Diagnostic Approach to Traumatic Axonal Injury of the Spinothalamic Tract in Individual Patients with Mild Traumatic Brain Injury
Abstract
:1. Introduction
2. Case Report
3. Statistical Analysis
4. Results
5. Discussion
Author Contributions
Funding
Conflicts of Interest
References
- Mild Traumatic Brain Injury Committee. Definition of mild traumatic brain injury. J. Head Trauma Rehabil. 1993, 8, 86–87. [Google Scholar] [CrossRef]
- Alexander, M.P. Mild traumatic brain injury: Pathophysiology, natural history, and clinical management. Neurology 1995, 45, 1253–1260. [Google Scholar] [CrossRef] [PubMed]
- Oppenheimer, D.R. Microscopic lesions in the brain following head injury. J. Neurol. Neurosurg. Psychiatry 1968, 31, 299–306. [Google Scholar] [CrossRef] [PubMed]
- Blumbergs, P.C.; Scott, G.; Manavis, J.; Wainwright, H.; Simpson, D.A.; McLean, A.J. Staining of amyloid precursor protein to study axonal damage in mild head injury. Lancet 1994, 344, 1055–1056. [Google Scholar] [CrossRef]
- Bigler, E.D. Neuropsychological results and neuropathological findings at autopsy in a case of mild traumatic brain injury. J. Int. Neuropsychol. Soc. 2004, 10, 794–806. [Google Scholar] [CrossRef]
- Arfanakis, K.; Haughton, V.M.; Carew, J.D.; Rogers, B.P.; Dempsey, R.J.; Meyerand, M.E. Diffusion tensor MR imaging in diffuse axonal injury. Am. J. Neuroradiol. 2002, 23, 794–802. [Google Scholar]
- Shenton, M.E.; Hamoda, H.M.; Schneiderman, J.S.; Bouix, S.; Pasternak, O.; Rathi, Y.; Vu, M.-A.; Purohit, M.P.; Helmer, K.; Koerte, I.; et al. A review of magnetic resonance imaging and diffusion tensor imaging findings in mild traumatic brain injury. Brain Imaging Behav. 2012, 6, 137–192. [Google Scholar] [CrossRef]
- Jang, S.H. Traumatic axonal injury in mild traumatic brain injury. In Traumatic Brain Injury; Gorbunoy, N., Ed.; InTech: London, UK, 2018; pp. 137–154. [Google Scholar]
- Jang, S.H. A review of corticospinal tract location at corona radiata and posterior limb of the internal capsule in human brain. NeuroRehabilitation 2009, 24, 279–283. [Google Scholar]
- Seo, J.P.; Kwon, Y.H.; Jang, S.H. Mini-review of studies reporting the repeatability and reproducibility of diffusion tensor imaging. Investig. Magn. Reson. Imaging 2019, in press. [Google Scholar] [CrossRef]
- Jang, S.H.; Kwon, Y.H. Central pain due to traumatic axonal injury of the spinothalamic tract in patients with mild traumatic brain injury. Brain Neurorehabil. 2018, 11, e7. [Google Scholar] [CrossRef]
- Jang, S.H.; Kwon, H.G. Apathy due to injury of the prefrontocaudate tract following mild traumatic brain injury. Am. J. Phys. Med. Rehabil. 2017, 96, e130–e133. [Google Scholar] [CrossRef] [PubMed]
- Shenton, M.E.; Price, B.H.; Levin, L.; Edersheim, J.G. Mild traumatic brain injury: Is DTI ready for the courtroom? Int. J. Law Psychiatry 2018, 61, 50–63. [Google Scholar] [CrossRef] [PubMed]
- Jang, S.H.; Lee, H.D. Diagnostic approach to traumatic axonal injury of the optic radiation in mild traumatic brain injury: A case report. Am. J. Phys. Med. Rehabil. 2018, 98, e92–e96. [Google Scholar] [CrossRef] [PubMed]
- Kim, J.H.; Ahn, S.H.; Cho, Y.W.; Kim, S.H.; Jang, S.H. The relation between injury of the spinothalamocortical tract and central pain in chronic patients with mild traumatic brain injury. J. Head Trauma Rehabil. 2015, 30, E40–E46. [Google Scholar] [CrossRef]
