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Traumatic Microbleeds in the Hippocampus and Corpus Callosum Predict Duration of Posttraumatic Amnesia

Nicole L Mazwi1, Saef Izzy, Can Ozan Tan

  • 1Department of Physical Medicine and Rehabilitation (Drs Mazwi and Zafonte), Department of Neurology (Drs Izzy, Martinez, and Edlow), Department of Radiology (Dr Tan), Department of Radiology (Dr Wu), Athinoula A. Martinos Center for Biomedical Imaging (Drs Wu and Edlow), and Center for Neurotechnology and Neurorecovery (Dr Edlow), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts (Drs Mazwi, Tan, Glenn, Giacino, and Zafonte); Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Drs Izzy and Martinez); and Cerebrovascular Research Laboratory, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts (Dr Tan).

The Journal of Head Trauma Rehabilitation
|April 30, 2019
PubMed
Abstract

Insights

Traumatic microbleeds (TMBs) in the hippocampus and corpus callosum may predict prolonged posttraumatic amnesia (PTA) duration after traumatic brain injury (TBI). These radiologic findings, along with age and initial GCS score, help identify patients at risk for longer recovery.

Area of Science:

  • Neuroimaging
  • Neurology
  • Radiology

Background:

  • Posttraumatic amnesia (PTA) duration is a critical outcome measure following traumatic brain injury (TBI).
  • Predicting PTA duration is challenging, and reliable radiologic markers are needed.
  • Gradient recalled echo (GRE) magnetic resonance imaging (MRI) can detect traumatic microbleeds (TMBs).

Purpose of the Study:

  • To investigate whether the number and distribution of TMBs detected by GRE MRI can predict PTA duration in TBI patients.
  • To identify specific brain regions where TMBs are most predictive of PTA duration.

Main Methods:

  • Retrospective analysis of 65 adult TBI patients with acute GRE MRI.
  • PTA duration assessed using standardized clinical measures.
  • TMBs identified and quantified in specific memory-related and control brain regions.
  • Regression tree analysis to determine radiologic predictors of PTA duration, controlling for clinical factors.

Main Results:

  • PTA duration varied widely (0-240 days), with a median of 43 days.
  • Univariate analysis showed correlations between PTA duration and TMBs in the corpus callosum and admission Glasgow Coma Scale (GCS) score.
  • Multivariate analysis indicated admission GCS score as the sole significant predictor.
  • Regression tree analysis revealed that hippocampal TMBs, callosal TMBs, age, and admission GCS score explained 26% of PTA duration variance and identified a subgroup with prolonged PTA.

Conclusions:

  • Hippocampal and callosal TMBs show potential as radiologic predictors of PTA duration.
  • GRE MRI detection of TMBs may offer valuable prognostic information in TBI.
  • Further research is warranted to validate these findings and integrate them into clinical practice.

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