Joseph Delic MD, Presenter: Nothing to Disclose

Lea M. Alhilali MD, Abstract Co-Author: Nothing to Disclose

Michael W. Collins PhD, Abstract Co-Author: Nothing to Disclose

Saeed Fakhran MD, Abstract Co-Author: Nothing to Disclose

To determine if different white matter injury severity relates to demographics, injury mechanism or results in differing post-concussive symptoms by analyzing whole brain fractional anisotropy histograms.

Fractional anisotropy (FA) maps and serial neurocognitive testing with Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) were obtained in 75 mild traumatic brain injury (mTBI) patients. FA histograms were obtained with the Image Histogram Function in the Tract-Based Spatial Statistics software package. Kurtosis and skewness, previously shown as markers of overall injury severity, were extracted and correlated with demographic factors (age, sex), concussion mechanism, neurocognitive test scores, prior concussions, and time to recovery. Comparison of kurtosis and skewness was then performed between patients with and without major post-concussive symptoms (vestibulopathy, oculomotor insufficiency, sleep disturbances, anxiety, depression, anger, cervicalgia, parethesias, and migraines). Analysis was performed with Pearson's correlation coefficient for continuous variables. Comparison between groups was performed with a two-tailed unpaired t-test.

Right skewness and leptokurtosis increased with decreasing age (r=-0.302 and r=-0.280, p=0.01 and p=0.008, respectively) and was greater in patients with sports-related injuries (p=0.007 and p=0.01, respectively), indicating greater injury severity with a more uniform distribution of injuries in these patients. Greater severity and variability in injuries was detected in patients with depression after mTBI (p=0.04 and p=0.02, respectively). No significant difference was seen in injury severity or variability among the remaining major post concussive symptoms. Injury severity and variability, as indicated by skewness and kurtosis, did correlate with initial symptom severity (r=0.288 and 0.280, p=0.02), but not neurocognitive testing, time to recovery, or prior injury.

More severe injuries are seen in younger patients, sports-related injuries, and depression after mTBI. No significant difference in the overall injury severity was seen among the remaining post-concussive symptoms.

The more severe overall white matter injury seen in younger patients, sports-related concussion, and patients with depression after mTBI may indicate groups at risk on which to focus future clinical trials and interventions.

Delic, J, Alhilali, L, Collins, M, Fakhran, S, Relationship of Post-concussive White Matter Injuries to Demographic Factors, Injury Mechanism, and Major Symptoms Utilizing Global Fractional Anisotropy Histogram Analysis.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14005216.html