Page 58 - NNS 2014 Program & Abstract Book

lesion number averaged 49% (range 0–81%) and the reduction in
volume averaged 50% (range 0–89%). For brain subregions, greatest
improvement (65% in number, 62% in volume) occurred in deep brain
structures (CC, BG, THAL, IC). 46% of patients retained > 50% of
the initial lesion number and 37% retained > 50% of the initial
hemorrhagic volume.
Most traumatic hemorrhagic lesions occur in the cortex and sub-
cortical white matter, particularly the frontal lobes. There is a negative
correlation between hemorrhage extent and GCS, but lesions are also
detectable in patients with GCS of 15. On average, hemorrhages de-
crease by approximately 50% at one year and many patients re-
tain > 50% of the original lesion number/volume. [Support from NIH/
NINDS:R01-NS054001].
Key words
hemorrhage, MRI, one-year follow-up, pediatric, susceptibility-
weighted imaging, TBI
A2-05
ACUTE SUSCEPTIBILITY-WEIGHTED MRI OF HEMOR-
RHAGIC BRAIN LESIONS AND ONE-YEAR NEU-
ROPSYCHOLOGIC OUTCOMES AFTER PEDIATRIC TBI
Tong, K.A., Al-Ramadhani, R., Pivonka-Jones, J., Rundquist, M.,
Holshouser, B.A., Ghosh, N., Ashwal, S.
Loma Linda University Medical Center, Loma Linda, USA
We present an update on acute hemorrhagic injuries detected by MRI
susceptibility-weighted imaging (SWI), and their relation to one-year
neurologic and neuropsychological outcomes in 52 prospectively
studied pediatric TBI patients.
Pediatric patients, aged 4 to 18, were enrolled if they sustained a
moderate/severe TBI (GCS score < 13 or hemorrhagic intracranial
injury on CT). Patients underwent MRI (at 3.0 Tesla), acutely (6–17
days). The number and volume of hemorrhagic lesions at initial MRI
were compared to neurologic (PCPCS) and neuropsychological out-
comes at 12 months, specifically general measures of memory uti-
lizing the Children’s Memory Scale (CMS: General Memory score),
attention utilizing the Test of Everyday Attention for Children
(TEA-CH: Teach G score), and the Wechsler Abbreviated Scale of
Intelligence (WASI: Full Scale IQ).
We studied 52 children (38 males and 14 females, mean age 12.3
years), who were injured in vehicle/bike accidents (31), falls (12),
sports-related injuries (7), or assaulted (1). The number/volume of
lesions in all brain regions were negatively correlated with one-year
PCPCS as well as one-year TEA-CH scores. Lesions in the corpus
callosum were negatively correlated with FSIQ. Lesions in the frontal
lobes and basal ganglia were negatively correlated with one-year
CMS General Memory scores.
The extent of hemorrhagic brain lesions on acute MRI correlated
with one year neurologic outcomes. Neuropsychologic assessment
showed significant negative correlations between lesions in all brain
regions and attention scores. Callosal lesions correlated with dimin-
ished Full Scale IQ scores, and lesions in the frontal lobes and basal
ganglia correlated with diminished memory scores. SWI confirms that
hemorrhagic shearing injuries have an important effect on many
cognitive and neurologic domains. SWI can also be used in future
models to predict long-term neuropsychological outcomes. [Support
from NIH/NINDS:R01-NS054001].
Key words
hemorrhage, MRI, outcomes, pediatric, susceptibility-weighted im-
aging, TBI
A2-06
MULITIMODAL NEUROIMAGING WITH HYPERCAPNIA
TO MONITOR CEREBROVASCULAR FUNCTION AFTER
TRAUMATIC BRAIN INJURY AND EVALUATE TREAT-
MENT
Pronger, A.M.1,3, Korotcov, A.2,3, Bosomtwi, A.2,3, Jones, S.2,3,
Selwyn, R.G.2,3, Diaz-Arrastia, R.1,3
1Uniformed Services University of the Health Sciences, Department of
Neurology, Bethesda, USA
2Uniformed Services University of the Health Sciences, Translational
Imaging Facility, Bethesda, USA
3Uniformed Services University of the Health Sciences, Center for
Neuroscience and Regenerative Medicine, Bethesda, USA
Damage to the cerebral microvasculature is a major contributor to the
pathophysiology of traumatic brain injury (TBI). In order to facilitate
translation of pro-angiogenic therapies into clinical trials, there is a
need to develop non-invasive biomarkers capable of monitoring ce-
rebrovascular function over time and evaluating response to thera-
peutic intervention. Our objective was to develop a pre-clinical model
that allows rapid assessment of candidate drugs and that can be
adapted to the bedside. Regional differences in cerebrovascular re-
activity to carbon dioxide (CVRCO2) were examined using multimodal
magnetic resonance imaging (MRI), including Blood Oxygen Level
Dependent (BOLD) Imaging, Arterial Spin Labeling (ASL), and
Susceptibility Weighted Imaging (SWI), in young adult male rats
subjected to moderate fluid percussion injury and treated with silde-
nafil (Viagra) or saline. The temporal profiles of lesion volume and
regional CVRCO2 were compared to histological measures and neu-
robehavioral outcome. The effects of dexmedetomidine and isoflurane
anesthesia on CVRCO2 were also compared in healthy animals. Re-
commendations to optimize the design of hypercapnia neuroimaging
studies and avoid potential pitfalls are provided.
Key words
angiogenesis, cerebrovascular reactivity, hypercapnia, MRI, sildenafil,
treatment
A2-07
MULTISENSORY COGNITIVE CONTROL IN AN FMRI
STUDY OF MTBI
Dodd, A.B., Hanlon, F.M., Teshiba, T.M., Klimaj, S.D., Ling, J.M.,
Mayer, A.R.
The Mind Research Network/Lovelace Biomedical and Environmental
Research Institute, Albuquerque, USA
Mild traumatic brain injury (mTBI) has been associated with both
deficits in cognitive control and neurosensory dysfunction. Multi-
sensory cognitive control tasks presented at low (0.33 Hz) and higher
(0.66 Hz) frequencies can evaluate whether dysfunction occurs in
response to basic stimulus properties or as an interaction between
unisensory cortex and cognitive control (attention-related modula-
tions; ARMs). During a multisensory Stroop task, behavioral and
functional magnetic resonance imaging data were collected on a group
of 48 mTBI patients approximately 2 weeks post injury and 48 mat-
ched healthy controls (HC). An increased incidence of vestibular
(43% vs. 10%) and visual (26% vs. 7%) symptoms were self-reported
in patients relative to HC (p < 0.05), whereas no significant differences
existed for auditory symptoms (5% vs. 2%). Basic sensory integrity
(difference between high and low frequency trials) and ARMs were
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