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dc.contributor.authorGriffin, A.D.
dc.contributor.authorTurtzo, L.C.
dc.contributor.authorParikh, G.Y.
dc.date.accessioned2019-11-12T20:30:54Z
dc.date.available2019-11-12T20:30:54Z
dc.date.issued2019
dc.identifier.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85074304123&doi=10.1093%2fbrain%2fawz290&partnerID=40&md5=60a2a77bbb9ece5c5a543a7c2c65899c
dc.identifier.urihttp://hdl.handle.net/10713/11388
dc.description.abstractTraumatic microbleeds are small foci of hypointensity seen on T2*-weighted MRI in patients following head trauma that have previously been considered a marker of axonal injury. The linear appearance and location of some traumatic microbleeds suggests a vascular origin. The aims of this study were to: (i) identify and characterize traumatic microbleeds in patients with acute traumatic brain injury; (ii) determine whether appearance of traumatic microbleeds predict clinical outcome; and (iii) describe the pathology underlying traumatic microbleeds in an index patient. Patients presenting to the emergency department following acute head trauma who received a head CT were enrolled within 48 h of injury and received a research MRI. Disability was defined using Glasgow Outcome Scale-Extended ?6 at follow-up. All magnetic resonance images were interpreted prospectively and were used for subsequent analysis of traumatic microbleeds. Lesions on T2* MRI were stratified based on 'linear' streak-like or 'punctate' petechial-appearing traumatic microbleeds. The brain of an enrolled subject imaged acutely was procured following death for evaluation of traumatic microbleeds using MRI targeted pathology methods. Of the 439 patients enrolled over 78 months, 31% (134/439) had evidence of punctate and/or linear traumatic microbleeds on MRI. Severity of injury, mechanism of injury, and CT findings were associated with traumatic microbleeds on MRI. The presence of traumatic microbleeds was an independent predictor of disability (P < 0.05; odds ratio = 2.5). No differences were found between patients with punctate versus linear appearing microbleeds. Post-mortem imaging and histology revealed traumatic microbleed co-localization with iron-laden macrophages, predominately seen in perivascular space. Evidence of axonal injury was not observed in co-localized histopathological sections. Traumatic microbleeds were prevalent in the population studied and predictive of worse outcome. The source of traumatic microbleed signal on MRI appeared to be iron-laden macrophages in the perivascular space tracking a network of injured vessels. While axonal injury in association with traumatic microbleeds cannot be excluded, recognizing traumatic microbleeds as a form of traumatic vascular injury may aid in identifying patients who could benefit from new therapies targeting the injured vasculature and secondary injury to parenchyma. This work is written by US Government employees and is in the public domain in the US.en_US
dc.description.urihttps://doi.org/10.1093/brain/awz290en_US
dc.description.urihttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6821371/
dc.language.isoen_USen_US
dc.publisherOxford University Pressen_US
dc.relation.ispartofBrain : a journal of neurology
dc.subjectmild traumatic brain injuryen_US
dc.subjectMRI biomarkers of traumatic brain injuryen_US
dc.subjectradiological-pathological analysisen_US
dc.subjecttraumatic microbleedsen_US
dc.subjecttraumatic vascular injuryen_US
dc.titleTraumatic microbleeds suggest vascular injury and predict disability in traumatic brain injuryen_US
dc.typeArticleen_US
dc.identifier.doi10.1093/brain/awz290
dc.identifier.pmid31608359


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