Advertisement

Neuroradiology

, Volume 46, Issue 7, pp 550–558 | Cite as

Abnormalities on magnetic resonance imaging seen acutely following mild traumatic brain injury: correlation with neuropsychological tests and delayed recovery

  • David G. HughesEmail author
  • Alan Jackson
  • Damon L. Mason
  • Elizabeth Berry
  • Sally Hollis
  • David W. Yates
Diagnostic Neuroradiology

Abstract

Mild traumatic brain injury (MTBI) is a common reason for hospital attendance and is associated with significant delayed morbidity. We studied a series of 80 persons with MTBI. Magnetic resonance imaging (MRI) and neuropsychological testing were used in the acute phase and a questionnaire for post-concussion syndrome (PCS) and return to work status at 6 months. In 26 subjects abnormalities were seen on MRI, of which 5 were definitely traumatic. There was weak correlation with abnormal neuropsychological tests for attention in the acute period. There was no significant correlation with a questionnaire for PCS and return to work status. Although non-specific abnormalities are frequently seen, standard MRI techniques are not helpful in identifying patients with MTBI who are likely to have delayed recovery.

Keywords

Magnetic resonance imaging Mild traumatic brain injury Neuropsychology 

References

  1. 1.
    Bazarian JJ, Wong T, Harris M, Leahey N, Mookerjee S, Dombovy M (1999) Epidemiology and predictors of post-concussive syndrome after minor head injury in an emergency population. Brain Inj 13:173–189CrossRefPubMedGoogle Scholar
  2. 2.
    Cicerone KD (1996) Attention deficits and dual task demands after mild traumatic brain injury. Brain Inj 10:79–89CrossRefPubMedGoogle Scholar
  3. 3.
    Arcia E, Gualtieri CT (1993) Association between patient report of symptoms after mild head injury and neurobehavioural performance. Brain Inj 7:481–489PubMedGoogle Scholar
  4. 4.
    Alexander MP (1995) Mild traumatic brain injury: pathophysiology, natural history, and clinical management. Neurology 45:1253–1260PubMedGoogle Scholar
  5. 5.
    Thornhill S, Teasdale GM, Murray GD, McEwen J, Roy CW, Penny K (2000) Disability in young people and adults one year after head injury: prospective cohort study. BMJ 320:1631–1635CrossRefPubMedGoogle Scholar
  6. 6.
    Stiell IG, Wells GA, Vandemheen K (2001) The Canadian head rule for patients with minor head injury. Lancet 357:1391–1396CrossRefPubMedGoogle Scholar
  7. 7.
    Kelly AB, Zimmerman RD, Snow RB, Gandy SE, Heier LA, Deck MD (1988) Head trauma: comparison of MR and CT-experience in 100 patients. AJNR Am J Neuroradiol 9:699–708PubMedGoogle Scholar
  8. 8.
    Ashikaga R, Araki Y, Ishida O (1997) MRI of head injury using FLAIR. Neuroradiology 39:239–242PubMedGoogle Scholar
  9. 9.
    Yanagawa Y, Tsushima Y, Tokumaru A et al (2000) A quantitative analysis of head injury using T2*-weighted gradient-echo imaging. J Trauma 49:272–277PubMedGoogle Scholar
  10. 10.
    Wallesch CW, Curio N, Galazky I, Jost S, Synowitz H (2001) The neuropsychology of blunt head injury in the early postacute stage: effects of focal lesions and diffuse axonal injury. J Neurotrauma 18:11–20CrossRefPubMedGoogle Scholar
  11. 11.
