title: Microbleeds may expand acutely after traumatic brain injury.
abstract: OBJECTIVE
  Susceptibility weighted imaging (SWI) is a very sensitive tool for the detection of microbleeds in traumatic brain injury (TBI). The number and extent of such traumatic microbleeds (TMBs) have been shown to correlate with the severity of the injury and the clinical outcome. However, the acute dynamics of TMBs have not been revealed so far. Since TBI is known to constitute dynamic pathological processes, we hypothesized that TMBs are not constant in their appearance, but may progress acutely after injury.
  
  
  METHODS
  We present here five closed moderate/severe (Glasgow coma scale≤13) TBI patients who underwent SWI very early (average=23.4 h), and once again a week (average=185.8 h) after the injury. The TMBs were mapped at both time points by a conventional radiological approach and their numbers and volumes were measured with manual tracing tools by two observers. TMB counts and extents were compared between time points.
  
  
  RESULTS
  TMBs were detected in four patients, three of them displaying an apparent TMB change. In these patients, TMB confluence and apparent growth were detected in the corpus callosum, coronal radiation or subcortical white matter, while unchanged TMBs were also present. These changes caused a decrease in the TMB count associated with an increase in the overall TMB volume over time.
  
  
  CONCLUSIONS
  We have found a compelling evidence that diffuse axonal injury-related microbleed development is not limited strictly to the moment of injury: the TMBs might expand in the acute phase of TBI. The timing of SWI acquisition may be relevant for optimizing the prognostic utility of this imaging biomarker.
authors.affiliation: Department of Neurosurgery, Pécs Medical School, H-7623, Rét. u. 2., Pécs, Hungary. Electronic address: prsarn@gmail.com.
authors.forename: Arnold
authors.initials: A
authors.lastname: Toth
authors.affiliation: Department of Neurosurgery, Pécs Medical School, H-7623, Rét. u. 2., Pécs, Hungary. Electronic address: noemi.kovacs5@gmail.com.
authors.forename: Noemi
authors.initials: N
authors.lastname: Kovacs
authors.affiliation: Department of Neurosurgery, Pécs Medical School, H-7623, Rét. u. 2., Pécs, Hungary. Electronic address: tamas.viktoria@pte.hu.
authors.forename: Viktoria
authors.initials: V
authors.lastname: Tamas
authors.affiliation: Department of Neurosurgery, Pécs Medical School, H-7623, Rét. u. 2., Pécs, Hungary. Electronic address: kornyei.balint@windowslive.com.
authors.forename: Balint
authors.initials: B
authors.lastname: Kornyei
authors.affiliation: Department of Neurosurgery, Pécs Medical School, H-7623, Rét. u. 2., Pécs, Hungary. Electronic address: nagy.mate@pte.hu.
authors.forename: Mate
authors.initials: M
authors.lastname: Nagy
authors.affiliation: Department of Neurosurgery, Pécs Medical School, H-7623, Rét. u. 2., Pécs, Hungary; Diagnostic Center of Pécs, H-7623, Rét. u. 2., Pécs, Hungary. Electronic address: andrhorvath@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Horvath
authors.affiliation: Department of Radiology, Pécs Medical School, H-7624, Ifjusag str. 13., Pécs, Hungary. Electronic address: rostas.tamas@pte.hu.
authors.forename: Tamas
authors.initials: T
authors.lastname: Rostas
authors.affiliation: Department of Neurosurgery, Pécs Medical School, H-7623, Rét. u. 2., Pécs, Hungary; Department of Radiology, Pécs Medical School, H-7624, Ifjusag str. 13., Pécs, Hungary. Electronic address: peter.bogner@gmail.com.
authors.forename: Peter
authors.initials: P
authors.lastname: Bogner
authors.affiliation: Department of Neurology, Pécs Medical School, H-7623, Rét. u. 2., Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Hungary. Electronic address: jozsef.janszky@gmail.com.
authors.forename: Jozsef
authors.initials: J
authors.lastname: Janszky
authors.affiliation: Department of Neurosurgery, Pécs Medical School, H-7623, Rét. u. 2., Pécs, Hungary; Diagnostic Center of Pécs, H-7623, Rét. u. 2., Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Hungary. Electronic address: doczi.tamas@pte.hu.
authors.forename: Tamas
authors.initials: T
authors.lastname: Doczi
authors.affiliation: Department of Neurosurgery, Pécs Medical School, H-7623, Rét. u. 2., Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Hungary. Electronic address: 2saturn@pte.hu.
authors.forename: Andras
authors.initials: A
authors.lastname: Buki
authors.affiliation: Department of Neurosurgery, Pécs Medical School, H-7623, Rét. u. 2., Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Hungary. Electronic address: schwarcz.attila@pte.hu.
authors.forename: Attila
authors.initials: A
authors.lastname: Schwarcz
mesh_terms: D000208:Acute Disease; D000328:Adult; D001921:Brain / Q000473:pathology; D020201:Brain Hemorrhage, Traumatic / Q000175:diagnosis* / Q000473:pathology; D020833:Diffuse Axonal Injury / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D055815:Young Adult
keywords: Diffuse axonal injury; Magnetic resonance imaging; Microbleed; Microhemorrhage; Susceptibility weighted imaging; Traumatic brain injury