Brain pathology after mild traumatic brain injury: an exploratory study by repeated magnetic resonance examination.

Abstract

OBJECTIVE: To explore brain pathology after mild traumatic brain injury by repeated magnetic resonance examination. DESIGN: A prospective follow-up study. SUBJECTS: Nineteen patients with mild traumatic brain injury presenting with Glasgow Coma Scale (GCS) 14-15. METHODS: The patients were examined on day 2 or 3 and 3-7 months after the injury. The magnetic resonance protocol comprised conventional T1- and T2-weighted sequences including fluid attenuated inversion recovery (FLAIR), two susceptibility-weighted sequences to reveal haemorrhages, and diffusion-weighted sequences. Computer-aided volume comparison was performed. Clinical outcome was assessed by the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), Hospital Anxiety and Depression Scale (HADS) and Glasgow Outcome Scale Extended (GOSE). RESULTS: At follow-up, 7 patients (37%) reported ≥__3 symptoms in RPQ, 5 reported some anxiety and 1 reported mild depression. Fifteen patients reported upper level of good recovery and 4 patients lower level of good recovery (GOSE 8 and 7, respectively). Magnetic resonance pathology was found in 1 patient at the first examination, but 4 patients (21%) showed volume loss at the second examination, at which 3 of them reported <_3 symptoms and 1 ≥_3 symptoms, all exhibiting GOSE scores of 8. CONCLUSION: Loss of brain volume, demonstrated by computer-aided magnetic resonance imaging volumetry, may be a feasible marker of brain pathology after mild traumatic brain injury.