Objective Documentation of Traumatic Brain Injury Subsequent to Mild Head Trauma: Multimodal Brain Imaging With MEG, SPECT, and MRI

ObjectiveTo determine to what extent magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT), and magnetoencephalography (MEG) can provide objective evidence of brain injury in adult patients with persistent (>1 year) postconcussive symptoms following mild blunt head trauma. DesignA retrospective and blind review of imaging data with respect to the presence of specific somatic, psychiatric, and cognitive complaints. Setting/ParticipantsThirty complete data sets (with MRI, SPECT, MEG, and neuropsychological testing results) were collected between 1994 and 2000 from the MEG programs at the Albuquerque VAMC and the University of Utah. Main Outcome MeasuresMRI data were evaluated for focal and diffuse structural abnormalities, SPECT data for regions of hypoperfusion, and resting MEG data for abnormal dipolar slow wave activity (DSWA) and epileptiform transients. ResultsStructural MRI was abnormal for 4 patients. SPECT showed regions of hypoperfusion in 12 patients, while MEG showed abnormal activity in 19 patients. None of the imaging methods produced findings statistically associated with postconcussive psychiatric symptoms. A significant association was found between basal ganglia hypoperfusion and postconcussive headaches. For patients with cognitive complaints, abnormalities were more likely to be detected by MEG (86%) than either SPECT (40%) or MRI (18%) (P < .01). MEG also revealed significant (P < .01) associations between temporal lobe DSWA and memory problems, parietal DSWA and attention problems, and frontal DSWA and problems in executive function. ConclusionsFunctional brain imaging data collected in a resting state can provide objective evidence of brain injury in mild blunt head trauma patients with persistent postconcussive somatic and/or cognitive symptoms. MEG proved to be particularly informative for patients with cognitive symptoms.

[1]  T. Oliver.  TRAUMATISM AND TUBERCULOSIS , 1915, British medical journal.

[2]  H. Miller.  Accident Neurosis* , 1961, British medical journal.

[3]  D. Oppenheimer,et al.  Microscopic lesions in the brain following head injury. , 1968, Journal of neurology, neurosurgery, and psychiatry.

[4]  P Gloor,et al.  Brain lesions that produce delta waves in the EEG , 1977, Neurology.

[5]  B. Giordani,et al.  Disability caused by minor head injury. , 1981, Neurosurgery.

[6]  S. Kornstein,et al.  Psychiatric complications of closed head trauma. , 1985, Psychosomatics.

[7]  B. Thompson,et al.  MR imaging of head trauma: review of the distribution and radiopathologic features of traumatic lesions. , 1988, AJR. American journal of roentgenology.

[8]  R. Thatcher,et al.  EEG discriminant analyses of mild head trauma. , 1989, Electroencephalography and clinical neurophysiology.

[9]  D. Wyper,et al.  SPECT cerebral blood flow, MR imaging, and neuropsychological findings in traumatic head injury. , 1989 .

[10]  M M Mesulam,et al.  Large‐scale neurocognitive networks and distributed processing for attention, language, and memory , 1990, Annals of neurology.

[11]  J. Vieth.  Magnetoencephalography in the study of stroke (cerebrovascular accident). , 1990, Advances in neurology.

[12]  Vieth Jb.  Magnetoencephalography in the study of stroke (cerebrovascular accident). , 1990 .

[13]  K. Gulenchyn,et al.  Cerebral Perfusion Imaging with Technetium-99m HMPAO Following Cerebral Trauma: Initial Experience , 1990, Clinical nuclear medicine.

[14]  T A Gennarelli,et al.  Animate models of human head injury. , 1994, Journal of neurotrauma.

[15]  M. Ichise,et al.  Technetium-99m-HMPAO SPECT, CT and MRI in the evaluation of patients with chronic traumatic brain injury: a correlation with neuropsychological performance. , 1994, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[16]  W W Orrison,et al.  Spike and slow wave localization by magnetoencephalography. , 1995, Neuroimaging clinics of North America.

[17]  Lewine Jd,et al.  Spike and slow wave localization by magnetoencephalography. , 1995 .

[18]  J. Lewine,et al.  CHAPTER 9 – Magnetoencephalography and Magnetic Source Imaging , 1995 .

[19]  C. Tesche,et al.  Non-invasive imaging of neuronal population dynamics in human thalamus , 1996, Brain Research.

[20]  Joseph James Duffy,et al.  Tc-HMPAO SPECT in persistent post-concussion syndrome after mild head injury: comparison with MRI/CT. , 1997, Brain injury.

[21]  K. Willmes,et al.  Subjective experience in brain-injured patients and their close relatives: a European Brain Injury Questionnaire study. , 1997, Brain injury.

[22]  F E Bloom,et al.  Magnetic Source Imaging of Abnormal Low‐Frequency Magnetic Activity in Presurgical Evaluations of Epilepsy , 1997, Epilepsia.

[23]  D. Poeppel,et al.  Magnetoencephalography and magnetic source imaging. , 1998, Neuropsychiatry, neuropsychology, and behavioral neurology.

