American Academy of Neurology 65th annual meeting; San Diego, California, USA: 16–23 March 2013
medwireNews: Brain imaging has detected lesions in patients with apparent mild traumatic brain injury (mTBI) that may help identify patients in need of acute treatment, researchers say.
Initial magnetic resonance imaging (MRI) or computed tomography was used to identify hemorrhage in 104 of 256 patients with mTBI attending an emergency room over 2 years. These patients were aged a median of 50 years and had a Glasgow Coma Scale score of 13-15, denoting minor injury, with 67% reporting loss of consciousness and 65% amnesia.
More detailed MRI, performed an average of 17 hours after injury, revealed that 20% of the patients with hemorrhage had punctate microbleeds distributed across the lobar (n=37), deep (n=3), or infratentorial (n=9) brain.
A further 33% of patients had linear lesions, defined as tube-shaped and branching over multiple axial slices. These lesions were most commonly (82%) found in the anterior corona radiate; 59% of the lesions crossed white matter, grey matter, and sulcus, and 68% were graded as severe.
Analysis showed a significant correlation between the presence of linear lesions with ischemia on diffuse-weighted MRI or the presence of edema on fluid attenuated inversion recovery MRI, report Gunjan Parikh (University of Maryland, Baltimore, USA) and co-workers.
The team explains that studies of patients with severe head trauma have detected two types of small hemorrhagic lesions: punctate lesions in the corpus callosum grey-white junction or brainstem associated with diffuse axonal injury; and streak-like lesions in the parasagittal white matter affecting blood vessels.
"Linear hemorrhagic lesions following mTBI are distinct from punctate microbleeds and may be the imaging correlate of vascular injury seen in histopathology following severe TBI," the researchers write.
"While these lesions are often equated to [diffuse axonal injury], the MRI findings are suggestive of primary injury to the vasculature, and thus may be a target for acute therapy."
The study was reported at the American Academy of Neurology 65th annual meeting held in San Diego, California, USA.