Search Our Scientific Publications & Authors

Front Neurol 2022 31;13:888815. Epub 2022 May 31.

Turku Brain Injury Center, Turku University Hospital, University of Turku, Turku, Finland.

Diffuse axonal injury (DAI) is a common neuropathological manifestation of traumatic brain injury (TBI), presenting as traumatic alterations in the cerebral white matter (WM) microstructure and often leading to long-term neurocognitive impairment. These WM alterations can be assessed using diffusion tensor imaging (DTI). Cerebral microbleeds (CMBs) are a common finding on head imaging in TBI and are often considered a visible sign of DAI, although they represent diffuse vascular injury. Read More

J Neurosci Res 2022 Jul 20;100(7):1413-1421. Epub 2022 Apr 20.

Adelaide Spinal Research Group, Centre for Orthopaedic & Trauma Research, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.

Pathological outcomes of traumatic brain injury (TBI), including diffuse axonal injury, are influenced by the direction, magnitude, and duration of head acceleration during the injury exposure. Ovine models have been used to study injury mechanics and pathological outcomes of TBI. To accurately describe the kinematics of the head during an injury exposure, and better facilitate comparison with human head kinematics, anatomical coordinate systems (ACS) with an origin at the head or brain center of mass (CoM), and axes that align with the ovine Frankfort plane equivalent, are required. Read More

Neurohospitalist 2022 Apr 13;12(2):280-284. Epub 2022 Jan 13.

Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

Neuroprognostication following diffuse axonal injury (DAI) has historically relied on neuroimaging techniques with lower spatial resolution and contrast than techniques currently available in clinical practice. Since the initial studies of DAI classification and prognosis in the 1980s and 1990s, advances in neuroimaging have improved detection of brainstem microbleeds, a hallmark feature of Grade 3 DAI that has traditionally been associated with poor neurologic outcome. Here, we report clinical and radiologic data from two patients with severe traumatic brain injury and grade 3 DAI who recovered functional independence and returned to work within 4 months of injury. Read More

SA J Radiol 2022 24;26(1):2321. Epub 2022 Mar 24.

Trauma Service and Trauma ICU, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.

Background: The incidence of concurrent traumatic brain injury (TBI) and cervical spine injury (c-spine) is relatively high, with a variety of risk factors.

Objectives: The purpose of this study was to determine the incidence and related factors associated with combined cranial and c-spine injury in TBI patients by assessing their demographics and clinical profiles.

Method: A retrospective study of patients attending the Trauma Centre at the Inkosi Albert Luthuli Hospital as post head trauma emergencies and their CT brain and c-spine imaging performed between January 2018 and December 2018. Read More

AJNR Am J Neuroradiol 2022 05 7;43(5):764-768. Epub 2022 Apr 7.

From the Edward B. Singleton Department of Radiology (G.O., S.F.K., N.K.D., T.A.G.M.H.).

Background And Purpose: Abusive head trauma is the leading cause of morbidity and mortality in young children. Radiology provides valuable information for this challenging diagnosis, but no single neuroimaging finding is independently diagnostic of abusive head trauma. Our purposes were to describe the prevalence of brain and spine neuroimaging findings and to analyze the association of neuroimaging findings with clinical factors to determine which neuroimaging findings may be used as prognostic indicators. Read More

J Neurotrauma 2022 Apr 4. Epub 2022 Apr 4.

The Children's Hospital of Philadelphia, 6567, Department of Anesthesiology and Critical Care Medicine, Philadelphia, Pennsylvania, United States;

In order to establish the clinical relevance of porcine model of TBI using the plasma biomarkers of injury with diffusion tensor imaging (DTI) over 30 days, we performed a randomized, blinded, preclinical trial using Yorkshire pigs weighing 7-10kg. Twelve pigs were subjected to Sham injury (n=5) by skin incision, or traumatic brain injury (n=7) by controlled cortical impact. Blood samples were collected before the injury, then at approximately 5-day intervals until 30 days. Read More

Arq Neuropsiquiatr 2022 03;80(3):280-288

Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Radiologia, São Paulo SP, Brazil.

Background: Diffuse axonal injury occurs with high acceleration and deceleration forces in traumatic brain injury (TBI). This lesion leads to disarrangement of the neuronal network, which can result in some degree of deficiency. The Extended Glasgow Outcome Scale (GOS-E) is the primary outcome instrument for the evaluation of TBI victims. Read More

Neurol India 2022 Jan-Feb;70(1):334-336

Department of Neurology, Manipal Hospital, Bengaluru, Karnataka, India.