- Woolf, C.J.; Mannion, R.J. Neuropathic pain: Aetiology, symptoms, mechanisms, and management. Lancet 1999, 353, 1959–1964. [Google Scholar] [CrossRef]
- Devulder, J.; Crombez, E.; Mortier, E. Central pain: An overview. Acta Neurol. Belg. 2002, 102, 97–103. [Google Scholar]
- Dworkin, R.H.; Backonja, M.; Rowbotham, M.C.; Allen, R.R.; Argoff, C.R.; Bennett, G.J.; Bushnell, M.C.; Farrar, J.T.; Galer, B.S.; Haythornthwaite, J.A.; et al. Advances in neuropathic pain: Diagnosis, mechanisms, and treatment recommendations. Arch. Neurol. 2003, 60, 1524–1534. [Google Scholar] [CrossRef]
- Barad, M.; Greicius, M.D.; Mackey, S. Imaging the CNS correlates of neuropathic pain. Continuum 2009, 15, 30–46. [Google Scholar] [CrossRef]
- Klit, H.; Finnerup, N.B.; Jensen, T.S. Central post-stroke pain: Clinical characteristics, pathophysiology, and management. Lancet Neurol. 2009, 8, 857–868. [Google Scholar] [CrossRef]
- Smith, S.M.; Jenkinson, M.; Woolrich, M.W.; Beckmann, C.F.; Behrens, T.E.; Johansen-Berg, H.; Bannister, P.R.; De Luca, M.; Drobjak, I.; Flitney, D.E.; et al. Advances in functional and structural MR image analysis and implementation as FSL. Neuroimage 2004, 23 (Suppl. 1), S208–S219. [Google Scholar] [CrossRef]
- Behrens, T.E.; Berg, H.J.; Jbabdi, S.; Rushworth, M.F.; Woolrich, M.W. Probabilistic diffusion tractography with multiple fibre orientations: What can we gain? Neuroimage 2007, 34, 144–155. [Google Scholar] [CrossRef] [PubMed]
- Hong, J.H.; Son, S.M.; Jang, S.H. Identification of spinothalamic tract and its related thalamocortical fibers in human brain. Neurosci. Lett. 2010, 468, 102–105. [Google Scholar] [CrossRef] [PubMed]
- Crawford, J.R.; Garthwaite, P.H.; Porter, S. Point and interval estimates of effect sizes for the case-controls design in neuropsychology: Rationale, methods, implementations, and proposed reporting standards. Cogn. Neuropsychol. 2010, 27, 245–260. [Google Scholar] [CrossRef]
- Mori, S.; Crain, B.J.; Chacko, V.P.; van Zijl, P.C. Three-dimensional tracking of axonal projections in the brain by magnetic resonance imaging. Ann. Neurol. 1999, 45, 265–269. [Google Scholar] [CrossRef]
- Assaf, Y.; Pasternak, O. Diffusion tensor imaging (DTI)-based white matter mapping in brain research: A review. J. Mol. Neurosci. 2008, 34, 51–61. [Google Scholar] [CrossRef] [PubMed]
- Povlishock, J.T. Traumatically induced axonal injury: Pathogenesis and pathobiological implications. Brain Pathol. 1992, 2, 1–12. [Google Scholar] [PubMed]
- Lee, S.K.; Kim, D.I.; Kim, J.; Kim, D.J.; Kim, H.D.; Kim, D.S.; Mori, S. Diffusion-tensor MR imaging and fiber tractography: A new method of describing aberrant fiber connections in developmental CNS anomalies. Radiographics 2005, 25, 53–65. [Google Scholar] [CrossRef]
- Parker, G.J.; Alexander, D.C. Probabilistic anatomical connectivity derived from the microscopic persistent angular structure of cerebral tissue. Philos. Trans. R. Soc. B Biol. Sci. 2005, 360, 893–902. [Google Scholar] [CrossRef]
- Yamada, K. Diffusion tensor tractography should be used with caution. Proc. Natl. Acad. Sci. USA 2009, 106, E14. [Google Scholar] [CrossRef] [Green Version]
Patient 1 | Patient 2 | Patient 3 | Patient 4 | Patient 5 | Controls (n = 12) | |
---|---|---|---|---|---|---|
Age (year) | 42 | 48 | 42 | 48 | 45 | 45.71 ± 4.15 |
Duration to DTT | 2 days | 14 months | 1 month | 2 months | 1 month | - |