    Uchino Y, Okimura Y, Tanaka M, Saeki N, Yamaura A (2001) Computed tomography and magnetic resonance imaging of mild head injury-is it appropriate to classify patients with Glasgow Coma Scale score of 13 to 15 as “mild injury”? Acta Neurochir (Wien) 143:1031–1037Google Scholar
  12. 12.
    Voller B, Auff E, Schnider P, Aichner F (2001) To do or not to do? Magnetic resonance imaging in mild traumatic brain injury. Brain Inj 15:107–115CrossRefPubMedGoogle Scholar
  13. 13.
    Kay T (1993) Definitions of mild traumatic brain injury. J Head Trauma Rehabil 8:86–87Google Scholar
  14. 14.
    Nelson H (1982) National adult reading test. NFER-Nelson, WindsorGoogle Scholar
  15. 15.
    King NS, Crawford S, Wenden FJ, Moss NE, Wade DT, Caldwell FE (1997) Measurement of post-traumatic amnesia: how reliable is it? J Neurol Neurosurg Psychiatry 62:38–42PubMedGoogle Scholar
  16. 16.
    King NS, Crawford S, Wenden FJ, Moss NE, Wade DT (1995) The Rivermead Post Concussion Symptoms Questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. J Neurol 242:587–592PubMedGoogle Scholar
  17. 17.
    Binder LM, Rohling ML, Larrabee J (1997) A review of mild head trauma. I. Meta-analytic review of neuropsychological studies. J Clin Exp Neuropsychol 19:421–431PubMedGoogle Scholar
  18. 18.
    Binder LM (1997) A review of mild head trauma. II. Clinical implications. J Clin Exp Neuropsychol 19:432–457PubMedGoogle Scholar
  19. 19.
    Stewart DP, Kaylor J, Koutanis E (1996) Cognitive deficits in presumed minor head-injured patients. Acad Emerg Med 3:21–26PubMedGoogle Scholar
  20. 20.
    Rimel RW, Giordani B, Barth JT, Boll TJ, Jane JA (1981) Disability caused by minor head injury. Neurosurgery 9:221–228PubMedGoogle Scholar
  21. 21.
    Echemendia RJ, Putukian M, Mackin RS, Julian L, Shoss N (2001) Neuropsychological test performance prior to and following sports-related mild traumatic brain injury. Clin J Sport Med 11:23–31CrossRefPubMedGoogle Scholar
  22. 22.
    Laforce R Jr, Martin-MacLeod L (2001) Symptom cluster associated with mild traumatic brain injury in university students. Percept Mot Skills 93:281–288PubMedGoogle Scholar
  23. 23.
    Van der Naalt J, Van Zomeren AH, Sluiter WJ, Minderhoud JM (2000) Acute behavioural disturbances related to imaging studies and outcome in mild-to-moderate head injury. Brain Inj 14:781–788CrossRefPubMedGoogle Scholar
  24. 24.
    Ponsford J, Willmott C, Rothwell A et al (2000) Factors influencing outcome following mild traumatic brain injury in adults. J Int Neuropsychol Soc 6:568–579CrossRefPubMedGoogle Scholar
  25. 25.
    Mittenberg W, Strauman S (2000) Diagnosis of mild head injury and the postconcussion syndrome. J Head Trauma Rehabil 15:783–791PubMedGoogle Scholar
  26. 26.
    Voller B, Benke T, Benedetto K, Schnider P, Auff E, Aichner F (1999) Neuropsychological, MRI and EEG findings after very mild traumatic brain injury. Brain Inj 13:821–827CrossRefPubMedGoogle Scholar
  27. 27.
    Tellier A, Della Malva LC, Cwinn A, Grahovac S, Morrish W, Brennan-Barnes M (1999) Mild head injury: a misnomer. Brain Inj 13:463–475CrossRefPubMedGoogle Scholar
  28. 28.
    Satz PS, Alfano MS, Light RF et al (1999) Persistent post-concussive syndrome: a proposed methodology and literature review to determine the effects, if any, of mild head and other bodily injury. J Clin Exp Neuropsychol 21:620–628CrossRefPubMedGoogle Scholar
