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Case 44 - Mild traumatic brain injury

Published online by Cambridge University Press:  18 December 2013

Nafi Aygun ,
Gaurang Shah  and
Dheeraj Gandhi
Nafi Aygun
Affiliation:
The Johns Hopkins University
Gaurang Shah
Affiliation:
University of Michigan Health System
Dheeraj Gandhi
Affiliation:
University of Maryland Medical Center
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Summary

Imaging description

Traumatic brain injury (TBI) is the most common neurologic disorder. Approximately 1.5 million TBI cases are seen in the USA every year. About 80% of these are mild (mTBI) (a.k.a. concussion). The operative definition of mTBI is based on any period of observed or self-reported

  • transient confusion, disorientation, or impaired consciousness; or

  • dysfunction of memory around the time of injury; or

  • loss of consciousness lasting <30 minutes.

It is considered safe to discharge patients with mTBI from the emergency department if the head CT and the neurologic exam are normal. About 15–30% of patients with mTBI will develop long-term symptoms including headache, confusion, cognitive and/or memory problems, fatigue, changes in sleep patterns, mood changes, and/or sensory problems such as changes in vision or hearing (post-concussion syndrome) [1]. While the exact pathophysiology of these symptoms is not clear, MRI with diffusion-weighted and susceptibility-weighted imaging (DWI and SWI) can demonstrate lesions in the brain when CT is completely normal (Figs. 44.1, Fig. 44.2), and the number and extent of these lesions appear to correlate with long-term outcome in mTBI patients [2].

Type
Chapter
Information
Pearls and Pitfalls in Head and Neck and Neuroimaging
Variants and Other Difficult Diagnoses
 , pp. 224 - 226
Publisher: Cambridge University Press
Print publication year: 2013

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References

Shenton, ME, Hamoda, HM, Schneiderman, JS, et al. A review of magnetic resonance imaging and diffusion tensor imaging findings in mild traumatic brain injury. Brain Imaging Behav 2012; 6: 137–92.CrossRefGoogle ScholarPubMed
Yuh, EL, Mukherjee, P, Lingsma, HF et al. Magnetic resonance imaging improves 3-month outcome prediction in mild traumatic brain injury. Ann Neurol 2012; .
Kasahara, K, Hashimoto, K, Abo, M, Senoo, A. Voxel- and atlas-based analysis of diffusion tensor imaging may reveal focal axonal injuries in mild traumatic braininjury – comparison with diffuse axonal injury. Magn Reson Imaging 2012; 30: 496–505.CrossRefGoogle Scholar

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