Clinical relevance of microhemorrhagic lesions in subacute mild traumatic brain injury

Brain Imaging and Behavior, Jun 2017

Magnetic resonance imaging (MRI) is often performed in patients with persistent complaints after mild traumatic brain injury (mTBI). However, the clinical relevance of detected microhemorrhagic lesions is still unclear. In the current study, 54 patients with uncomplicated mTBI and 20 matched healthy controls were included. Post-traumatic complaints were measured at two weeks post-injury. Susceptibility weighted imaging and T2*-gradient echo imaging (at 3 Tesla) were performed at four weeks post-injury. Microhemorrhagic lesions (1–10 mm) were subdivided based on depth (superficial or deep) and anatomical location (frontal, temporoparietal and other regions). Twenty-eight per cent of patients with mTBI had ≥1 lesions compared to 0 % of the healthy controls. Lesions in patients with mTBI were predominantly located within the superficial frontal areas. Number, depth and anatomical location of lesions did not differ between patients with and without post-traumatic complaints. Within the group of patients with complaints, number of complaints was not correlated with number of lesions. In summary, microhemorrhages were found in one out of four patients with uncomplicated mTBI during follow-up at four weeks post-injury, but they were not related to early complaints.

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Clinical relevance of microhemorrhagic lesions in subacute mild traumatic brain injury

Clinical relevance of microhemorrhagic lesions in subacute mild traumatic brain injury H. J. van der Horn 0 1 2 S. de Haan 0 1 2 J. M. Spikman 0 1 2 J. C. de Groot 0 1 2 J. van der Naalt 0 1 2 0 Department of Radiology, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands 1 Department of Neuropsychology, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands 2 Department of Neurology, University of Groningen, University Medical Center Groningen , Hanzeplein 1, 9700, RB Groningen , The Netherlands Magnetic resonance imaging (MRI) is often performed in patients with persistent complaints after mild traumatic brain injury (mTBI). However, the clinical relevance of detected microhemorrhagic lesions is still unclear. In the current study, 54 patients with uncomplicated mTBI and 20 matched healthy controls were included. Posttraumatic complaints were measured at two weeks postinjury. Susceptibility weighted imaging and T2*-gradient echo imaging (at 3 Tesla) were performed at four weeks post-injury. Microhemorrhagic lesions (1-10 mm) were subdivided based on depth (superficial or deep) and anatomical location (frontal, temporoparietal and other regions). Twenty-eight per cent of patients with mTBI had ≥1 lesions compared to 0 % of the healthy controls. Lesions in patients with mTBI were predominantly located within the superficial frontal areas. Number, depth and anatomical location of lesions did not differ between patients with and without post-traumatic complaints. Within the group of patients with complaints, number of complaints was not correlated with number of lesions. In summary, microhemorrhages were found in one out of four patients with uncomplicated mTBI during follow-up at four weeks post-injury, but they were not related to early complaints. Mild traumatic brain injury; MRI; Microhemorrhages; Microbleeds; Post-traumatic complaints Introduction Frequently, no abnormalities are found on computed tomography (CT) in the acute phase after mild traumatic brain injury (mTBI) (G L Iverson et al. 2000) . When patients suffer from (persistent) cognitive complaints interfering with daily activities, magnetic resonance imaging (MRI) is routinely performed to assess traumatic parenchymal abnormalities. However, studies have shown that the number of selfreported symptoms (which we will refer to as post-traumatic complaints) in the sub-acute phase after mTBI does not differ between patients with and without lesions on admission CT and/or follow-up MRI (i.e. complicated vs. uncomplicated mTBI) (Grant L. Iverson et al. 2012; Panenka et al. 2015) . Microhemorrhagic lesions are among the most frequently found traumatic abnormalities in mTBI, especially due to the sensitivity of susceptibility weighted imaging (SWI) and to a lesser extent of T2*-gradient echo (GRE) imaging (Huang et al. 2015; Yuh et al. 2013) . However, the clinical relevance of these microhemorrhages in addition to other traumatic lesions, with regard to post-traumatic complaints (Hofman et al. 2001; Hughes et al. 2004) , cognitive performance (Hofman et al. 2001; Huang et al. 2015; Hughes et al. 2004; Lee et al. 2008) and outcome (Yuh et al. 2013) , is still unclear. Hence, clear criteria to make a distinction between clinically relevant and non-relevant lesions in mTBI are currently not available. This pertains not only to the number of lesions, but also to depth and anatomical location of these lesions. The aim of the current study was to gain more insight into t h e n u m b e r , d e p t h a n d a n a t o m i c a l l o c a t i o n o f microhemorrhages on SWI and T2*-GRE in patients with uncomplicated mTBI and healthy controls, and to find clues for the interpretation in clinical practice, especially with regard to the presence or absence of post-traumatic complaints at two weeks post-injury. Methods Participants This study is part of a larger prospective multicentre cohort study on outcome post-mTBI (UPFRONT study) conducted between March 2013 and February 2015. Patients were included at the emergency department (ER) of the University Medical Centre Groningen (a level I trauma centre). Inclusion criteria for the MRI study were: age between 18 and 65, no abnormalities on admission CT-scan (i.e. uncomplicated mTBI), and the presence or absence of post-traumatic complaints at two weeks post-injury. Exclusion criteria were: major neurologic or psychiatric co-morbidity, admission for prior TBI, drug or alcohol abuse, mental retardation. This information was obtained from the patients’ history at the ER or neurology ward, and through questionnaires at two weeks postinjury. Contraindications for MRI were: implanted ferromagnetic devices or objects, pregnancy or claustrophobia. Twenty age, sex and education matched healthy controls without a history of TBI were recruited among social contacts and via advertisements. The study was approved by the Medical Ethics C (...truncated)


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H. J. van der Horn, S. de Haan, J. M. Spikman, J. C. de Groot, J. van der Naalt. Clinical relevance of microhemorrhagic lesions in subacute mild traumatic brain injury, Brain Imaging and Behavior, 2017, pp. 1-5, DOI: 10.1007/s11682-017-9743-6