+ Head Injuries: Widespread Brain Tissue Loss After a Year

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A large-scale study of traumatic brain injury (TBI) patients in Toronto seems to indicate that the more severe the injury, the greater the loss of brain tissue — particularly white matter.

“This is an important finding as TBI is one of the most common forms of disability,” says Dr. Brian Levine, Senior Scientist at Baycrest Rotman Research Institute and lead author of the study.  It is published in the March 4 2008 issue of Neurology, the medical journal of the American Academy of Neurology.

TBI causes both localized damage through bruises or bleeds, as well as more diffuse damage through disconnection of brain cells, which ultimately causes cell death.

Both kinds of damage contribute to difficulties with concentration, working memory, organizing and planning (vital skills for holding a job), and mood changes.

Sixty-nine TBI patients participated in the study.  All were one year out from a head injury.  Eighty percent of the patients sustained their injury from a motor vehicle accident.  Injury severity was determined by the depth of coma or consiousness alteration at the time of the initial hospitalization.

Twelve healthy, non-injured participants were recruited as the comparison group.

 Subjects’ brains were scanned with high resolution magnetic resonance imaging (MRI), which provides the most sensitive picture of volume changes in the brain.  The computerized analysis revealed widespread brain tissue loss that was closely related to the severity of the TBI sustained one year earlier.

“We were surprised at the extent of volume loss, which encompassed both frontal and posterior brain regions,” says Levine.  Brain tissue loss was greatest in the white matter (containing axons which can be compared to telephone wire interconnectivity), but  also involved gray matter (containing the cell bodies important for information processing).

A surprise was that volume loss was widespread even in TBI patients who had no obvious lesions on their MRI scans.  “A significant blow to the head causing loss of consciousness can cause extensive reduction of brain tissue volume that may evade detection by traditional qualitative radiological examination,” Dr Levine notes.

He is leading follow-up studies on the same group of patients to examine more closely the significance of localized white and gray matter volume loss on behavior.

The study was supported by grants from the Canadian Institutes of Health Research and the National Institutes of Health.

source: www.newswire.ca article on 3/3/08

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