Oculomotor nerve palsy following traumatic brain injury is a rare entity. A head injury can result in diffuse neuronal axonal injury with subsequent microbleed within the nerve tissue. We report an unusual case of a patient who presented with complete isolated right third nerve palsy following a road traffic accident. Read More

Brain Inj 2022 02 7;36(3):353-358. Epub 2022 Feb 7.

Department of Neurosurgery, Royal London Hospital, London, UK.

Introduction: Over the last decade advancements in computer processing have enabled the application of machine learning (ML) to complex medical problems. Convolutional neural networks (CNN), a type of ML, have been used to interrogate medical images for variety of purposes. In this study, we aimed to investigate the potential application of CNN in prognosticating patients with traumatic brain injury (TBI). Read More

eNeuro 2022 Jan-Feb;9(1). Epub 2022 Feb 16.

Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario M6A 2E1, Canada

Following traumatic brain injury (TBI), cognitive impairments manifest through interactions between microscopic and macroscopic changes. On the microscale, a neurometabolic cascade alters neurotransmission, while on the macroscale diffuse axonal injury impacts the integrity of long-range connections. Large-scale brain network modeling allows us to make predictions across these spatial scales by integrating neuroimaging data with biophysically based models to investigate how microscale changes invisible to conventional neuroimaging influence large-scale brain dynamics. Read More

Brain Behav 2022 03 1;12(3):e2490. Epub 2022 Feb 1.

Department of Radiology and Oncology, Hospital das Clínicas, Faculdade de Medicina da USP, São Paulo, Brazil.

Background: Diffuse axonal injury (DAI) is a frequent mechanism of traumatic brain injury (TBI) that triggers a sequence of parenchymal changes that progresses from focal axonal shear injuries up to inflammatory response and delayed axonal disconnection.

Objective: The main purpose of this study is to evaluate changes in the axonal/myelinic content and the brain volume up to 12 months after TBI and to correlate these changes with neuropsychological results.

Methods: Patients with DAI (n = 25) were scanned at three time points after trauma (2, 6, and 12 months), and the total brain volume (TBV), gray matter volume, and white matter volume (WMV) were calculated in each time point. Read More

J Neurosurg Pediatr 2022 Jan 21:1-5. Epub 2022 Jan 21.

Objective: Multiple studies have evaluated the use of MRI for prognostication in pediatric patients with severe traumatic brain injury (TBI) and have found a correlation between diffuse axonal injury (DAI)-type lesions and outcome. However, there remains a limited understanding about the use of MRI for prognostication after severe TBI in children who have undergone cranial surgery.

Methods: Children with severe TBI who underwent craniectomy or craniotomy at Primary Children's Hospital in Salt Lake City, Utah, between 2010 and 2019 were identified retrospectively. Read More

Medicine (Baltimore) 2021 Dec;100(48):e27805

Department of Radiology, Taizhou People's Hospital, Fifth Affiliated Hospital of Nantong University, Taizhou, Jiangsu, China.

Abstract: This study aims to investigate whether there is imaging evidence of disrupted hypothalamic functional connectivity (FC) in patients with diffuse axonal injury (DAI) and relationships with cognitive impairment.Resting-state functional magnetic resonance imaging (fMRI) data were acquired from acute patients with diagnosed DAI (n = 30) and healthy controls (HC) (n = 30). We first assessed hypothalamic FC with seed-based analysis. Read More

Brain Inj 2021 12 11;35(14):1674-1681. Epub 2022 Jan 11.

Logopedics, School of Humanities, Philosophical Faculty, University of Eastern Finland, Joensuu, Finland.

Purpose: Individuals with traumatic brain injury (TBI) often have persistent cognitive-linguistic deficits that negatively influence their life. Our objective was to examine the cognitive-linguistic outcome in individuals with moderate to severe diffuse axonal injury (DAI) with a novel test battery. As fatigue is a common symptom affecting the lives of individuals with DAI, we also wanted to assess whether the self-reported fatigue was associated with cognitive-linguistic abilities. Read More

Neurosurgery 2022 02;90(2):170-179

Department of Medicine, University Division of Anaesthesia, University of Cambridge, Cambridge, UK.

