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Brain dysfunction underlying prolonged post-concussive syndrome: A systematic review.

Bruno Biagianti1, Nino Stocchetti2, Paolo Brambilla3

  • 1Department of R&D, Posit Science Corporation, 160 Pine Street, Suite 200, San Francisco, CA 94111, USA; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.

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Mild traumatic brain injury (mTBI) can cause persistent post-concussive symptoms (PCS) due to underlying brain dysfunction. Neuroimaging reveals lingering damage and altered brain function in PCS patients, highlighting potential biomarkers for this condition.

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Area of Science:

  • Neuroscience
  • Radiology
  • Neurology

Background:

  • Mild traumatic brain injury (mTBI) affects 1 in 4 patients with persistent complaints.
  • Conventional neuroimaging often shows no structural brain damage in these cases.
  • The link between occult brain dysfunction and persistent post-concussive symptoms (PCS) is not well understood.

Purpose of the Study:

  • To integrate findings from longitudinal neuroimaging studies.
  • To identify predictors or biomarkers of persistent PCS after mTBI.
  • To understand neural changes within 12 months post-mTBI.

Main Methods:

  • Systematic review of 9 longitudinal studies.
  • Inclusion of studies using resting state functional MRI, Diffusion Weighted Imaging, and 1H-MR Spectroscopy.
  • Analysis of neuroimaging data within the first year following mTBI.

Main Results:

  • All included studies reported structural, functional, or metabolic brain abnormalities post-mTBI.
  • Persistent PCS in patients correlates with lingering mTBI-induced damage.
  • Identified biomarkers include white matter diffusion changes, altered perfusion, metabolic disruption, and reduced network connectivity.
  • Brain function disruptions in PCS can emerge exclusively in the chronic phase.

Conclusions:

  • Neuroimaging modalities are valuable for understanding mTBI-related brain changes over time.
  • Further research is needed to fully characterize injury and recovery mechanisms influencing PCS persistence.
  • Understanding these mechanisms is crucial for predicting and managing persistent post-concussive symptoms.