Skip to main content Accessibility help
×
Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-24T00:41:06.242Z Has data issue: false hasContentIssue false

17 - Biomarkers for Concussion: The Need and the Prospects for the Near Future

from Part III - Diagnosis and Management of Concussion

Published online by Cambridge University Press:  22 February 2019

Jeff Victoroff
Affiliation:
University of Southern California, Torrance
Erin D. Bigler
Affiliation:
Brigham Young University, Utah
Get access

Summary

This slender volume of introductory notes on concussive brain injury (CBI) is published at a curious historical moment. The twenty-first century has blessedly heralded the first serious reconsideration of what a concussion is for perhaps more than 100 years. The eye-opening discoveries that typical CBIs are commonly associated with lasting deleterious effects and that sport-related repetitive head impact may often or always cause brain damage have been met with various degrees of shock, resistance, and hope for progress in human knowledge. However, a Gibraltar-sized stone in the road blocks any major advance. We cannot diagnose CBI in a scientific way. That fact has provoked a costly global search for a valid biomarker -- and perhaps unseemly commercialization of that quest. In 2018, one for-profit corporation (reportedly funded with many taxpayer dollars) announced their discovery of a "concussion test." They found nothing of the sort. The co-authors of the present chapter are widely regarded as the genuine world authorities on potential chemical markers for CBI. Their review counterbalances the overheated commercial rhetoric and explains the prospects for science.
Type
Chapter
Information
Concussion and Traumatic Encephalopathy
Causes, Diagnosis and Management
, pp. 638 - 645
Publisher: Cambridge University Press
Print publication year: 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

U.S. Food and Drug Administration. FDA authorizes marketing of first blood test to aid in the evaluation of concussion in adults. July 14, 2018. Available at: www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm596531.htm.Google Scholar
Bazarian, JJ. Serum GFAP and UCH1-L1 predict traumatic injuries on head CT scan after mild-moderate traumatic brain injury: Results of the ALERT-TBI multicenter study. Ann Emerg Med 2017; 70:S2.Google Scholar
Costandi, M. FDA okays first concussion blood test – but some experts are wary. Scientific American 02/18/18. Available at: www.scientificamerican.com/article/fda-okays-first-concussion-blood-test-but-some-experts-are-wary/.Google Scholar
Van Meter, T, Mirshahi, N, Peters, M, Roy, D, Rao, V, Diaz-Arrastia, R, et al. Machine learning models identify mild traumatic brain injury patients with significant depressive symptoms over six months of recovery using a three biomarker blood test. Ann Emerg Med 2017; 70:S104S105.Google Scholar
Welch, RD, Ellis, M, Lewis, LM, Ayaz, SI, Mika, VH, Millis, S, et al. Modeling the kinetics of serum glial fibrillary acidic protein, ubiquitin carboxyl-terminal hydrolase-L1, and S100B concentrations in patients with traumatic brain injury. J Neurotrauma 2017;34:19571971.CrossRefGoogle ScholarPubMed
American Congress of Rehabilitation Medicine. Definition of mild traumatic brain injury. J Head Trauma Rehabil 1993;8:8687.CrossRefGoogle Scholar
Baugh, CM, Stamm, JM, Riley, DO, Gavett, BE, Shenton, ME, Lin, A, Nowinski, CJ, Cantu, RC, McKee, AC, Stern, RA. Chronic traumatic encephalopathy: Neurodegeneration following repetitive concussive and subconcussive brain trauma. Brain Imaging Behav 2012;6(2):244254.Google Scholar
