Traumatic brain injuries

Nat Rev Dis Primers. 2016 Nov 17:2:16084. doi: 10.1038/nrdp.2016.84.

Abstract

Traumatic brain injuries (TBIs) are clinically grouped by severity: mild, moderate and severe. Mild TBI (the least severe form) is synonymous with concussion and is typically caused by blunt non-penetrating head trauma. The trauma causes stretching and tearing of axons, which leads to diffuse axonal injury - the best-studied pathogenetic mechanism of this disorder. However, mild TBI is defined on clinical grounds and no well-validated imaging or fluid biomarkers to determine the presence of neuronal damage in patients with mild TBI is available. Most patients with mild TBI will recover quickly, but others report persistent symptoms, called post-concussive syndrome, the underlying pathophysiology of which is largely unknown. Repeated concussive and subconcussive head injuries have been linked to the neurodegenerative condition chronic traumatic encephalopathy (CTE), which has been reported post-mortem in contact sports athletes and soldiers exposed to blasts. Insights from severe injuries and CTE plausibly shed light on the underlying cellular and molecular processes involved in mild TBI. MRI techniques and blood tests for axonal proteins to identify and grade axonal injury, in addition to PET for tau pathology, show promise as tools to explore CTE pathophysiology in longitudinal clinical studies, and might be developed into diagnostic tools for CTE. Given that CTE is attributed to repeated head trauma, prevention might be possible through rule changes by sports organizations and legislators.

Publication types

  • Review

MeSH terms

  • Athletic Injuries / complications
  • Biomarkers / analysis
  • Biomarkers / cerebrospinal fluid
  • Brain Injuries, Traumatic / complications*
  • Brain Injuries, Traumatic / epidemiology
  • Brain Injuries, Traumatic / physiopathology*
  • Chronic Traumatic Encephalopathy / complications
  • Humans
  • Intermediate Filaments / pathology
  • Magnetic Resonance Imaging / methods
  • Microglia / pathology
  • Military Medicine / statistics & numerical data
  • Military Personnel / statistics & numerical data
  • Neurodegenerative Diseases / etiology
  • Neurofilament Proteins / analysis
  • Neurofilament Proteins / cerebrospinal fluid
  • Phosphopyruvate Hydratase / analysis
  • Phosphopyruvate Hydratase / cerebrospinal fluid
  • Positron-Emission Tomography / methods
  • Post-Concussion Syndrome / complications
  • Post-Concussion Syndrome / epidemiology
  • S100 Calcium Binding Protein beta Subunit / analysis
  • S100 Calcium Binding Protein beta Subunit / cerebrospinal fluid
  • Tomography, X-Ray Computed / methods
  • Warfare

Substances

  • Biomarkers
  • Neurofilament Proteins
  • S100 Calcium Binding Protein beta Subunit
  • S100B protein, human
  • neurofilament protein M
  • Phosphopyruvate Hydratase