[24]  M. Sandel,et al.  Functional assessment of mild traumatic brain injury using SPECT and neuropsychological testing. , 1998, Brain injury.

[25]  S. Naddaf,et al.  SPECT brain perfusion abnormalities in mild or moderate traumatic brain injury. , 1998, Clinical nuclear medicine.

[26]  J. Lewine,et al.  Neuromagnetic assessment of pathophysiologic brain activity induced by minor head trauma. , 1999, AJNR. American journal of neuroradiology.

[27]  J A Maldjian,et al.  Traumatic brain injury: diffusion-weighted MR imaging findings. , 1999, AJNR. American journal of neuroradiology.

[28]  J. van der Naalt,et al.  Computed tomography and magnetic resonance imaging in mild to moderate head injury: Early and late imaging related to outcome , 1999, Annals of neurology.

[29]  J. Kassubek,et al.  Time course of focal slow wave activity in transient ischemic attacks and transient global amnesia as measured by magnetoencephalography , 2000, Neuroreport.

[30]  Michael Weinberg.  Electrophysiological indices of persistent post-concussion symptoms , 2000, Brain injury.

[31]  R I Grossman,et al.  Magnetization transfer imaging in the detection of injury associated with mild head trauma. , 2000, AJNR. American journal of neuroradiology.

[32]  M. Gaetz,et al.  Electrophysiological evidence for the cumulative effects of concussion. , 2000, Brain injury.

[33]  R. Thatcher,et al.  An EEG severity index of traumatic brain injury. , 2001, The Journal of neuropsychiatry and clinical neurosciences.

[34]  J. Jolles,et al.  MR imaging, single-photon emission CT, and neurocognitive performance after mild traumatic brain injury. , 2001, AJNR. American journal of neuroradiology.

[35]  Andrew J. Saykin,et al.  Differential Working Memory Load Effects after Mild Traumatic Brain Injury , 2001, NeuroImage.

[36]  P J Donovick,et al.  Traumatic brain injury (TBI) 10-20 years later: a comprehensive outcome study of psychiatric symptomatology, cognitive abilities and psychosocial functioning. , 2001, Brain injury.

[37]  G Nolte,et al.  Partial signal space projection for artefact removal in MEG measurements: a theoretical analysis. , 2001, Physics in medicine and biology.

[38]  B. Rockstroh,et al.  Source distribution of neuromagnetic slow waves and MEG-delta activity in schizophrenic patients , 2001, Biological Psychiatry.

[39]  E. Bigler,et al.  Quantitative magnetic resonance imaging in traumatic brain injury. , 2001, The Journal of head trauma rehabilitation.

[40]  V. Eder,et al.  Technetium‐99m ECD Single Photon Emission Computed Tomography in Brain Trauma: Comparison of Early Scintigraphic Findings With Long‐Term Neuropsychological Outcome , 2001, Journal of neuroimaging : official journal of the American Society of Neuroimaging.

[41]  A. Alavi,et al.  Dynamic imaging in mild traumatic brain injury: support for the theory of medial temporal vulnerability. , 2002, Archives of physical medicine and rehabilitation.

[42]  Alberto Fernández,et al.  Correlations of hippocampal atrophy and focal low-frequency magnetic activity in Alzheimer disease: volumetric MR imaging-magnetoencephalographic study. , 2003, AJNR. American journal of neuroradiology.

[43]  D. Kareken,et al.  A study of persistent post-concussion symptoms in mild head trauma using positron emission tomography , 2003, Journal of neurology, neurosurgery, and psychiatry.

[44]  David J. Schretlen,et al.  A quantitative review of the effects of traumatic brain injury on cognitive functioning , 2003, International review of psychiatry.

[45]  Cornelis J. Stam,et al.  The influence of brain tumor treatment on pathological delta activity in MEG , 2003, NeuroImage.

[46]  B. Lerer,et al.  Cerebral blood flow in chronic symptomatic mild traumatic brain injury , 2003, Psychiatry Research: Neuroimaging.

[47]  Peter M Rees.  Contemporary issues in mild traumatic brain injury. , 2003, Archives of physical medicine and rehabilitation.

[48]  G. Manley,et al.  Volumetric proton spectroscopic imaging of mild traumatic brain injury. , 2004, AJNR. American journal of neuroradiology.

[49]  Alain Ptito,et al.  Functional abnormalities in symptomatic concussed athletes: an fMRI study , 2004, NeuroImage.

[50]  Helmut Kober,et al.  Sources of spontaneous slow waves associated with brain lesions, localized by using the MEG , 2005, Brain Topography.

[51]  A. Sack,et al.  Functional activation imaging in aging and dementia , 2005, Psychiatry Research: Neuroimaging.

[52]  Ronald Ruff,et al.  Two Decades of Advances in Understanding of Mild Traumatic Brain Injury , 2005, The Journal of head trauma rehabilitation.

[53]  M. Hogge,et al.  Exploration of the neural substrates of executive functioning by functional neuroimaging , 2006, Neuroscience.