Objective documentation of traumatic brain injury subsequent to mild head trauma: multimodal brain imaging with MEG, SPECT, and MRI.
OBJECTIVE
To determine to what extent magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT), and magnetoencephalography (MEG) can provide objective evidence of brain injury in adult patients with persistent (>1 year) postconcussive symptoms following mild blunt head trauma.


METHODS
A retrospective and blind review of imaging data with respect to the presence of specific somatic, psychiatric, and cognitive complaints.


METHODS
Thirty complete data sets (with MRI, SPECT, MEG, and neuropsychological testing results) were collected between 1994 and 2000 from the MEG programs at the Albuquerque VAMC and the University of Utah.


METHODS
MRI data were evaluated for focal and diffuse structural abnormalities, SPECT data for regions of hypoperfusion, and resting MEG data for abnormal dipolar slow wave activity (DSWA) and epileptiform transients.


RESULTS
Structural MRI was abnormal for 4 patients. SPECT showed regions of hypoperfusion in 12 patients, while MEG showed abnormal activity in 19 patients. None of the imaging methods produced findings statistically associated with postconcussive psychiatric symptoms. A significant association was found between basal ganglia hypoperfusion and postconcussive headaches. For patients with cognitive complaints, abnormalities were more likely to be detected by MEG (86%) than either SPECT (40%) or MRI (18%) (P<.01). MEG also revealed significant (P<.01) associations between temporal lobe DSWA and memory problems, parietal DSWA and attention problems, and frontal DSWA and problems in executive function.


CONCLUSIONS
Functional brain imaging data collected in a resting state can provide objective evidence of brain injury in mild blunt head trauma patients with persistent postconcussive somatic and/or cognitive symptoms. MEG proved to be particularly informative for patients with cognitive symptoms.
Lewine
Jeffrey David
JD
Department of Radiology, the University of Utah School of Medicine, Salt Lake City, Utah, USA. Jeffrey.Lewine@abbhh.net
Davis
John T
JT
Bigler
Erin D
ED
Thoma
Robert
R
Hill
Dina
D
Funke
Michael
M
Sloan
John Henry
JH
Hall
Sandra
S
Orrison
William W
WW
D000293:Adolescent; D000328:Adult; D000368:Aged; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis; D001479:Basal Ganglia / Q000098:blood supply; D001930:Brain Injuries / Q000175:diagnosis*; D002560:Cerebrovascular Circulation / Q000502:physiology; D003072:Cognition Disorders / Q000175:diagnosis; D006259:Craniocerebral Trauma / Q000150:complications*; D004827:Epilepsy / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000175:diagnosis; D006801:Humans; D008279:Magnetic Resonance Imaging; D015225:Magnetoencephalography; D008297:Male; D008569:Memory Disorders / Q000175:diagnosis; D008606:Mental Processes / Q000502:physiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D038223:Post-Concussion Syndrome / Q000175:diagnosis; D012189:Retrospective Studies; D016037:Single-Blind Method; D015899:Tomography, Emission-Computed, Single-Photon; D014949:Wounds, Nonpenetrating / Q000150:complications*