Background: Blood biomarkers are of increasing importance in the diagnosis and assessment of traumatic brain injury (TBI). However, the relationship between them and lesions seen on imaging remains unclear.

Objective: To perform a systematic review of the relationship between blood biomarkers and intracranial lesion types, intracranial lesion injury patterns, volume/number of intracranial lesions, and imaging classification systems. Read More

EBioMedicine 2022 Jan 24;75:103777. Epub 2021 Dec 24.

University Division of Anaesthesia, Department of Medicine, University of Cambridge, UK. Electronic address:

Background: We aimed to understand the relationship between serum biomarker concentration and lesion type and volume found on computed tomography (CT) following all severities of TBI.

Methods: Concentrations of six serum biomarkers (GFAP, NFL, NSE, S100B, t-tau and UCH-L1) were measured in samples obtained <24 hours post-injury from 2869 patients with all severities of TBI, enrolled in the CENTER-TBI prospective cohort study (NCT02210221). Imaging phenotypes were defined as intraparenchymal haemorrhage (IPH), oedema, subdural haematoma (SDH), extradural haematoma (EDH), traumatic subarachnoid haemorrhage (tSAH), diffuse axonal injury (DAI), and intraventricular haemorrhage (IVH). Read More

J Neurotrauma 2022 01;39(1-2):58-66

Department of Clinical Neuroscience, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.

Studies show conflicting results regarding the prognostic significance of traumatic axonal injuries (TAI) in patients with traumatic brain injury (TBI). Therefore, we documented the presence of TAI in several brain regions, using different magnetic resonance imaging (MRI) sequences, and assessed their association to patient outcomes using machine learning. Further, we created a novel MRI-based TAI grading system with the goal of improving outcome prediction in TBI. Read More

Neurology 2021 Nov 19. Epub 2021 Nov 19.

Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.

Background And Objectives: The neurological deficits of neonatal post-hemorrhagic hydrocephalus (PHH) have been linked to periventricular white matter injury. To improve understanding of PHH-related injury, diffusion basis spectrum imaging (DBSI) was applied in neonates, modeling axonal and myelin integrity, fiber density, and extra-fiber pathologies. Objectives included characterizing DBSI measures in periventricular tracts, associating measures with ventricular size, and examining MRI findings in the context of post-mortem white matter histology from similar cases. Read More

Radiol Case Rep 2022 Jan 1;17(1):91-94. Epub 2021 Nov 1.

Department of Radiology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.

Diffuse axonal injury (DAI) is one of the most severe types of primary traumatic brain injury. In recent years, MR imaging has been gaining popularity as an adjunctive imaging method in patients with DAI. In this case report, we describe MRI findings of an 11-year-old male patient diagnosed with DAI and discuss the role of different sequences in the evaluation of DAI. Read More

Neuroradiology 2022 Jun 31;64(6):1145-1156. Epub 2021 Oct 31.

Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, Netherlands.

Introduction: In order to augment the certainty of the radiological interpretation of "possible microbleeds" after traumatic brain injury (TBI), we assessed their longitudinal evolution on 3-T SWI in patients with moderate/severe TBI.

Methods: Standardized 3-T SWI and T1-weighted imaging were obtained 3 and 26 weeks after TBI in 31 patients. Their microbleeds were computer-aided detected and classified by a neuroradiologist as no, possible, or definite at baseline and follow-up, separately (single-scan evaluation). Read More

Stroke 2022 03 27;53(3):808-816. Epub 2021 Oct 27.

Vanderbilt Memory & Alzheimer's Center (E.E.M., N.S., K.R.P., D.L., K.A.G., T.J.H., A.L.J.), Vanderbilt University Medical Center, Nashville, TN.

Background And Purpose: Left ventricular (LV) mass index is a marker of subclinical LV remodeling that relates to white matter damage in aging, but molecular pathways underlying this association are unknown. This study assessed if LV mass index related to cerebrospinal fluid (CSF) biomarkers of microglial activation (sTREM2 [soluble triggering receptor expressed on myeloid cells 2]), axonal injury (NFL [neurofilament light]), neurodegeneration (total-tau), and amyloid-β, and whether these biomarkers partially accounted for associations between increased LV mass index and white matter damage. We hypothesized higher LV mass index would relate to greater CSF biomarker levels, and these pathologies would partially mediate associations with cerebral white matter microstructure. Read More

Front Neurosci 2021 30;15:711074. Epub 2021 Sep 30.