  29. 29.
    Abu-Judeh HH, Parker R, Singh M et al (1999) SPECT brain perfusion imaging in mild traumatic brain injury without loss of consciousness and normal computed tomography. Nucl Med Commun 20:505–510PubMedGoogle Scholar
  30. 30.
    Abdel-Dayem HM, Abu-Judeh H, Kumar M et al (1998) SPECT brain perfusion abnormalities in mild or moderate traumatic brain injury. Clin Nucl Med 23:309–317CrossRefPubMedGoogle Scholar
  31. 31.
    Arciniegas DB, Held K, Wagner P (2002) Cognitive impairment following traumatic brain injury. Curr Treat Options Neurol 4:43–57PubMedGoogle Scholar
  32. 32.
    Brooks J, Fos LA, Greve KW, Hammond JS (1999) Assessment of executive function in patients with mild traumatic brain injury. J Trauma 46:159–163PubMedGoogle Scholar
  33. 33.
    Feinstein A, Rapoport M (2000) Mild traumatic brain injury: the silent epidemic. Can J Public Health 91:325–332PubMedGoogle Scholar
  34. 34.
    De Kruijk JR, Twijnstra A, Meerhoff S, Leffers P (2001) Management of mild traumatic brain injury: lack of consensus in Europe. Brain Inj 15:117–123PubMedGoogle Scholar
  35. 35.
    Inamasu J, Hori S, Aoki K, Suga S, Kawase T, Aikawa N (2000) CT scans essential after posttraumatic loss of consciousness. Am J Emerg Med 18:810–811CrossRefPubMedGoogle Scholar
  36. 36.
    Clausen T, Bullock R (2001) Medical treatment and neuroprotection in traumatic brain injury. Curr Pharm Des 7:1517–1532PubMedGoogle Scholar
  37. 37.
    Von Wild K, Terwey S (2001) Diagnostic confusion in mild traumatic brain injury (MTBI). Lessons from clinical practice and EFNS-inquiry. European Federation of Neurological Societies. Brain Inj 15:273–277CrossRefPubMedGoogle Scholar
  38. 38.
    Servadei F, Teasdale G, Merry G (2001) Defining acute mild head injury in adults: a proposal based on prognostic factors, diagnosis, and management. J Neurotrauma 18:657–664CrossRefPubMedGoogle Scholar
  39. 39.
    Arciniegas DB, Silver JM (2001) Regarding the search for a unified definition of mild traumatic brain injury. Brain Inj 15:649–652CrossRefPubMedGoogle Scholar
  40. 40.
    Ruff RM, Jurica P (1999) In search of a unified definition for mild traumatic brain injury. Brain Inj 13:943–952CrossRefPubMedGoogle Scholar
  41. 41.
    Weight DG (1998) Minor head trauma. Psychiatr Clin North Am 21:609–624PubMedGoogle Scholar
  42. 42.
    Van der Naalt J, Hew JM, Van Zomeren AH, Sluiter WJ, Minderhoud JM (1999) Computed tomography and magnetic resonance imaging in mild to moderate head injury: early and late imaging related to outcome. Ann Neurol 46:70–78PubMedGoogle Scholar
  43. 43.
    Umile EM, Plotkin RC, Sandel ME (1998) Functional assessment of mild traumatic brain injury using SPECT and neuropsychological testing. Brain Inj 12:577–594Google Scholar
  44. 44.
    Levin HS, Amparo E, Eisenberg HM et al (1987) Magnetic resonance imaging and computerized tomography in relation to the neurobehavioral sequelae of mild and moderate head injuries. J Neurosurg 66:706–713PubMedGoogle Scholar
  45. 45.
    Hofman PA, Stapert SZ, Van Kroonenburgh MJ, Jolles J, De Kruijk J, Wilmink JT (2001) MR imaging, single-photon emission CT, and neurocognitive performance after mild traumatic brain injury. AJNR Am J Neuroradiol 22:441–449PubMedGoogle Scholar