Blennow, K, Hardy, J, Zetterberg, H. The neuropathology and neurobiology of traumatic brain injury. Neuron 2012;76(5):886899.Google Scholar
New Zealand Guidelines Group. Traumatic brain injury: Diagnosis, acute management and rehabilitation. Wellington, NZ: New Zealand Guidelines Group, 2006.Google Scholar
Iverson, GL, Gaetz, M, Lovell, MR, Collins, MW. Cumulative effects of concussion in amateur athletes. Brain Inj 2004;18(5):433443.Google Scholar
Brooks, WM, Stidley, CA, Petropoulos, H, Jung, RE, Weers, DC, Friedman, SD, Barlow, MA, Sibbitt, WL, Jr., Yeo, RA. Metabolic and cognitive response to human traumatic brain injury: A quantitative proton magnetic resonance study. J Neurotrauma 2000;17(8):629640.Google Scholar
Neselius, S, Brisby, H, Granholm, F, Zetterberg, H, Blennow, K. Monitoring severity of brain damage and recovery after boxing knockout by CSF biomarkers for axonal damage. Knee Surg Sports Traumatol Arthrosc 2015; 23:25362539.Google Scholar
Stern, RA, Riley, DO, Daneshvar, DH, Nowinski, CJ, Cantu, RC, McKee, AC. Long-term consequences of repetitive brain trauma: Chronic traumatic encephalopathy. PM R 2011; 3(10 Suppl 2):S460S467.CrossRefGoogle ScholarPubMed
Roberts, GW, Allsop, D, Bruton, C. The occult aftermath of boxing. J Neurol Neurosurg Psychiatry 1990;53(5):373378.Google Scholar
Tokuda, T, Ikeda, S, Yanagisawa, N, Ihara, Y, Glenner, GG. Re-examination of ex-boxers’ brains using immunohistochemistry with antibodies to amyloid beta-protein and tau protein. Acta Neuropathol 1991;82(4):280285.CrossRefGoogle ScholarPubMed
Johnson, VE, Stewart, W, Smith, DH. Traumatic brain injury and amyloid-beta pathology: A link to Alzheimer’s disease? Nat Rev Neurosci 2010;11(5):361370.CrossRefGoogle Scholar
Jordan, BD. Chronic traumatic brain injury associated with boxing. Semin Neurol 2000;20(2):179185.CrossRefGoogle ScholarPubMed
Blennow, K, Hampel, H, Weiner, M, Zetterberg, H. Cerebrospinal fluid and plasma biomarkers in Alzheimer disease. Nat Rev Neurol 2010;6(3):131144.CrossRefGoogle ScholarPubMed
Mortberg, E, Zetterberg, H, Nordmark, J, Blennow, K, Catry, C, Decraemer, H, Vanmechelen, E, Rubertsson, S. Plasma tau protein in comatose patients after cardiac arrest treated with therapeutic hypothermia. Acta Anaesthesiol Scand 2011;55(9): 11321138.Google Scholar
Randall, J, Mortberg, E, Provuncher, GK, Fournier, DR, Duffy, DC, Rubertsson, S, Blennow, K, Zetterberg, H, Wilson, DH. Tau proteins in serum predict neurological outcome after hypoxic brain injury from cardiac arrest: Results of a pilot study. Resuscitation 2013; 84: 351356.CrossRefGoogle ScholarPubMed
Rissin, DM, Kan, CW, Campbell, TG, Howes, SC, Fournier, DR, Song, L, Piech, T, Patel, PP, Chang, L, Rivnak, AJ, et al. Single-molecule enzyme-linked immunosorbent assay detects serum proteins at subfemtomolar concentrations. Nat Biotechnol 2010;28(6):595599.CrossRefGoogle ScholarPubMed
Savage, MJ, Kalinina, J, Wolfe, A, Tugusheva, K, Korn, R, Cash-Mason, T, Maxwell, JW, Hatcher, NG, Haugabook, SJ, Wu, G, et al. A sensitive abeta oligomer assay discriminates Alzheimer’s and aged control cerebrospinal fluid. J Neurosci 2014;34(8): 28842897.CrossRefGoogle ScholarPubMed
Abbott, NJ, Ronnback, L, Hansson, E. Astrocyte–endothelial interactions at the blood–brain barrier. Nat Rev Neurosci 2006;7(1):4153.Google Scholar
