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DefinitionTraumatic brain injury, or TBI, is a disturbance of normal brain function induced by an external mechanical force, such as a direct blow to the head or a penetrating injury. It can affect both brain structure and function, producing a wide range of clinical outcomes. TBI is a heterogeneous condition, meaning its effects may differ based on the type, location, and severity of the injury.Basis of ClassificationTBI is classified based on severity, injury mechanism, or pathophysiology. In...
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Concussive brain injury from explosive blast.

Nihal C de Lanerolle1, Hamada Hamid2, Joseph Kulas3

  • 1Department of Neurosurgery, Yale University New Haven, Connecticut, 06520.

Annals of Clinical and Translational Neurology
|December 11, 2014
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Magnetic resonance spectroscopic imaging (MRSI) detects hippocampal injury in veterans with explosive blast mild traumatic brain injury (mTBI). This brain injury is linked to memory deficits and differs from posttraumatic stress disorder (PTSD) injury.

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Area of Science:

  • Neuroscience
  • Radiology
  • Military Medicine

Background:

  • Explosive blast mild traumatic brain injury (mTBI) causes memory impairment and posttraumatic stress disorder (PTSD).
  • Hippocampal injury is a known consequence of explosive shock waves.
  • Magnetic resonance spectroscopic imaging (MRSI) shows promise for detecting mTBI-related brain injury.

Purpose of the Study:

  • To apply MRSI to study veterans with explosive blast mTBI.
  • To compare hippocampal injury in veterans with mTBI, controls, and subjects with PTSD without blast exposure.
  • To correlate MRSI findings with neuropsychiatric and cognitive deficits.

Main Methods:

  • MRSI at 7 Tesla was used to study the hippocampi of 25 veterans with blast mTBI, 20 controls, and 12 subjects with PTSD (no blast).
  • Psychiatric and cognitive assessments were performed.
  • MRSI data were analyzed for metabolite ratios (NAA/Ch, NAA/Cr) and hippocampal volume.

Main Results:

  • Veterans with blast mTBI showed reduced N-acetyl aspartate to choline (NAA/Ch) and N-acetyl aspartate to creatine (NAA/Cr) ratios in the anterior hippocampus (P < 0.05).
  • The right hippocampus was 15% smaller in volume in the mTBI group (P < 0.05).
  • These changes were independent of PTSD, depression, or anxiety comorbidities. PTSD without blast showed lesser, posterior hippocampal injury and less visual memory reduction.

Conclusions:

  • Hippocampal injury location differentiates explosive blast mTBI from PTSD.
  • MRSI effectively detects and localizes neuronal injury in the hippocampus associated with memory impairment following blast exposure.