Evaluation of White Matter Injury Patterns Underlying Neuropsychiatric Symptoms after Mild Traumatic Brain Injury

Authors

Lea M. Alhilali, From the Department of Radiology, Division of Neuroradiology, UPMC Presbyterian Hospital, University of Pittsburgh Medical Center, 200 Lothrop St, Presby South Tower, 3rd Floor, Suite 3950, Pittsburgh, PA 15213.Follow
Joseph A. Delic, From the Department of Radiology, Division of Neuroradiology, UPMC Presbyterian Hospital, University of Pittsburgh Medical Center, 200 Lothrop St, Presby South Tower, 3rd Floor, Suite 3950, Pittsburgh, PA 15213.
Serter Gumus, From the Department of Radiology, Division of Neuroradiology, UPMC Presbyterian Hospital, University of Pittsburgh Medical Center, 200 Lothrop St, Presby South Tower, 3rd Floor, Suite 3950, Pittsburgh, PA 15213.
Saeed Fakhran, From the Department of Radiology, Division of Neuroradiology, UPMC Presbyterian Hospital, University of Pittsburgh Medical Center, 200 Lothrop St, Presby South Tower, 3rd Floor, Suite 3950, Pittsburgh, PA 15213.

Document Type

Article

Abstract

PURPOSE: To determine if a central axonal injury underlies neuropsychiatric symptoms after mild traumatic brain injury (mTBI) by using tract-based spatial statistics analysis of diffusion-tensor images. MATERIALS AND METHODS: The institutional review board approved this study, with waiver of informed consent. Diffusion-tensor imaging and serial neurocognitive testing with the Immediate Post-Concussion Assessment and Cognitive Testing evaluation were performed in 45 patients with mTBI (38 with irritability, 32 with depression, and 18 with anxiety). Control subjects consisted of 29 patients with mTBI without neuropsychiatric symptoms. Fractional anisotropy and diffusivity maps were analyzed by using tract-based spatial statistics with a multivariate general linear model. Diffusion-tensor imaging findings were correlated with symptom severity, neurocognitive test scores, and time to recovery with the Pearson correlation coefficient. RESULTS: Compared with control subjects, patients with mTBI and depression had decreased fractional anisotropy in the superior longitudinal fasciculus (P = .006), white matter around the nucleus accumbens (P = .03), and anterior limb of the internal capsule (P = .02). Patients with anxiety had diminished fractional anisotropy in the vermis (P = .04). No regions of significantly decreased fractional anisotropy were seen in patients with irritability relative to control subjects. Injury in the region of the nucleus accumbens inversely correlated with recovery time in patients with depression (r = -0.480, P = .005). CONCLUSION: Unique white matter injury patterns were seen for two major posttraumatic neuropsychiatric symptoms. Injury to the cerebellar vermis in patients with mTBI and anxiety may indicate underlying dysfunction in primitive fear conditioning circuits in the cerebellum. Involvement of the nucleus accumbens in depression after mTBI may suggest an underlying dysfunctional reward circuit that affects the prognosis in these patients.

Medical Subject Headings

Adolescent; Adult; Anisotropy; Anxiety (etiology); Brain Injuries (complications); Child; Depression (etiology); Diffusion Tensor Imaging; Female; Humans; Internal Capsule (injuries); Magnetic Resonance Imaging; Male; Middle Aged; Nucleus Accumbens (injuries); Prognosis; White Matter (injuries)

Publication Date

12-1-2015

Publication Title

Radiology

E-ISSN

1527-1315

Volume

277

Issue

3

First Page

793

Last Page

800

PubMed ID

26079380

Digital Object Identifier (DOI)

10.1148/radiol.2015142974

Recommended Citation

Alhilali, Lea M.; Delic, Joseph A.; Gumus, Serter; and Fakhran, Saeed, "Evaluation of White Matter Injury Patterns Underlying Neuropsychiatric Symptoms after Mild Traumatic Brain Injury" (2015). Neurology. 1278.
https://scholar.barrowneuro.org/neurology/1278