Csuka, E, Morganti-Kossmann, MC, Lenzlinger, PM, Joller, H, Trentz, O, Kossmann, T. IL-10 levels in cerebrospinal fluid and serum of patients with severe traumatic brain injury: Relationship to IL-6, TNF-alpha, TGF-beta1 and blood–brain barrier function. J Neuroimmunol 1999;101(2):211221.Google Scholar
Kossmann, T, Hans, VH, Imhof, HG, Stocker, R, Grob, P, Trentz, O, Morganti-Kossmann, C. Intrathecal and serum interleukin-6 and the acute-phase response in patients with severe traumatic brain injuries. Shock 1995;4(5):311317.CrossRefGoogle ScholarPubMed
Blennow, K, Jonsson, M, Andreasen, N, Rosengren, L, Wallin, A, Hellstrom, PA, Zetterberg, H. No neurochemical evidence of brain injury after blast overpressure by repeated explosions or firing heavy weapons. Acta Neurol Scand 2011;123(4):245251.Google Scholar
Zetterberg, H, Hietala, MA, Jonsson, M, Andreasen, N, Styrud, E, Karlsson, I, Edman, A, Popa, C, Rasulzada, A, Wahlund, LO, et al. Neurochemical aftermath of amateur boxing. Arch Neurol 2006;63(9):12771280.Google Scholar
Zetterberg, H, Smith, DH, Blennow, K. Biomarkers of mild traumatic brain injury in cerebrospinal fluid and blood. Nat Rev Neurol 2013;9(4):201210.Google Scholar
Ost, M, Nylen, K, Csajbok, L, Ohrfelt, AO, Tullberg, M, Wikkelso, C, Nellgard, P, Rosengren, L, Blennow, K, Nellgard, B. Initial CSF total tau correlates with 1-year outcome in patients with traumatic brain injury. Neurology 2006;67(9):16001604.Google Scholar
Franz, G, Beer, R, Kampfl, A, Engelhardt, K, Schmutzhard, E, Ulmer, H, Deisenhammer, F. Amyloid beta 1–42 and tau in cerebrospinal fluid after severe traumatic brain injury. Neurology 2003;60(9):14571461.Google Scholar
Zemlan, FP, Jauch, EC, Mulchahey, JJ, Gabbita, SP, Rosenberg, WS, Speciale, SG, Zuccarello, M. C-tau biomarker of neuronal damage in severe brain injured patients: Association with elevated intracranial pressure and clinical outcome. Brain Res 2002;947(1):131139.Google Scholar
Neselius, S, Brisby, H, Theodorsson, A, Blennow, K, Zetterberg, H, Marcusson, J. CSF-biomarkers in Olympic boxing: Diagnosis and effects of repetitive head trauma. PLoS One 2012;7(4):e33606.CrossRefGoogle ScholarPubMed
Hesse, C, Rosengren, L, Andreasen, N, Davidsson, P, Vanderstichele, H, Vanmechelen, E, Blennow, K. Transient increase in total tau but not phospho-tau in human cerebrospinal fluid after acute stroke. Neurosci Lett 2001;297(3):187190.Google Scholar
Siman, R, Toraskar, N, Dang, A, McNeil, E, McGarvey, M, Plaum, J, Maloney, E, Grady, MS. A panel of neuron-enriched proteins as markers for traumatic brain injury in humans. J Neurotrauma 2009;26(11):18671877.Google Scholar
Olsson, B, Zetterberg, H, Hampel, H, Blennow, K. Biomarker-based dissection of neurodegenerative diseases. Prog Neurobiol 2011;95(4):520534.Google Scholar
Scarna, H, Delafosse, B, Steinberg, R, Debilly, G, Mandrand, B, Keller, A, Pujol, JF. Neuron-specific enolase as a marker of neuronal lesions during various comas in man. Neurochem Int 1982; 4(5):405411.CrossRefGoogle ScholarPubMed
Bohmer, AE, Oses, JP, Schmidt, AP, Peron, CS, Krebs, CL, Oppitz, PP, D’Avila, TT, Souza, DO, Portela, LV, Stefani, MA. Neuron-specific enolase, S100B, and glial fibrillary acidic protein levels as outcome predictors in patients with severe traumatic brain injury. Neurosurgery 2011;68(6):16241630; discussion 1630-1631.Google Scholar
Chiaretti, A, Barone, G, Riccardi, R, Antonelli, A, Pezzotti, P, Genovese, O, Tortorolo, L, Conti, G. NGF, DCX, and NSE upregulation correlates with severity and outcome of head trauma in children. Neurology 2009;72(7):609616.Google Scholar
