White Matter Compromise in Veterans Exposed to Primary Blast Forces

Overview

Journal J Head Trauma Rehabil

Specialties Emergency Medicine
Rehabilitation Medicine

Date 2014 Mar 5

PMID 24590156

Citations 63

Authors

Katherine H Taber

Robin A Hurley

Courtney C Haswell

Jared A Rowland

Susan D Hurt

Cory D Lamar

Rajendra A Morey

Affiliations

Soon will be listed here.

Abstract

Objective: Use diffusion tensor imaging to investigate white matter alterations associated with blast exposure with or without acute symptoms of traumatic brain injury (TBI).

Participants: Forty-five veterans of the recent military conflicts included 23 exposed to primary blast without TBI symptoms, 6 having primary blast with mild TBI, and 16 unexposed to blast.

Design: Cross-sectional case-control study.

Main Measures: Neuropsychological testing and diffusion tensor imaging metrics that quantified the number of voxel clusters with altered fractional anisotropy (FA) radial diffusivity, and axial diffusivity, regardless of their spatial location.

Results: Significantly lower FA and higher radial diffusivity were observed in veterans exposed to primary blast with and without mild TBI relative to blast-unexposed veterans. Voxel clusters of lower FA were spatially dispersed and heterogeneous across affected individuals.

Conclusion: These results suggest that lack of clear TBI symptoms following primary blast exposure may not accurately reflect the extent of brain injury. If confirmed, our findings would argue for supplementing the established approach of making diagnoses based purely on clinical history and observable acute symptoms with novel neuroimaging-based diagnostic criteria that "look below the surface" for pathology.

Citing Articles

Differences in Brain Volume in Military Service Members and Veterans After Blast-Related Mild TBI: A LIMBIC-CENC Study.

Dennis E, Rowland J, Esopenko C, Tustison N, Newsome M, Hovenden E JAMA Netw Open. 2024; 7(11):e2443416.

PMID: 39527059 PMC: 11555548. DOI: 10.1001/jamanetworkopen.2024.43416.

Miller A, Martindale S, Rowland J, Walton S, Talmy T, Walker W NeuroRehabilitation. 2024; 55(3):329-345.

PMID: 39093081 PMC: 11612977. DOI: 10.3233/NRE-230268.

Considerations for the assessment of blast exposure in service members and veterans.

Rowland J, Martindale S Front Neurol. 2024; 15:1383710.

PMID: 38685944 PMC: 11056521. DOI: 10.3389/fneur.2024.1383710.

The relationship between blast-related mild traumatic brain injury and executive function is moderated by white matter integrity.

OBrien M, Disner S, Davenport N, Sponheim S Brain Imaging Behav. 2024; 18(4):764-772.

PMID: 38448704 DOI: 10.1007/s11682-024-00864-z.

Clinical Gaps-in-Noise Measures in Blast-Exposed Veterans: Associations with Electrophysiological and Behavioral Responses.

Papesh M, Koerner T Semin Hear. 2024; 45(1):83-100.

PMID: 38370515 PMC: 10872670. DOI: 10.1055/s-0043-1770139.

References

Zhuang L, Wen W, Zhu W, Trollor J, Kochan N, Crawford J . White matter integrity in mild cognitive impairment: a tract-based spatial statistics study. Neuroimage. 2010; 53(1):16-25. DOI: 10.1016/j.neuroimage.2010.05.068. View

Koerte I, Kaufmann D, Hartl E, Bouix S, Pasternak O, Kubicki M . A prospective study of physician-observed concussion during a varsity university hockey season: white matter integrity in ice hockey players. Part 3 of 4. Neurosurg Focus. 2012; 33(6):E3: 1-7. PMC: 5687247. DOI: 10.3171/2012.10.FOCUS12303. View

Cernak I, Noble-Haeusslein L . Traumatic brain injury: an overview of pathobiology with emphasis on military populations. J Cereb Blood Flow Metab. 2009; 30(2):255-66. PMC: 2855235. DOI: 10.1038/jcbfm.2009.203. View

Bazarian J, Zhu T, Blyth B, Borrino A, Zhong J . Subject-specific changes in brain white matter on diffusion tensor imaging after sports-related concussion. Magn Reson Imaging. 2011; 30(2):171-80. PMC: 3254806. DOI: 10.1016/j.mri.2011.10.001. View