  46. 46.
    Mitchener A, Wyper DJ, Patterson J et al (1997) SPECT, CT, and MRI in head injury: acute abnormalities followed up at six months. J Neurol Neurosurg Psychiatry 62:633–636PubMedGoogle Scholar
  47. 47.
    Levin HS, Williams DH, Eisenberg HM, High WM Jr, Guinto FC Jr (1992) Serial MRI and neurobehavioural findings after mild to moderate closed head injury. J Neurol Neurosurg Psychiatry 55:255–262PubMedGoogle Scholar
  48. 48.
    Yokota H, Kurokawa A, Otsuka T, Kobayashi S, Nakazawa S (1991) Significance of magnetic resonance imaging in acute head injury. J Trauma 31:351–357PubMedGoogle Scholar
  49. 49.
    Kant R, Smith-Seemiller L, Isaac G, Duffy J (1997) Tc-HMPAO SPECT in persistent post-concussion syndrome after mild head injury: comparison with MRI/CT. Brain Inj 11:115–124CrossRefPubMedGoogle Scholar
  50. 50.
    Gawne-Cain ML, Silver NC, Moseley IF, Miller DH (1997) Fast FLAIR of the brain: the range of appearances in normal subjects and its application to quantification of white-matter disease. Neuroradiology 39:243–249CrossRefPubMedGoogle Scholar
  51. 51.
    Sklar EM, Quencer RM, Bowen BC, Altman N, Villanueva PA (1999) Magnetic resonance applications in cerebral injury. Radiol Clin North Am 30:353–366Google Scholar
  52. 52.
    Hadley DM, Teasdale GM, Jenkins A, Condon B, MacPherson P, Patterson J, Rowan JO (1988) MRI in acute head injury. Clin Radiol 39:131–139PubMedGoogle Scholar
  53. 53.
    Mittl RL, Grossman RI, Hiehle JF et al (1994) Prevalence of MR evidence of diffuse axonal injury in patients with mild head injury and normal head CT findings. AJNR Am J Neuroradiol 15:1583–1589PubMedGoogle Scholar
  54. 54.
    Wakamoto H, Miyazaki H, Inaba M, Ishiyama N, Kawase T (1998) [FLAIR images of mild head trauma with transient amnesia]. No Shinkei Geka 26:985–990PubMedGoogle Scholar
  55. 55.
    Hayman LA, Taber KH, Ford JJ, Bryan RN (1991) Mechanisms of MR signal alteration by acute intracerebral blood: old concepts and new theories. AJNR Am J Neuroradiol 12:899–907PubMedGoogle Scholar
  56. 56.
    Blatter DD, Bigler ED, Gale SD et al (1997) MR-based brain and cerebrospinal fluid measurement after traumatic brain injury: correlation with neuropsychological outcome. AJNR Am J Neuroradiol 18:1–10PubMedGoogle Scholar
  57. 57.
    McGowan JC, Yang JH, Plotkin RC et al (2000) Magnetization transfer imaging in the detection of injury associated with mild head trauma. AJNR Am J Neuroradiol 21:875–880PubMedGoogle Scholar
  58. 58.
    Sinson G, Bagley LJ, Cecil KM et al (2001) Magnetization transfer imaging and proton MR spectroscopy in the evaluation of axonal injury: correlation with clinical outcome after traumatic brain injury. AJNR Am J Neuroradiol 22:143–151Google Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • David G. Hughes
    • 1
    Email author
  • Alan Jackson
    • 1
  • Damon L. Mason
    • 2
  • Elizabeth Berry
    • 2
  • Sally Hollis
    • 3
  • David W. Yates
    • 4
  1. 1.Department of NeuroradiologyHope HospitalSalfordUK
  2. 2.Department of Behavioural MedicineHope HospitalSalfordUK
  3. 3.Medical Statistics UnitLancaster UniversityLancasterUK
  4. 4.Department of Emergency MedicineHope HospitalSalfordUK

Personalised recommendations