Berger, RP, Dulani, T, Adelson, PD, Leventhal, JM, Richichi, R, Kochanek, PM. Identification of inflicted traumatic brain injury in well-appearing infants using serum and cerebrospinal markers: A possible screening tool. Pediatrics 2006;117(2):325332.Google Scholar
Ramont, L, Thoannes, H, Volondat, A, Chastang, F, Millet, MC, Maquart, FX. Effects of hemolysis and storage condition on neuron-specific enolase (NSE) in cerebrospinal fluid and serum: Implications in clinical practice. Clin Chem Lab Med 2005;43(11):12151217.Google Scholar
Czeiter, E, Mondello, S, Kovacs, N, Sandor, J, Gabrielli, A, Schmid, K, Tortella, F, Wang, KK, Hayes, RL, Barzo, P, et al. Brain injury biomarkers may improve the predictive power of the IMPACT outcome calculator. J Neurotrauma 2012;29(9):17701778.Google Scholar
Raby, CA, Morganti-Kossmann, MC, Kossmann, T, Stahel, PF, Watson, MD, Evans, LM, Mehta, PD, Spiegel, K, Kuo, YM, Roher, AE, et al. Traumatic brain injury increases beta-amyloid peptide 1–42 in cerebrospinal fluid. J Neurochem 1998;71(6):25052509.CrossRefGoogle ScholarPubMed
Olsson, A, Csajbok, L, Ost, M, Hoglund, K, Nylen, K, Rosengren, L, Nellgard, B, Blennow, K. Marked increase of beta-amyloid(1–42) and amyloid precursor protein in ventricular cerebrospinal fluid after severe traumatic brain injury. J Neurol 2004;251(7):870876.CrossRefGoogle ScholarPubMed
Marklund, N, Farrokhnia, N, Hanell, A, Vanmechelen, E, Enblad, P, Zetterberg, H, Blennow, K, Hillered, L. Monitoring of beta-amyloid dynamics after human traumatic brain injury. J Neurotrauma 2014;31(1):4255.CrossRefGoogle ScholarPubMed
Pike, BR, Flint, J, Dutta, S, Johnson, E, Wang, KK, Hayes, RL. Accumulation of non-erythroid alpha II-spectrin and calpain-cleaved alpha II-spectrin breakdown products in cerebrospinal fluid after traumatic brain injury in rats. J Neurochem 2001;78(6):12971306.Google Scholar
Pineda, JA, Lewis, SB, Valadka, AB, Papa, L, Hannay, HJ, Heaton, SC, Demery, JA, Liu, MC, Aikman, JM, Akle, V, et al. Clinical significance of alphaII-spectrin breakdown products in cerebrospinal fluid after severe traumatic brain injury. J Neurotrauma 2007;24(2):354366.Google Scholar
Riederer, BM, Zagon, IS, Goodman, SR. Brain spectrin(240/235) and brain spectrin(240/235E): Two distinct spectrin subtypes with different locations within mammalian neural cells. J Cell Biol 1986;102(6):20882097.Google Scholar
Farkas, O, Polgar, B, Szekeres-Bartho, J, Doczi, T, Povlishock, JT, Buki, A. Spectrin breakdown products in the cerebrospinal fluid in severe head injury – Preliminary observations. Acta Neurochir (Wien) 2005;147(8):855861.Google Scholar
Mondello, S, Robicsek, SA, Gabrielli, A, Brophy, GM, Papa, L, Tepas, J, Robertson, C, Buki, A, Scharf, D, Jixiang, M, et al. AlphaII-spectrin breakdown products (SBDPs): Diagnosis and outcome in severe traumatic brain injury patients. J Neurotrauma 2010;27(7):12031213.Google Scholar
Wilkinson, KD, Lee, KM, Deshpande, S, Duerksen-Hughes, P, Boss, JM, Pohl, J. The neuron-specific protein PGP 9.5 is a ubiquitin carboxyl-terminal hydrolase. Science 1989;246(4930): 670673.Google Scholar
Ottens, AK, Kobeissy, FH, Golden, EC, Zhang, Z, Haskins, WE, Chen, SS, Hayes, RL, Wang, KK, Denslow, ND. Neuroproteomics in neurotrauma. Mass Spectrom Rev 2006;25(3):380408.Google Scholar
Mondello, S, Muller, U, Jeromin, A, Streeter, J, Hayes, RL, Wang, KK. Blood-based diagnostics of traumatic brain injuries. Expert Rev Mol Diagn 2011;11(1):6578.Google Scholar
Kovesdi, E, Luckl, J, Bukovics, P, Farkas, O, Pal, J, Czeiter, E, Szellar, D, Doczi, T, Komoly, S, Buki, A. Update on protein biomarkers in traumatic brain injury with emphasis on clinical use in adults and pediatrics. Acta Neurochir (Wien) 2010;152(1):117.CrossRefGoogle ScholarPubMed
