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Serial measurement of memory and diffusion tensor imaging changes within the first week following uncomplicated mild traumatic brain injury

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Abstract

Patients (n = 8) with uncomplicated mild traumatic brain injury (mTBI) underwent serial assessments (4) with diffusion tensor imaging (DTI) and neuropsychological testing within the first 8 days post-injury. Using a multi-case study design, we examined changes in brain parenchyma (via DTI-derived fractional anisotropy [FA], apparent diffusion coefficient [ADC], axial diffusivity [AD] and radial diffusivity [RD] in the left cingulum bundle) and in memory performance (via Hopkins Verbal Learning Test-Revised). Qualitative inspection of the results indicated that memory performance was transiently affected in most participants over the course of the week, with performance most negatively impacted on the second assessment (days 3–4 or 97–144 h post-injury), and then returning to within normal limits by 8 days post-injury. Alternatively, FA and other DTI metrics showed a more complex pattern, with the trajectory of some participants changing more prominently than others. For example, FA transiently increased in some participants over the study period, but the pattern was heterogeneous. Memory performance appeared to mirror changes in FA in certain cases, supporting a pathophysiological basis to memory impairment following mTBI. However, the pattern and the degree of symmetry between FA and memory performance was complex and did not always correspond. Serial imaging over the semi-acute recovery period may be important in reconciling conflicting findings in mTBI utilizing memory and/or DTI. Serial use of imaging modalities including DTI may aid understanding of underlying pathophysiological changes in the semi-acute post-injury period. Should a consistent pattern emerge that allows identification of patients at-risk for acute and/or persistent symptoms, such knowledge could guide development of therapeutic targets in mTBI and in understanding the most effective administration time window for these agents.

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Acknowledgements

This work was supported by the National Institute of Neurological Disorders and Stroke grant 1R03NS069943-01 (“Diffusion Tensor Imaging of Acute and Subacute Mild TBI”; Wilde and McCauley, Co-PIs). We gratefully acknowledge the contribution of Ponnada Narayana, Ph.D. and Vipulkumar S. Patel in implementation and execution of the imaging sequences. We would also like to thank Melisa L. Frisby, MSN, Reni Varghese, and Hector M. Garza for their support and assistance in patient recruitment. We thank the participants and their families for their participation in this research. Finally, we wish to thank the anonymous reviewers of this manuscript for their thoughtful insights and suggestions. None of the authors have any financial or other relationship(s) that could be construed as a conflict of interest with respect to the content of this manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Correspondence to Elisabeth A. Wilde.

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Elisabeth A. Wilde and Stephen R. McCauley contributed equally to this work and wish to be considered co-first authors.

This project was supported by grant number 1R03NS069943-01 from the National Institute of Neurological Disorders and Stroke. Portions of this study were presented at the 29th annual meeting of the National Neurotrauma Symposium, Ft. Lauderdale, Florida, June, 2011.

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Wilde, E.A., McCauley, S.R., Barnes, A. et al. Serial measurement of memory and diffusion tensor imaging changes within the first week following uncomplicated mild traumatic brain injury. Brain Imaging and Behavior 6, 319–328 (2012). https://doi.org/10.1007/s11682-012-9174-3

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