Central pain site (VAS) | Head (5), right arm, and leg (5) | Left head, arm, and leg (5) | Head (4), right leg (4) | Head (2), both legs (3) | Head (5), both arms and legs (4) | No pain |
Characteristics of central pain | Tingling sensation & allodynia | Tingling sensation & allodynia | Electric shock-like sensation & allodynia | Tingling & electric shock-like sensations | Tingling sensation & allodynia | No pain |
Patient 1 | Patient 2 | Patient 3 | Patient 4 | Patient 5 | Controls | |||
---|---|---|---|---|---|---|---|---|
Diffusion Tensor Tractography Parameters | ||||||||
[Significance] a | FA | Right | 0.44 [0.32] | 0.41 [0.38] | 0.40 [0.29] | 0.42 [0.48] | 0.45 [0.24] | 0.42 ± 0.03 |
Left | 0.41 [0.31] | 0.39 [0.15] | 0.45 [0.26] | 0.47 [0.12] | 0.43 [0.46] | 0.42 ± 0.03 | ||
MD | Right | 0.84 [0.31] | 0.81 [0.21] | 0.86 [0.39] | 0.79 [0.15] | 0.90 [0.42] | 0.88 ± 0.08 | |
Left | 0.89 [0.21] | 0.80 [0.35] | 0.77 [0.22] | 0.78 [0.26] | 0.76 [0.19] | 0.82 ± 0.07 | ||
FN | Right | 298 [0.02] c | 660 [0.04] c | 1935 [0.23] | 438 [0.02] c | 632 [0.03] c | 1576.81 ± 461.74 | |
Left | 1824 [0.41] | 1934 [0.36] | 38 [0.01] c | 202 [0.02] c | 20 [0.01] c | 1680.90 ± 656.56 | ||
Estimated effect size b (95% CI) | FA | Right | 0.501 (−1.913, 2.916) | −0.327 (−2.757, 2.101) | −0.598 (−3.002, 1.805) | −0.050 (−2.491, 2.389) | 0.765 (−1.614, 3.146) | |
Left | −0.539 (−2.950, 1.871) | −1.115 (−3.425, 1.195) | 0.703 (−1.686, 3.093) | 1.303 (−1.016, 3.532) | 0.086 (−2.353, 2.526) | |||
MD | Right | −0.533 (−2.945, 1.877) | −0.888 (−3.247, 1.470)- | −0.286 (−2.718, 2.146) | −1.110 (−3.422, 1.201) | 0.217 (−2.218, 2.653) | ||
Left | 0.881 (−1.478, 3.242) | 0.412 (−2.836, 2.010) | 1.063 (−3.202, 1.536) | −0.676 (−3.087, 1.694) | −0.965 (−3.309, 1.378) | |||
FN | Right | −2.001 (−3.993, −0.007) | −1.784 (−3.876, 0.307) | 0.792 (−1.584, 3.168) | −2.072 (−4.028, −0.116) | −1.824 (−3.899, 0.250) | ||
Left | 0.228 (−2.207, 2.663) | 0.401 (−2.022, 2.825) | −2.091 (−4.037, −0.146) | −1.951 (−3.968, 0.647) | −2.106 (−4.044, −0.168) | |||
Spinothalamic Tract Area | ||||||||
STT area (mm) [Significance] a | Right | 12.50 [0.02] c | 9.37 [0.02] c | 18.75 [0.03] c | 11.50 [0.02] c | 16.87 [0.03] c | 98.95 ± 17.86 | |
Left | 101.25 [0.58] | 78.12 [0.34] | 1.56 [0.04] c | 3.12 [0.04] c | 1.56 [0.04] c | 91.40 ± 9.66 | ||
Estimated effect size b (95% CI) | Right | −2.03 (−3.97, −0.10) | −2.07 (−3.96, −0.17) | −1.96 (−4.00, 0.06) | −2.00 (−3.98, −0.020) | −1.92 (−4.01, 0.15) | ||
Left | 1.02 (−1.78, 3.82) | −0.10 (−3.14, 2.93) | −1.52 (−4.00, 0.96) | −1.50 (−4.00, 1.00) | −1.52 (−4.00, 0.96) |
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Jang, S.H.; Lee, H.D. Diagnostic Approach to Traumatic Axonal Injury of the Spinothalamic Tract in Individual Patients with Mild Traumatic Brain Injury. Diagnostics 2019, 9, 199. https://doi.org/10.3390/diagnostics9040199
Jang SH, Lee HD. Diagnostic Approach to Traumatic Axonal Injury of the Spinothalamic Tract in Individual Patients with Mild Traumatic Brain Injury. Diagnostics. 2019; 9(4):199. https://doi.org/10.3390/diagnostics9040199
Chicago/Turabian StyleJang, Sung Ho, and Han Do Lee. 2019. "Diagnostic Approach to Traumatic Axonal Injury of the Spinothalamic Tract in Individual Patients with Mild Traumatic Brain Injury" Diagnostics 9, no. 4: 199. https://doi.org/10.3390/diagnostics9040199