MRS and DTI evidence of progressive posterior cingulate cortex and corpus callosum injury in the hyper-acute phase after Traumatic Brain Injury.
Tim P Lawrence, Adam Steel, Martyn Ezra and 7 others
PMID 30848964WHAT IT FOUND
MRI scans within 24 hours of traumatic brain injury showed metabolic disruption in the posterior cingulate cortex and white matter damage in the corpus callosum.
These changes progressed over the first week and correlated with short-term clinical outcome, suggesting early markers of secondary injury.
Key findings
01Within 24 hours of injury, patients had lower N-acetylaspartate and higher choline ratios in the posterior cingulate cortex compared to controls, indicating early neuronal injury and membrane disruption.
02Fractional anisotropy was lower in the corpus callosum of patients within 24 hours, and axial diffusivity was lower at 7-15 days, showing progressive white matter injury.
03In moderate-severe patients, an increase in choline ratios between scans correlated with poorer Glasgow Coma Scale scores at one week, suggesting metabolic progression tracks with short-term outcome.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study included only 18 patients, making subgroup analyses of mild versus moderate-severe injury very small and prone to error. The patient group was heterogeneous in age, injury type, and severity, complicating the interpretation of results. Scans were spaced 7-15 days apart, so the exact timing of injury progression between these points is unknown. The study did not assess long-term functional or cognitive outcomes, only short-term clinical status at one week.
Declared interests
The work was supported by the National Institute for Health Research, Integra (Codman Surgical Specialties), and the Wellcome Trust.
The easy way to misread this
Do not use these MRI findings to predict long-term patient recovery or make immediate treatment decisions. The study was small, exploratory, and only measured outcomes at one week, so the link to persistent disability or therapy needs is not yet proven.