may be associated with subtle cognitive improvements. (JINS, 2012,18, 1–13)

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

2011 ◽  
Vol 17 (4) ◽  
pp. 663-673 ◽  
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)

Behavioural Profiles and Injury Severity Following Childhood Traumatic Brain Injury

2007 ◽  
Vol 8 (1) ◽  
pp. 22-30 ◽  
Author(s):  
Suzanne L. Barker-Collo
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Stay ◽  
Child Behavior Checklist ◽  
Injury Severity ◽  
Attention Problems ◽  
Normal Limits ◽  
Orthopaedic Injury ◽  
Severe Tbi ◽  
The Impact

AbstractTraumatic brain injury (TBI) is a leading cause of death and morbidity in children and can result in cognitive, behavioural, social and emotional difficulties that may impact quality of life. This study examined the impact of mild, moderate, and severe childhood TBI, when compared to severe orthopaedic injury, on behaviour as measured by the Child Behavior Checklist (CBCL) in a sample of 74 children with TBI and 13 with orthopaedic injury aged 4 to 13 years at the time of injury. Correlational analyses revealed that within the TBI sample increased anxiety/depression and somatisation were related to increased age at the time of injury and shorter inpatient hospital stay. Increased age was also related to increased parental reports of attention problems; while increased hospital stay was related to increased withdrawal and thought problems. Symptomatology was within normal limits for all groups, approaching the borderline clinical range in the moderate TBI group for somatic symptoms and in the severe TBI group for thought and attention problems. Those with severe TBI had more thought and attention problems, and to a lesser extent social problems, than those with mild or moderate TBI; while those with moderate TBI had the highest levels of somatic and anxious–depressed symptoms. The only scale where performance seemed to increase in relation to injury severity was the attention problems scale. It is suggested that the findings for those with moderate TBI reflect increased awareness of one's own vulnerability/mortality, with the implication that issues such as grief, loss, and mortality may need to be addressed therapeutically.

scholarly journals Executive functioning, cortisol reactivity, and symptoms of psychopathology in girls with premature adrenarche

2012 ◽  
Vol 24 (1) ◽  
pp. 211-223 ◽  
Author(s):  
Lisa M. Sontag-Padilla ◽  
Lorah D. Dorn ◽  
Abbigail Tissot ◽  
Elizabeth J. Susman ◽  
Sue R. Beers ◽  
...  
Keyword(s):  
Executive Functioning ◽  
Behavioral Problems ◽  
Child Behavior Checklist ◽  
Stress Reactivity ◽  
Serum Cortisol ◽  
Emotional And Behavioral Problems ◽  
Cortisol Reactivity ◽  
Early Maturation ◽  
Premature Adrenarche ◽  
The Impact

AbstractThe study examined the interaction between early maturational timing (measured by premature adrenarche [PA]) and executive functioning and cortisol reactivity on symptoms of psychopathology. The study included 76 girls aged 6 through 8 years (mean = 7.50,SD= 0.85) with PA (n= 40) and on-time adrenarche (n= 36). Girls completed a battery of psychological and neuropsychological tests and blood sampling for cortisol. Parents completed the Child Behavior Checklist. The results demonstrated that girls with PA with lower levels of executive functioning had higher externalizing and anxious symptoms compared to other girls. In addition, girls with PA who demonstrated increases in serum cortisol had higher externalizing symptoms than those with stable patterns. Finally, girls with PA who demonstrated decreases in cortisol reported higher depressive symptoms. The findings from this study provide important information concerning the impact of cognitive functioning and stress reactivity on adjustment to early maturation in girls with PA. The results of this research may inform screening and intervention efforts for girls who may be at greatest risk for emotional and behavioral problems as a result of early maturation.

scholarly journals Calendar age and puberty-related development of regional gray matter volume and white matter tracts during adolescence

2021 ◽  
Author(s):  
Ayaka Ando ◽  
Peter Parzer ◽  
Michael Kaess ◽  
Susanne Schell ◽  
Romy Henze ◽  
...  
Keyword(s):  
White Matter ◽  
Brain Development ◽  
Gray Matter ◽  
Gray Matter Volume ◽  
Brain Maturation ◽  
Healthy Children ◽  
White Matter Tract ◽  
Pubertal Status ◽  
Matter Volume ◽  
The Impact

Abstract Background Adolescence is a critical time for brain development. Findings from previous studies have been inconsistent, failing to distinguish the influence of pubertal status and aging on brain maturation. The current study sought to address these inconsistencies, addressing the trajectories of pubertal development and aging by longitudinally tracking structural brain development during adolescence. Methods Two cohorts of healthy children were recruited (cohort 1: 9–10 years old; cohort 2: 12–13 years old at baseline). MRI data were acquired for gray matter volume and white matter tract measures. To determine whether age, pubertal status, both or their interaction best modelled longitudinal data, we compared four multi-level linear regression models to the null model (general brain growth indexed by total segmented volume) using Bayesian model selection. Results Data were collected at baseline (n = 116), 12 months (n = 97) and 24 months (n = 84) after baseline. Findings demonstrated that the development of most regional gray matter volume, and white matter tract measures, were best modelled by age. Interestingly, precentral and paracentral regions of the cortex, as well as the accumbens demonstrated significant preference for the pubertal status model. None of the white matter tract measures were better modelled by pubertal status. Limitations: The major limitation of this study is the two-cohort recruitment. Although this allowed a faster coverage of the age span, a complete per person trajectory over 6 years of development (9–15 years) could not be investigated. Conclusions Comparing the impact of age and pubertal status on regional gray matter volume and white matter tract measures, we found age to best predict longitudinal changes. Further longitudinal studies investigating the differential influence of puberty status and age on brain development in more diverse samples are needed to replicate the present results and address mechanisms underlying norm-variants in brain development.

