MRI pinpoints region of brain injury in some concussion patients

Researchers using information provided by a magnetic resonance imaging (MRI) technique have identified regional white matter damage in the brains of people who experience chronic dizziness and other symptoms after concussion.

The findings suggest that information provided by MRI can speed the onset of effective treatments for concussion . The results of this research are published online in the journal Radiology.

Concussions, also known as mild (mTBI), affect between 1.8 and 3.8 million individuals in the United States annually.

One of the most common and debilitating effects of concussion is vestibulopathy, a condition characterized by dizziness, imbalance and visual problems. Vestibulopathy impairs activities of daily living and puts patients at increased risk for a second injury. Up until now, no specific regions have been linked to the prognosis of patients with vestibulopathy.

For the study, the researchers retrospectively reviewed imaging data from 30 mTBI patients with vestibular symptoms and 25 with ocular convergence insufficiency, a condition that occurs when the eyes don't turn inward properly when focusing on a nearby object. Controls consisted of 39 mTBI patients without vestibular abnormalities and 17 with normal ocular convergence. The imaging data was acquired using an MRI technique called diffusion tensor imaging (DTI), which produces a fractional anisotropy (FA) value that can be used to determine damage to the brain's signal-transmitting white matter.

"FA provides a measure of how intact the white matter is," said Lea Alhilali, M.D., from the University of Pittsburgh Medical Center. "The lower the FA value, the more injured the white matter is."

When Dr. Alhilali and colleagues compared the DTI results, they found that the concussion patients with vestibular symptoms had decreased FA values in brain regions not previously suspected to be involved in post-traumatic vestibulopathy.

"Patients with vestibular symptoms had injury in the cerebellar area, which is known to control balance and movement, and also in the fusiform gyri, a brain area that integrates the visual fields of the left and right eye and is important to spatial orientation," she said.

The findings appear to show a connection between vestibulopathy and regional brain damage, Dr. Alhilali added.

"Vestibulopathy was previously thought to be related to the inner ear structure," she said. "What's unique about our study is that it shows that, in these patients, there is also injury to the brain itself."

The researchers also found that injury to the cerebellar area was associated with a lengthier recovery time.

The findings have the potential to change the clinical management of vestibulopathy in concussion patients, Dr. Alhilali said. For example, DTI results could be used alongside neurocognitive testing to help determine a patient's prognosis and begin appropriate treatments.

"Vestibular therapy is often very effective," Dr. Alhilali said. "Using DTI findings, we can treat patients earlier and get them back to a baseline state much sooner."

The researchers have two goals in the near term, Dr. Alhilali said. First they want to identify brain injuries associated with other post- symptoms, and then they hope to conduct prospective studies to track patients from shortly after their concussions through recovery.

"Concussion is not just one pathology, but many different injuries with different symptoms," Dr. Alhilali said. "Not every case is the same, and we need to treat each patient individually."

More information: "Detection of Central White Matter Injury Underlying Vestibulopathy after Mild Traumatic Brain Injury." Radiology, 2014.

add to favorites email to friend print save as pdf

Related Stories

Imaging shows some brains compensate after traumatic injury

Nov 26, 2012

Using a special magnetic resonance imaging (MRI) technique to image patients with mild traumatic brain injury (MTBI), researchers have identified a biomarker that may predict which patients will do well over the long term, ...

Concussion patients show Alzheimer's-like brain abnormalities

Jun 18, 2013

The distribution of white matter brain abnormalities in some patients after mild traumatic brain injury (MTBI) closely resembles that found in early Alzheimer's dementia, according to a new study published online in the journal ...

Recommended for you

New ALS associated gene identified using innovative strategy

15 hours ago

Using an innovative exome sequencing strategy, a team of international scientists led by John Landers, PhD, at the University of Massachusetts Medical School has shown that TUBA4A, the gene encoding the Tubulin Alpha 4A protein, ...

Can bariatric surgery lead to severe headache?

15 hours ago

Bariatric surgery may be a risk factor for a condition that causes severe headaches, according to a study published in the October 22, 2014, online issue of Neurology, the medical journal of the American Academy of Neurol ...

Bipolar disorder discovery at the nano level

15 hours ago

A nano-sized discovery by Northwestern Medicine scientists helps explain how bipolar disorder affects the brain and could one day lead to new drug therapies to treat the mental illness.

Brain simulation raises questions

19 hours ago

What does it mean to simulate the human brain? Why is it important to do so? And is it even possible to simulate the brain separately from the body it exists in? These questions are discussed in a new paper ...

Human skin cells reprogrammed directly into brain cells

19 hours ago

Scientists have described a way to convert human skin cells directly into a specific type of brain cell affected by Huntington's disease, an ultimately fatal neurodegenerative disorder. Unlike other techniques ...

User comments