Department of Medical Imaging, Medical School, University of Pécs, Pécs, Hungary.

A former rodent study showed that cerebral traumatic microbleeds (TMBs) may temporarily become invisible shortly after injury when detected by susceptibility weighted imaging (SWI). The present study aims to validate this phenomenon in human SWI. In this retrospective study, 46 traumatic brain injury (TBI) patients in various forms of severity were included and willingly complied with our strict selection criteria. Read More

Med Sci Monit 2021 Oct 17;27:e933959. Epub 2021 Oct 17.

Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, South Korea.

BACKGROUND The pathophysiology of traumatic subarachnoid hemorrhage and brain injury has not been fully elucidated. In this study, we examined abnormalities of white matter in isolated traumatic subarachnoid hemorrhage patients by applying tract-based spatial statistics. MATERIAL AND METHODS For this study, 10 isolated traumatic subarachnoid hemorrhage patients and 10 age- and sex-matched healthy control subjects were recruited. Read More

Neuroradiol J 2021 Oct 13:19714009211049714. Epub 2021 Oct 13.

Department of Radiology, University Hospital Leuven, Belgium.

Introduction: Imaging plays a crucial role in the diagnosis, prognosis and follow-up of traumatic brain injury. Whereas computed tomography plays a pivotal role in the acute setting, magnetic resonance imaging is best suited to detect the true extent of traumatic brain injury, and more specifically diffuse axonal injury. Post-traumatic brain atrophy is a well-known complication of traumatic brain injury. Read More

Brain Commun 2021 14;3(3):fcab213. Epub 2021 Sep 14.

Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.

A history of concussion has been linked to long-term cognitive deficits; however, the neural underpinnings of these abnormalities are poorly understood. This study recruited 26 asymptomatic male Australian footballers with a remote history of concussion (i.e. Read More

Neural Regen Res 2022 May;17(5):978-982

Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea.

The main advantage of diffusion tensor tractography is that it allows the entire neural tract to be evaluated. In addition, configurational analysis of reconstructed neural tracts can indicate abnormalities such as tearing, narrowing, or discontinuations, which have been used to identify axonal injury of neural tracts in concussion patients. This review focuses on the characteristic features of axonal injury in concussion or mild traumatic brain injury (mTBI) patients through the use of diffusion tensor tractography. Read More

Surg Neurol Int 2021 3;12:384. Epub 2021 Aug 3.

Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan.

Background: Diffuse axonal injury (DAI) is a common presentation in neurotrauma. Prognosis is variable but can be dependent on the initial presentation of the patient. In our study, we evaluated the outcome of diffuse axonal injury. Read More

Ann Biomed Eng 2021 Oct 1;49(10):2914-2923. Epub 2021 Sep 1.

School of Biomedical Engineering, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada.

Investigating head responses during hockey-related blunt impacts and hence understanding how to mitigate brain injury risk from such impacts still needs more exploration. This study used the recently developed hockey helmet testing methodology, known as the Hockey Summation of Tests for the Analysis of Risk (Hockey STAR), to collect 672 laboratory helmeted impacts. Brain strains were then calculated from the according 672 simulations using the detailed Global Human Body Models Consortium (GHBMC) finite element head model. Read More

Neurocrit Care 2022 04 30;36(2):492-503. Epub 2021 Aug 30.

Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.

Background: Traumatic brain injury (TBI) is the leading cause of death and disability in children, but effective tools for predicting outcome remain elusive. Although many pediatric patients receive early magnetic resonance imaging (MRI), data on its utility in prognostication are lacking. Diffuse axonal injury (DAI) is a hallmark of TBI detected on early MRI and was shown previously to improve prognostication in adult patients with TBI. Read More

Brain Commun 2021 19;3(3):fcab133. Epub 2021 Jul 19.

Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London W12 0NN, UK.

The recognition, diagnosis and management of mild traumatic brain injuries are difficult and confusing. It is unclear how the severity and number of injuries sustained relate to brain injuries, such as diffuse axonal injury, diffuse vascular injury and progressive neurodegeneration. Advances in neuroimaging techniques enable the investigation of neuropathologies associated with acute and long-term effects of injury. Read More