Unden, J, Ingebrigtsen, T, Romner, B. Scandinavian guidelines for initial management of minimal, mild and moderate head injuries in adults: An evidence and consensus-based update. BMC Med 2013;11:50.Google Scholar
Shahim, P, Tegner, Y, Wilson, DH, Randall, J, Skillback, T, Pazooki, D, Kallberg, B, Blennow, K, Zetterberg, H. Blood biomarkers for brain injury in concussed professional ice hockey players. JAMA Neurol 2014;71(6):684692.Google Scholar
Mussack, T, Kirchhoff, C, Buhmann, S, Biberthaler, P, Ladurner, R, Gippner-Steppert, C, Mutschler, W, Jochum, M. Significance of Elecsys S100 immunoassay for real-time assessment of traumatic brain damage in multiple trauma patients. Clin Chem Lab Med 2006;44(9):11401145.Google Scholar
Rothoerl, RD, Woertgen, C. High serum S100B levels for trauma patients without head injuries. Neurosurgery 2001;49(6):14901491; author reply 14921493.CrossRefGoogle ScholarPubMed
Anderson, RE, Hansson, LO, Nilsson, O, Dijlai-Merzoug, R, Settergren, G. High serum S100B levels for trauma patients without head injuries. Neurosurgery 2001;48(6):12551258; discussion 12581260.Google ScholarPubMed
Romner, B, Ingebrigtsen, T. High serum S100B levels for trauma patients without head injuries. Neurosurgery 2001;49(6):1490; author reply 14921493.Google Scholar
Stalnacke, BM, Ohlsson, A, Tegner, Y, Sojka, P. Serum concentrations of two biochemical markers of brain tissue damage S-100B and neurone specific enolase are increased in elite female soccer players after a competitive game. Br J Sports Med 2006;40(4):313316.Google Scholar
Metting, Z, Wilczak, N, Rodiger, LA, Schaaf, JM, van der Naalt, J. GFAP and S100B in the acute phase of mild traumatic brain injury. Neurology 2012;78(18):14281433.Google Scholar
Siman, R, Giovannone, N, Hanten, G, Wilde, EA, McCauley, SR, Hunter, JV, Li, X, Levin, HS, Smith, DH. Evidence that the blood biomarker SNTF predicts brain imaging changes and persistent cognitive dysfunction in mild TBI patients. Front Neurol 2013;4:190.Google Scholar
Berger, RP, Adelson, PD, Pierce, MC, Dulani, T, Cassidy, LD, Kochanek, PM. Serum neuron-specific enolase, S100B, and myelin basic protein concentrations after inflicted and noninflicted traumatic brain injury in children. J Neurosurg 2005;103 (1 Suppl):6168.Google Scholar
Zurek, J, Fedora, M. The usefulness of S100B, NSE, GFAP, NF-H, secretagogin and Hsp70 as a predictive biomarker of outcome in children with traumatic brain injury. Acta Neurochir (Wien) 2012;154(1):93103; discussion 103.Google Scholar
Zurek, J, Bartlova, L, Fedora, M. Hyperphosphorylated neurofilament NF-H as a predictor of mortality after brain injury in children. Brain Inj 2011;25(2):221226.Google Scholar
Blyth, BJ, Farahvar, A, He, H, Nayak, A, Yang, C, Shaw, G, Bazarian, JJ. Elevated serum ubiquitin carboxy-terminal hydrolase L1 is associated with abnormal blood–brain barrier function after traumatic brain injury. J Neurotrauma 2011;28(12):24532462.Google Scholar
Papa, L, Lewis, LM, Silvestri, S, Falk, JL, Giordano, P, Brophy, GM, Demery, JA, Liu, MC, Mo, J, Akinyi, L, et al. Serum levels of ubiquitin C-terminal hydrolase distinguish mild traumatic brain injury from trauma controls and are elevated in mild and moderate traumatic brain injury patients with intracranial lesions and neurosurgical intervention. J Trauma Acute Care Surg 2012;72(5):13351344.Google Scholar
