Innovative Brain Imaging Technique Discovers Effects of Concussions

A victim’s response to a concussion results in a wide variety of symptoms, which have caused scientists and researchers to ask the question, why? Now, utilizing a new method for analyzing data from brain imaging scans, scientists at Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center have discovered that patients suffering from concussions and post-concussion syndrome possess unique spatial patterns of brain abnormalities that have proven to change over time.

The innovative method may eventually aid in assessing concussion patients, determine which brain injuries are more prone to having long-term neurological damages, and analyze the effectiveness of diagnosed treatments, states lead author Michael L. Lipton, M.D., Ph.D., associate director of the Gruss Magnetic Resonance Research Center at Einstein and medical director of MRI services at Montefiore Medical Center. The findings were published last week in the online journal version of Brain Imaging and Behavior. It is estimated that over one million Americans sustain a concussion (a.k.a traumatic brain injury, or TBI) every year, according to The Center for Disease Control and Prevention. The vast majority of concussions result from automobile accidents, motorcycle accidents, and falls. An overwhelming 300,000 children and adults are impacted by sports-related concussions every year. Most victims recover from their concussion with little or no continuing symptoms, but a staggering 30% suffer some sort of permanent impairment. In a 2003 federal study, concussions were categorized as a serious health problem that costs the United States over $80 billion each year. In previous imaging scans, studies have found there to be distinct differences in the brains of patients who have sustained concussions and those who had not. Those studies, however, could not distinguish differences between the concussion victims. "In fact, most researchers have assumed that all people with concussions have abnormalities in the same brain regions," said Dr. Lipton, who is also associate professor of radiology, of psychiatry and behavioral sciences.  “But that doesn’t make sense, since it is more likely that different areas would be affected in each person because of differences in anatomy, vulnerability to injury and mechanism of injury.” In an ongoing study, the researchers at Einstein adopted a new MRI technique called diffusion tensor imaging (DTI) on 34 patients (19 women and 15 men ages 19 to 64) diagnosed with mild traumatic brain injury at Montefiore Medical Center in the Bronx and on 30 normal, or healthy individuals. The patients were first scanned within two weeks of their sustained injury and again three and six months afterward. The data scans were then viewed using a newly developed software system called Enhanced Z-score Microstructural Assessment Pathology (EZ-MAP), which was created by Dr. Lipton and his colleagues. EZ-MAP provides researchers the capability to analyze microstructural abnormalities across the entire brain of each individual patient. DTI recognizes subtle damage of the brain by measuring the direction of diffusion of water in the white matter of the brain. The consistency of diffusion direction indicates if the tissue has maintained its microstructural integrity. DTI results are measured on a 0-to-1 scale termed fractional anisotropy (FA). In the current study discussed above, areas of unusually low FA (an indicator of brain damage) were observed in concussed patients but not in the normal controls. Each concussion patient had a distinct spatial pattern of low FA that developed and changed over the study period. Remarkably, each concussed patient also had a unique, evolving arrangement of abnormally high FA areas, distinct from the low FA areas of the brain. “We found widespread high FA at every time point, all the way out to six months and even in patients more than one year out from their injury.” stated Dr. Lipton. "We suspect that high FA represents a response to the injury. In other words, the brain may be trying to compensate for the injury by developing and enhancing other neural connections. This is a new and unexpected finding." Currently, the diagnosis and treatment of a concussion is based primarily on the nature of the patient’s accident and the symptoms they suffer from. The symptoms may include headaches, confusion, dizziness, ringing in the ears, slurred speech, and behavioral abnormalities. DTI, combined with EZ-MAP technology, could possibly offer a more objective and accurate tool for diagnosing concussion injuries, and for determining which victims will have ongoing and escalating symptoms. If you or a friend, family member, colleague or acquaintance has sustained a physical injury such as TBI, as a result of the negligence exhibited by an individual or corporation, call the personal injury law attorneys at the Dolman Law Group for a free consultation and case evaluation at: (727) 451-6900, or email us at: Matt@DolmanLaw.com