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Investigations on Alterations of Hippocampal Circuit Function Following Mild Traumatic Brain Injury
Published on: November 19, 2012
Head circumference and brain and hippocampal volume after severe traumatic brain injury in childhood
Robert C Tasker1, Claire H Salmond, Amber Gunn Westland
1Department of Paediatrics, Addenbrooke's Hospital, Cambridge, CB2 2QQ, United Kingdom. rct32@hermes.cam.ac.uk
Insights
Severe traumatic brain injury (TBI) in childhood can impact brain growth and hippocampal volume into adulthood. Injury severity and white matter atrophy are key factors affecting long-term outcomes.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Radiology
Background:
- The hippocampus is vulnerable to traumatic brain injury (TBI), with outcomes linked to injury severity and white matter atrophy in adults.
- Long-term effects of childhood TBI on brain development, particularly hippocampal volume, require further investigation.
Purpose of the Study:
- To identify anthropometric and cerebral morphometric features years after severe childhood TBI.
- To assess the relationship between hippocampal volume, injury severity, and white matter changes post-TBI.
Main Methods:
- Magnetic resonance imaging (MRI) was used to analyze brain volumes, white matter integrity (voxel-based morphometry, diffusion tensor imaging), and hippocampal regions in 33 children post-TBI.
- Follow-up was conducted an average of 4.9 years after severe TBI requiring intensive care, with 23 patients receiving mechanical ventilation and ICP monitoring >3 days.
Main Results:
- Longer intensive care duration correlated with smaller occipitofrontal head circumference.
- Voxel-based morphometry identified periventricular white matter loss and reduced brain volume (atrophy) in some patients, while others showed growth disturbance relative to head circumference.
- Right hippocampal volume variation was significantly explained (93%) by injury severity and white matter atrophy.
Conclusions:
- Anthropometric and cerebral morphometric assessments provide valuable outcome data following severe childhood TBI.
- Despite normal stature growth, childhood TBI can have lasting effects on brain growth and hippocampal volume, extending into adulthood.
Abstract:
Vulnerability of the hippocampus to traumatic brain injury (TBI) in adults is related to severity of injury and white matter atrophy. The objectives of this study were to determine features of anthropometry and cerebral morphometry late after TBI in childhood and to assess whether hippocampal volume is related to severity of initial ictus and changes in white matter at follow-up. Thirty-three patients underwent magnetic resonance imaging 4.9 y after severe TBI that necessitated intensive care; 23 had mechanical ventilation and intracranial pressure monitoring longer than 3 d. Magnetic resonance imaging analyses included volume of brain, hemisphere, ventricles, and hippocampal and perihippocampal regions; spatial distribution of voxel-based morphometry differences in white matter; and eigenvalues of diffusion tensor imaging diffusivity. Patients with longer intensive care ictus had smaller-than-expected occipitofrontal head circumference. Eight of these, identified by voxel-based morphometry, had periventricular white matter loss and smaller-than-expected brain volume for OFC, suggesting "atrophy"; the remainder had expected volume for a smaller OFC, suggesting "growth disturbance." Ninety-three percent of the variation in right hippocampal volume was accounted for by factors related to severity of injury and white matter atrophy. It is concluded that anthropometry and cerebral morphometric measurements late after severe TBI in childhood provides useful outcome data and indicate that, despite adequate growth in stature, effects of TBI on brain growth and hippocampal volume may extend into adulthood.