scholarly journals Fiber Clustering Acceleration With a Modified Kmeans++ Algorithm Using Data Parallelism

2021 ◽  
Vol 15 ◽  
Author(s):  
Isaac Goicovich ◽  
Paulo Olivares ◽  
Claudio Román ◽  
Andrea Vázquez ◽  
Cyril Poupon ◽  
...  
Keyword(s):  
White Matter ◽  
Brain Research ◽  
Data Parallelism ◽  
Processing Unit ◽  
Brain White Matter ◽  
Fiber Clustering ◽  
New Variant ◽  
Clustering Quality ◽  
Kmeans Algorithm ◽  
The Impact

Fiber clustering methods are typically used in brain research to study the organization of white matter bundles from large diffusion MRI tractography datasets. These methods enable exploratory bundle inspection using visualization and other methods that require identifying brain white matter structures in individuals or a population. Some applications, such as real-time visualization and inter-subject clustering, need fast and high-quality intra-subject clustering algorithms. This work proposes a parallel algorithm using a General Purpose Graphics Processing Unit (GPGPU) for fiber clustering based on the FFClust algorithm. The proposed GPGPU implementation exploits data parallelism using both multicore and GPU fine-grained parallelism present in commodity architectures, including current laptops and desktop computers. Our approach implements all FFClust steps in parallel, improving execution times in all of them. In addition, our parallel approach includes a parallel Kmeans++ algorithm implementation and defines a new variant of Kmeans++ to reduce the impact of choosing outliers as initial centroids. The results show that our approach provides clustering quality results very similar to FFClust, and it requires an execution time of 3.5 s for processing about a million fibers, achieving a speedup of 11.5 times compared to FFClust.

scholarly journals The impact of image dynamic range on texture classification of brain white matter

2008 ◽  
Vol 8 (1) ◽  
Author(s):  
Doaa Mahmoud-Ghoneim ◽  
Mariam K Alkaabi ◽  
Jacques D de Certaines ◽  
Frank-M Goettsche
Keyword(s):  
White Matter ◽  
Dynamic Range ◽  
Texture Classification ◽  
Brain White Matter ◽  
The Impact

scholarly journals Outcome of Turf Toe Injuries in NFL Players

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0033
Author(s):  
Selene G. Parekh ◽  
Tejas J. Parekh
Keyword(s):  
Injury Severity ◽  
Wide Spectrum ◽  
Average Power ◽  
Metatarsophalangeal Joint ◽  
Joint Capsule ◽  
Control Group ◽  
Post Injury ◽  
Significant Difference ◽  
Turf Toe ◽  
The Impact

Category: Midfoot/Forefoot, Sports, Trauma Introduction/Purpose: “Turf toe” is an injury to the great toe’s metatarsophalangeal joint capsule. The increase in artificial turf in the 1970’s was thought to have contributed to increased incidence of this injury in players of the National Football League (NFL). To our knowledge, there are no publications that have critically analyzed the impact of this injury on player performance. The goal of this study was to quantify the impact a turf toe injury has on NFL players, specifically in time to return to competition and their performance post-injury compared to pre-injury. Methods: This is a retrospective review of NFL players who sustained a turf toe injury between the 2011-2014 seasons. Online resources including NFL injury reports, player registries, game summary sites, NFL news articles, fantasy football sites and NFL blogs were used to identify players with this injury. Additionally, an injury database from theFantasyDoctors.com was used to further identify injured players. Recorded variables included player age, position, games missed, and type of playing surface on which the injury occurred. The performance of each offensive skill player was analyzed separately by calculating their power rating (total yards divided by 10 plus touchdowns multiplied by 6) for the 3 seasons prior to injury, the injury season (index season) and the 2 seasons immediately following. Injured offensive skill players were then compared to a control group consisting of all running backs and wide receivers without a turf toe injury who competed in the 2012 season. Results: 71 turf toe injuries in 67 players were identified. Players’ average age was 26.4 years old. Injury by playing surface: 29 grass, 29 turf and 13 unidentified. The average time missed was 3.2 games. 9 players were placed on injured reserve and 8 required surgery. 16 offensive skill players were at or above 200 total points during the 6 observed seasons. The average power rating prior to injury was 105.7 per season (7.3 per game), 87.3 (6.9 per game) during the injury season and 115.5 (8.1 per game) for post-injury seasons. The power rating per season (p=0.53) and per game (p=0.4) was not significantly different after a turf toe injury compared to before. Power ratings were not significantly different from uninjured control players (p=0.24, p=0.27). Conclusion: ”Turf toe” is a term used for an injury that has a wide spectrum of consequence depending on injury severity. A mild sprain of the great toe should respond well to conservative treatment with rest, taping and possibly an orthotic while a complete tear of the metatarsophalangeal joint capsule typically is season-ending and requires surgical repair. We were unable to show a statistically significant difference in NFL players’ performances after turf toe injury based on power ratings.

Sign in / Sign up

Export Citation Format

Share Document