Le Bihan D . Looking into the functional architecture of the brain with diffusion MRI. Nat Rev Neurosci. 2003; 4(6):469-80. DOI: 10.1038/nrn1119. View

Bass C, Panzer M, Rafaels K, Wood G, Shridharani J, Capehart B . Brain injuries from blast. Ann Biomed Eng. 2011; 40(1):185-202. DOI: 10.1007/s10439-011-0424-0. View

Cubon V, Putukian M, Boyer C, Dettwiler A . A diffusion tensor imaging study on the white matter skeleton in individuals with sports-related concussion. J Neurotrauma. 2010; 28(2):189-201. PMC: 3037804. DOI: 10.1089/neu.2010.1430. View

Pierpaoli C, Barnett A, Pajevic S, Chen R, Penix L, Virta A . Water diffusion changes in Wallerian degeneration and their dependence on white matter architecture. Neuroimage. 2001; 13(6 Pt 1):1174-85. DOI: 10.1006/nimg.2001.0765. View

Goldstein L, Fisher A, Tagge C, Zhang X, Velisek L, Sullivan J . Chronic traumatic encephalopathy in blast-exposed military veterans and a blast neurotrauma mouse model. Sci Transl Med. 2012; 4(134):134ra60. PMC: 3739428. DOI: 10.1126/scitranslmed.3003716. View

10.

Jensen K, Kaptchuk T, Kirsch I, Raicek J, Lindstrom K, Berna C . Nonconscious activation of placebo and nocebo pain responses. Proc Natl Acad Sci U S A. 2012; 109(39):15959-64. PMC: 3465419. DOI: 10.1073/pnas.1202056109. View

11.

Messe A, Caplain S, Paradot G, Garrigue D, Mineo J, Ares G . Diffusion tensor imaging and white matter lesions at the subacute stage in mild traumatic brain injury with persistent neurobehavioral impairment. Hum Brain Mapp. 2010; 32(6):999-1011. PMC: 6870077. DOI: 10.1002/hbm.21092. View

12.

Jorge R, Acion L, White T, Tordesillas-Gutierrez D, Pierson R, Crespo-Facorro B . White matter abnormalities in veterans with mild traumatic brain injury. Am J Psychiatry. 2012; 169(12):1284-91. PMC: 4030599. DOI: 10.1176/appi.ajp.2012.12050600. View

13.

Smith S, Nichols T . Threshold-free cluster enhancement: addressing problems of smoothing, threshold dependence and localisation in cluster inference. Neuroimage. 2008; 44(1):83-98. DOI: 10.1016/j.neuroimage.2008.03.061. View

14.

Rosen A, Zhang Y, Zhan W, Kasprisin A, Martinson S, Cheng J . Radiology corner. Case 41. Arcuate fasciculus damage seen on DTI in a blast-exposed soldier with mild traumatic brain injury (mTBI) with associated conduction aphasia. Mil Med. 2009; 174(11):v-vi. View

15.

Duckworth J, Grimes J, Ling G . Pathophysiology of battlefield associated traumatic brain injury. Pathophysiology. 2012; 20(1):23-30. DOI: 10.1016/j.pathophys.2012.03.001. View

16.

White T, Ehrlich S, Ho B, Manoach D, Caprihan A, Schulz S . Spatial characteristics of white matter abnormalities in schizophrenia. Schizophr Bull. 2012; 39(5):1077-86. PMC: 3756779. DOI: 10.1093/schbul/sbs106. View

17.

Farkas O, Povlishock J . Cellular and subcellular change evoked by diffuse traumatic brain injury: a complex web of change extending far beyond focal damage. Prog Brain Res. 2007; 161:43-59. DOI: 10.1016/S0079-6123(06)61004-2. View

18.

Fakhran S, Yaeger K, Alhilali L . Symptomatic white matter changes in mild traumatic brain injury resemble pathologic features of early Alzheimer dementia. Radiology. 2013; 269(1):249-57. DOI: 10.1148/radiol.13122343. View

19.

. VA/DoD Clinical Practice Guideline for Management of Concussion/Mild Traumatic Brain Injury. J Rehabil Res Dev. 2010; 46(6):CP1-68. View

20.

Dashnaw M, Petraglia A, Bailes J . An overview of the basic science of concussion and subconcussion: where we are and where we are going. Neurosurg Focus. 2012; 33(6):E5: 1-9. DOI: 10.3171/2012.10.FOCUS12284. View