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physiological disturbance, we integrated mind-body techniques,
known to affect parasympathetic tone and autonomic balance, into a
four-week intensive interdisciplinary outpatient treatment program for
SM with combat-related TBI and psychological health (PH) condi-
tions. We measured BHI on admission and discharge, hypothesizing
that this program will have a beneficial effect on autonomic function.
Methods:
TCD with breath holding paradigm was performed on
patients admitted to the National Intrepid Center of Excellence. As a
part of integrative care, SMs received an average of 8 sessions of mind-
body training per week. Thirty-four patients with abnormal BHIs upon
admission were tested again at the end of the treatment program.
Results:
Over seventy percent (n
=
24) of the patients exhibited
improved (i.e., increased) BHI scores. A paired-sample t-test showed
that BHI scores were significantly higher (
t
= -
2.81,
p
=
.008, d
=
.46,
medium effect size) on the second TCD (
M
=
1.16, SD
=
.31) than the
first TCD (
M
=
1.02, SD
=
.20), with 38.2% (n
=
13) of patients re-
solving within the normal range (BHI
‡
1.2).
Conclusions:
TCD CVR evaluation in patients with chronic mTBI
revealed a high prevalence of cerebral autonomic disturbance. Ex-
posure to mind-body training was associated with improved cerebral
autoregulation as measured by changes in BHI, suggesting that TCD
BHI might have utility as a marker of treatment response in patients
with mTBI and PH conditions.
Disclaimer:
Any opinions, views, or assertions expressed are solely
those of the authors and do not necessarily represent those of NICoE,
WRNNMC, CNRM, the Uniformed Services University of the Health
Sciences, the Department of Defense, Department of Army/Navy/Air
Force, or the U.S. government.
Keywords: sympathetic nervous system, parasympathetic nervous
system, traumatic brain injury, transcranial doppler, military service
members
A5-06
PROGRESSIVE LIMBIC ANTEROGRADE TRANS-NEURONAL
DEGENERATION: A NEUROPATHOLOGICAL & RADIOLO-
GICAL BIOMARKER IN HIPPOCAMPAL DISEASE
William Torch
NeuroDevelopmental & NeuroDiagnostic and AASM-Accredited
Washoe Sleep Disorders Centers, NDC & WSDC, 75 Pringle Way, Ste
701, Reno, NV 89502, USA
In 1977 Torch et al. (Neurology, 27: 1157) described the case of a 64-
year-old man erroneously diagnosed with Alzheimer’s Disease (AD). In
the absence of typical AD-pathology, the unexpected autopsy finding of
a left hippocampal cystic infarct, with extensive 1
0
, 2
0
& 3
0
limbic
anterograde trans-neuronal-degeneration (LATND) accounted for a
previously noted left-temporal EEG slow wave focus and 8-year history
of progressive dementia. Question arose as to whether LATND in this
case was: 1) a rare neuropathological event; 2) an unrecognized phe-
nomenon due to the prosector’s lack of awareness; or 3) more prevalent
than commonly appreciated. As presented in Part I of this two-part
presentation, subsequent clinical-neuropathological metaanalysis by this
author of over 128 published cases of hippocampal injury, concluded
that LATND: 1) commonly occurs in many neurological conditions in
both children & adults (e.g., TBI/CTE, stroke, limbic encephalitis and
kernicterus, Atypical & Familial AD, carcinomatous vasculitis, etc); 2)
occurs uni- and bilaterally, where the extent, degree & rate of pro-
gression in each hemisphere is related to ‘‘Survival Time’’ [ST-duration
of time from symptom-onset to death], including acuity, chronicity,
severity of disease; 3) may be accompanied by a progressive two-stage
syndrome of cognitive, emotional & behavioral encephalopathy, where,
in its first early phase, transsynaptic denervation-hypersensitivity and/or
neuronal disinhibition it may be expressed by ‘‘positive’’ psychomotor
symptomatology, and in later end-stage, by ‘‘negative’’ symptomatol-
ogy, reflecting anterior thalamic/diencephalic dementia. Important to
note, all of the cases in the meta-analytical review, as well as the
primary case, had been post-mortemly studied
before
the availability of
modern radiological, metabolic, neurophysiological & histiological
technologies. Addressing the issue of whether LATND can be radio-
logically identified in a living patient, the author in reviewing recently-
published brain CT, MRI, fMRI, PET and SPECT neuro-radiological
studies & literature, concludes that LATND may be a valid radiological
Biomarker Model in a number of progressive dementias, where depo-
sition of neuro-toxic amyloid-beta, synuclein, tau-protein, neurofibril-
lary tangles, plaques and macromolecular proteinaceous prion
complexes may in part reflect hippocampal injury spreading to distal
locations along established limbic pathways, in association with glial
scavenger and microvascular inflammatory injury and secondary loss of
normal trophic metabolic processes necessary to sustain limbic con-
nectivity and functionality. In conclusion, this combined neuropatho-
logical and neuroradiological study and review demonstrates that
LATND processes can be tracked 1) neuro-radiologically, 2) through
human post-mortem analysis, as well as 3) by means of the same animal
models used by Papez & others in defining the Limbic Circuit.
Keywords: hippocampal limbic transneuronal degeneration, cog-
nition, dementia
A5-07
HELMETS MAY PROVIDE PARTIAL PROTECTION
AGAINST CONCUSSION: A PROSPECTIVE STUDY WITH
SCAT3 AND EYE TRACKING
Uzma Samadani
, Amie Kim, Radek Kolecki, Marleen Reyes, Robert
Ritlop, Stephen Wall, Spiros Frangos, Paul Huang
New York University School of Medicine, Neurosurgery, New York,
USA
Objective:
Helmet use has been shown to reduce death and neuro-
surgical intervention, but efficacy in concussion prevention remains
unknown. We hypothesized that helmet use reduces concussion ef-
fects as measured with Sport Concussion Assessment Tool 3 (SCAT3)
and an eye tracking measure. Outcome measures also included hem-
orrhage on head CT, admission, and length of stay (LOS).
Methods:
Patients involved in activity traditionally supporting
helmet use were prospectively recruited and administered SCAT3 and
eye tracking for 220 seconds while watching a music video. Uninjured
healthy controls were recruited for comparison. Two-tailed Mann-
Whitney test compared helmeted versus unhelmeted groups. Kruskal-
Wallis compared distributions among helmeted, unhelmeted and
control groups.
Results:
55 head trauma patients were recruited, 18 helmeted and
37 unhelmeted. There were 31 cyclists / athletes and 24 construction
workers. There was no difference in hemorrhage on CT scan, ad-
mission, LOS and SCAT3 subset scores between helmeted and un-
helmeted patients. SCAT3 subsets were significantly different in all
trauma patients versus all controls. 42 of 89 eye tracking metrics
significantly differed between helmeted and unhelmeted trauma pa-
tients versus controls. 7 of 89 eye tracking metrics were significantly
worse (trending away from controls) in unhelmeted versus helmeted
patients, while only 1 of 89 metrics was worse in helmeted versus
unhelmeted patients.
Discussion:
Helmet use was associated with less severe injury in 7
of 89 eye tracking metrics compared to unhelmeted patients, however
SCAT3 subsets were not different between these groups. Limitations
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