Gosset Alexi, Wagman Hayley, Pavel Dan, Cohen Philip Frank, Tarzwell Robert, de Bruin Simon, Siow Yin Hui, Numerow Leonard, Uszler John, Rossiter-Thornton John F, McLean Mary, van Lierop Muriel, Waisman Zohar, Brown Stephen, Mansouri Behzad, Basile Vincenzo Santo, Chaudhary Navjot, Mehdiratta Manu
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
University of Illinois Medical Center, Chicago, IL, United States.
Front Neurol. 2022 Apr 11;13:704844. doi: 10.3389/fneur.2022.704844. eCollection 2022.
Following mild traumatic brain injury (mTBI), also known as concussion, many patients with chronic symptoms (>3 months post injury) receive conventional imaging such as computed tomography (CT) or magnetic resonance imaging (MRI). However, these modalities often do not show changes after mTBI. We studied the benefit of triaging patients with ongoing symptoms >3 months post injury by quantitative electroencephalography (qEEG) and then completing a brain single positron emission computed tomography (SPECT) to aid in diagnosis and early detection of brain changes.
We conducted a retrospective case review of 30 outpatients with mTBI. The patients were assessed by a neurologist, consented, and received a qEEG, and if the qEEG was positive, they consented and received a brain SPECT scan. The cases and diagnostic tools were collectively reviewed by a multidisciplinary group of physicians in biweekly team meetings including neurology, nuclear medicine, psychiatry, neuropsychiatry, general practice psychotherapy, neuro-ophthalmology, and chiropractic providers. The team noted the cause of injury, post injury symptoms, relevant past medical history, physical examination findings, and diagnoses, and commented on patients' SPECT scans. We then analyzed the SPECT scans quantitatively using the 3D-SSP software.
All the patients had cerebral perfusion abnormalities demonstrated by SPECT that were mostly undetectable by conventional imaging (CT/MRI). Perfusion changes were localized primarily in the cerebral cortex, basal ganglia, and cingulate cortex, and correlated with the patients' symptoms and examination findings. Qualitative and quantitative analyses yielded similar results. Most commonly, the patients experienced persistent headache, memory loss, concentration difficulties, depression, and cognitive impairment post mTBI. Because of their symptoms, most of the patients were unable to return to their previous employment and activity level.
Our findings outline the physical basis of neurological and psychiatric symptoms experienced by patients with mTBI. Increased detection of mTBI can lead to development of improved targeted treatments for mTBI and its various sequelae.
轻度创伤性脑损伤（mTBI），又称脑震荡，许多慢性症状患者（受伤后超过3个月）会接受传统成像检查，如计算机断层扫描（CT）或磁共振成像（MRI）。然而，这些检查方式在mTBI后往往显示不出变化。我们研究了通过定量脑电图（qEEG）对受伤后超过3个月仍有持续症状的患者进行分流，然后进行脑单光子发射计算机断层扫描（SPECT）以辅助诊断和早期发现脑部变化的益处。
我们对30例mTBI门诊患者进行了回顾性病例分析。患者由神经科医生进行评估，签署知情同意书，接受qEEG检查，如果qEEG结果为阳性，则签署知情同意书并接受脑部SPECT扫描。一个多学科医生团队在包括神经科、核医学、精神病学、神经精神病学、全科心理治疗、神经眼科和整脊治疗师在内的双周团队会议上共同审查这些病例和诊断工具。该团队记录了受伤原因、受伤后症状、相关既往病史、体格检查结果和诊断，并对患者的SPECT扫描进行了评论。然后，我们使用3D - SSP软件对SPECT扫描进行定量分析。
所有患者的SPECT均显示脑灌注异常，而这些异常在传统成像（CT/MRI）中大多无法检测到。灌注变化主要局限于大脑皮层、基底神经节和扣带回皮层，且与患者的症状和检查结果相关。定性和定量分析得出了相似的结果。最常见的是，患者在mTBI后出现持续性头痛、记忆力减退、注意力不集中、抑郁和认知障碍。由于这些症状，大多数患者无法恢复到以前的工作和活动水平。
我们的研究结果概述了mTBI患者所经历的神经和精神症状的生理基础。mTBI检测的增加可导致开发出针对mTBI及其各种后遗症的更好的靶向治疗方法。
