Neurophysiology and Neuroimaging of Mild Traumatic Brain Injury

描述(由申请人提供)： 项目摘要/摘要创伤性脑损伤(TBI)正成为退伍军人管理局日益关注的问题，因为在战斗中获得创伤性脑损伤的回国士兵数量持续上升。然而，关于脑损伤严重程度、由此产生的神经病理和随后的神经行为障碍之间的关系，人们知之甚少。目前，我们仍然缺乏一种明确的生物标志物，既能对损伤的历史和/或存在敏感，又能随损伤的严重程度而变化。因此，拟议研究的总体目标是通过验证用于脑外伤诊断的体内、非侵入性生物标记物来满足这一需求。通过使用弥散张量成像(DTI)，我们试图研究丘脑和脑干中特定白质束的完整性，以期确定一个潜在的一致的脑损伤生物标志物。为了实现我们的目标，我们将招募72名有爆炸伤相关轻度脑外伤病史的退伍军人，24名非受伤对照组和24名颅外受伤对照组。患者将在创伤后应激障碍症状严重程度、在剧院的时间和战斗暴露方面进行匹配。患者还将完成3Tesla磁共振成像，对丘脑和脑干进行高分辨率DTI，并进行结构成像以量化萎缩和病变。此外，为了评估脑干-丘脑-前额叶回路的功能完整性，将进行眼球运动功能测试(注视、视觉引导眼跳、反眼跳)。认知、脑震荡后症状、情绪、焦虑和创伤后应激障碍症状将通过一系列对轻度脑外伤敏感的神经心理测试进行评估。将对这些数据进行分析，以确定(A)丘脑投射纤维和(B)脑干纤维是否受到与冲击波相关的脑损伤的影响，并确定这些纤维的损害是否会导致神经生理学和神经心理损害。主要结果将决定这项措施是否在临床上与返回的OIF/OEF退伍军人相关，以及这些方法在评估和诊断继发性冲击伤所致的轻度脑损伤中是否有效。

DESCRIPTION (provided by applicant): PROJECT SUMMARY / ABSTRACT Traumatic brain injury (TBI) is becoming an increasing concern for the Veterans Administration, as the number of returning soldiers who have acquired a TBI in combat continues to rise. Still, little is known about the relationship between brain injury severity, resultant neuropathology, and subsequent neurobehavioral disability. At present, we still lack a clear biomarker of TBI that is both sensitive to the history and/or presence of injury, and one that scales with severity of injury. Therefore, the overall objective of the proposed research is to fill this need by validating an in vivo, non-invasive biomarker for TBI diagnosis. Through the use of diffusion tensor imaging (DTI), we seek to investigate the integrity of specific white matter tracts in the thalamus and brainstem, in the hopes of identifying a potential consistent biomarker of TBI. To accomplish our objectives, we will recruit a total of 72 veterans with a history of mild TBI due to blast-related injury, 24 non-injured controls and 24 extra-cranial injured controls. Patients will be matched for post traumatic stress disorder symptom severity, time in theater and combat exposure. Patients will also complete a 3 Tesla MRI with high resolution DTI of the thalamus and brain stem, and structural imaging to quantify atrophy and lesions. In addition, in order to evaluate the functional integrity of the brain stem-thalamic-prefrontal circuit, tests of oculomotor function (fixation, visually guided saccades, anti-saccades) will be administered. Cognition, post-concussive symptoms, mood, anxiety and post traumatic stress disorder symptoms will be evaluated using a battery of neuropsychological tests sensitive to mild TBI. The data will be analyzed to determine whether (a) thalamus projection fibers and (b) brain stem fibers are affected by blast-related TBI and determine whether damage to these fibers results in neurophysiologic and neuropsychological impairment. The primary outcome will determine whether this measure is clinically relevant in returning OIF/OEF veterans, and whether or not these methods are valid in assessing and diagnosing mild TBI due to secondary blast injury.