Randall, J, Mortberg, E, Provuncher, GK, Fournier, DR, Duffy, DC, Rubertsson, S, Blennow, K, Zetterberg, H, Wilson, DH. Tau proteins in serum predict neurological outcome after hypoxic brain injury from cardiac arrest: Results of a pilot study. Resuscitation 2013;84(3):351356.Google Scholar
Corsellis, JA, Bruton, CJ, Freeman-Browne, D. The aftermath of boxing. Psychol Med 1973;3(3):270303.Google Scholar
King, A, Sweeney, F, Bodi, I, Troakes, C, Maekawa, S, Al-Sarraj, S. Abnormal TDP-43 expression is identified in the neocortex in cases of dementia pugilistica, but is mainly confined to the limbic system when identified in high and moderate stages of Alzheimer’s disease. Neuropathology 2010;30(4):408419.Google Scholar
McKee, AC, Gavett, BE, Stern, RA, Nowinski, CJ, Cantu, RC, Kowall, NW, Perl, DP, Hedley-Whyte, ET, Price, B, Sullivan, C, et al. TDP-43 proteinopathy and motor neuron disease in chronic traumatic encephalopathy. J Neuropathol Exp Neurol 2010;69(9): 918929.Google Scholar
Johnson, VE, Stewart, W, Trojanowski, JQ, Smith, DH. Acute and chronically increased immunoreactivity to phosphorylation-independent but not pathological TDP-43 after a single traumatic brain injury in humans. Acta Neuropathol 2011;122(6): 715726.Google Scholar
Neumann, M, Sampathu, DM, Kwong, LK, Truax, AC, Micsenyi, MC, Chou, TT, Bruce, J, Schuck, T, Grossman, M, Clark, CM, et al. Ubiquitinated TDP-43 in frontotemporal lobar degeneration and amyotrophic lateral sclerosis. Science 2006;314(5796):130133.CrossRefGoogle ScholarPubMed
Geser, F, Prvulovic, D, O’Dwyer, L, Hardiman, O, Bede, P, Bokde, AL, Trojanowski, JQ, Hampel, H. On the development of markers for pathological TDP-43 in amyotrophic lateral sclerosis with and without dementia. Prog Neurobiol 2011;95(4):649662.Google Scholar
Kozlowski Moreau, O, Yollin, E, Merlen, E, Daveluy, W, Rousseaux, M. Lasting pituitary hormone deficiency after traumatic brain injury. J Neurotrauma 2012;29(1):8189.Google Scholar
Kelly, DF, Chaloner, C, Evans, D, Matthews, A, Cohan, P, Wang, C, Swerdloff, R, Sim, MS, Lee, J, Wright, MJ, et al. Prevalence of pituitary hormone dysfunction, metabolic syndrome and impaired quality of life in retired professional football players: A prospective study. J Neurotrauma 2014;31(13):11611171.Google Scholar
Kelestimur, F, Tanriverdi, F, Atmaca, H, Unluhizarci, K, Selcuklu, A, Casanueva, FF. Boxing as a sport activity associated with isolated GH deficiency. J Endocrinol Invest 2004;27(11):RC28–RC32.Google Scholar
Tanriverdi, F, Unluhizarci, K, Kocyigit, I, Tuna, IS, Karaca, Z, Durak, AC, Selcuklu, A, Casanueva, FF, Kelestimur, F. Brief communication: pituitary volume and function in competing and retired male boxers. Ann Intern Med 2008;148(11):827831.Google Scholar
Tanriverdi, F, Unluhizarci, K, Coksevim, B, Selcuklu, A, Casanueva, FF, Kelestimur, F. Kickboxing sport as a new cause of traumatic brain injury-mediated hypopituitarism. Clin Endocrinol (Oxf) 2007;66(3):360366.Google Scholar
Wilkinson, CW, Pagulayan, KF, Petrie, EC, Mayer, CL, Colasurdo, EA, Shofer, JB, Hart, KL, Hoff, D, Tarabochia, MA, Peskind, ER. High prevalence of chronic pituitary and target-organ hormone abnormalities after blast-related mild traumatic brain injury. Front Neurol 2012;3:11.Google Scholar
Goldstein, LE, Fisher, AM, Tagge, CA, Zhang, XL, Velisek, L, Sullivan, JA, Upreti, C, Kracht, JM, Ericsson, M, Wojnarowicz, MW, et al. Chronic traumatic encephalopathy in blast-exposed military veterans and a blast neurotrauma mouse model. Sci Transl Med 2012;4(134):134ra160.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×