Department of Pediatrics, Division of Child Neurology, Doernbecher Children's Hospital, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA.
Layton Aging and Alzheimer's Disease Center, Neurology, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA.
J Neurotrauma. 2021 Sep 1;38(17):2391-2399. doi: 10.1089/neu.2020.7447. Epub 2021 Apr 20.
Impaired clearance of perivascular waste in the brain may play a critical role in morbidity after mild traumatic brain injury (mTBI). We aimed to determine the effect of mTBI on the burden of magnetic resonance imaging (MRI)-visible perivascular spaces (PVSs) in a cohort of U.S. military veterans and whether sleep modulates this effect. We also investigated the correlation between PVS burden and severity of persistent post-concussive symptoms. Fifty-six Iraq/Afghanistan veterans received 3 Tesla MRI as part of a prospective cohort study on military blast mTBI. White matter PVS burden (i.e., number and volume) was calculated using an established automated segmentation algorithm. Multi-variate regression was used to establish the association between mTBIs sustained in the military and PVS burden. Covariates included age, blood pressure, number of impact mTBIs outside the military, and blast exposures. Correlation coefficients were calculated between PVS burden and severity of persistent post-concussive symptoms. There was a significant positive relationship between the number of mTBIs sustained in the military and both PVS number and volume ( = 0.04). A significant interaction was found between mTBI and poor sleep on PVS volume ( = 0.04). A correlation was found between PVS number and volume, as well as severity of postconcussive symptoms ( = 0.03). Further analysis revealed a moderate correlation between PVS number and volume, as well as balance problems ( < 0.001). In Iraq/Afghanistan veterans, mTBI is associated with an increase in PVS burden. Further, an interaction exists between mTBI and poor sleep on PVS burden. Increased PVS burden, which may indicate waste clearance dysfunction, is associated with persistent post-concussive symptom severity.
脑内血管周围废物清除障碍可能在轻度创伤性脑损伤（mTBI）后发病率中起关键作用。我们旨在确定 mTBI 对美国退伍军人队列中磁共振成像（MRI）可见血管周围空间（PVS）负担的影响，以及睡眠是否调节这种影响。我们还研究了 PVS 负担与持续性脑震荡后症状严重程度之间的相关性。56 名伊拉克/阿富汗退伍军人接受了 3T MRI 作为军事爆炸 mTBI 前瞻性队列研究的一部分。使用成熟的自动分割算法计算白质 PVS 负担（即数量和体积）。多元回归用于确定军事中发生的 mTBI 与 PVS 负担之间的关联。协变量包括年龄、血压、军事外冲击性 mTBI 次数和爆炸暴露。计算了 PVS 负担与持续性脑震荡后症状严重程度之间的相关系数。在军事中发生的 mTBI 次数与 PVS 数量和体积呈显著正相关（=0.04）。发现 mTBI 与睡眠质量差之间存在 PVS 体积的显著交互作用（=0.04）。还发现 PVS 数量和体积以及脑震荡后症状严重程度之间存在相关性（=0.03）。进一步分析显示，PVS 数量和体积以及平衡问题之间存在中度相关性（<0.001）。在伊拉克/阿富汗退伍军人中，mTBI 与 PVS 负担增加相关。此外，mTBI 与睡眠质量差之间存在交互作用。PVS 负担增加，可能表明废物清除功能障碍，与持续性脑震荡后症状严重程度相关。
