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 a central axonal injury underlies cervicalgia and parethesias after mild traumatic brain injury (mTBI) utilizing tract-based spatial statistics (TBSS) analysis of diffusion tensor imaging (DTI).

The institutional review board approved this study, with waiver of informed consent. Retrospective review of diffusion tensor imaging in 19 mTBI patients with cervicalgia and 9 with peripheral paresthesias was performed. Control subjects consisted of 56 mTBI patients without cervicalgia and 66 mTBI patients without paresthesias, respectively. Fractional anisotropy (FA) maps were generated as a measure of white matter integrity and analyzed using TBSS regression analysis utilizing a general linear model and unpaired t-tests.

As compared to controls, mTBI patients with cervicalgia had decreased FA values in the right superior longitudinal fasciculus (p<0.05). Injuries to the right superior longitudinal fasciculus (SLF) have been previously associated with hemispatial neglect. No regions of significant difference were detected in FA values between mTBI patients with and without peripheral paresthesias.

Decreased FA values in the SLF in mTBI patients with cervicalgia support the hypothesis that post-traumatic neck pain has a central axonal injury component. Injury to the SLF is associated with hemispatial neglect, which is often treated with neck muscle vibration. This suggests that post-traumatic neck pain may result not from direct injury to the cervical region, but from attempts at compensation for spatial orientation insufficiencies after mTBI.

Detecting a central diffuse axonal injury (DAI) underlying post traumatic cervicalgia indicates that DAI is responsible for more post-concussion symptoms than simply the cognitive and executive deficits investigated previously. Diagnosis and treatment of patients with post-traumatic neck pain should not merely be focused on the cervical region, but also extend to possible intracranial injuries.

Delic, J, Alhilali, L, Collins, M, Fakhran, S, Detection of a Central White Matter Injury Underlying Peripheral Symptoms after Mild Traumatic Brain Injury.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14013604.html