MRI Finds Brain Injury Patterns in Concussion-Related Depression

Magnetic resonance imaging detects distinct brain injury pattern among people with concussion-related depression and anxiety, according to a study published online in Radiology.

Researchers from the UPMC Presbyterian Hospital, University of Pittsburgh Medical Center in Pennsylvania, sought to determine if central axonal injury underlies neuropsychiatric symptoms after mild traumatic brain injury (mTBI).

Using diffusion-tensor imaging and serial neurocognitive testing with the Immediate Post-Concussion Assessment and Cognitive Testing evaluation, the researchers assessed 45 patients with mTBI (38 with irritability, 32 with depression, and 18 with anxiety), and 29 control subjects, who had mTBI without neuropsychiatric symptoms.

“Using other concussion patients as our controls was a big advantage of our study,” lead author Lea M. Alhilali, MD, assistant professor of radiology, UPMC, said in a release. “When you are able to study a similar population with similar risk factors, you get much more reliable results.”

The researchers found that the patients with mTBI and depression had:[[{"type":"media","view_mode":"media_crop","fid":"38824","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_5416982053144","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3889","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 248px; width: 160px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Lea M. Alhilali, MD","typeof":"foaf:Image"}}]]

• Decreased fractional anisotropy in the superior longitudinal fasciculus

• White matter around the nucleus accumbens

• Anterior limb of the internal capsule

Patients with anxiety had diminished fractional anisotropy in the vermis. However, none of the control subjects had any significant decrease in fractional anisotropy. Injury in the region of the nucleus accumbens inversely correlated with recovery time in patients.

“The regions injured in concussion patients with depression were very similar to those of people with non-traumatic major depression disorder,” Alhilali noted in the release. “This suggests there may be similar mechanisms to non-trauma and trauma-dependent depression that may help guide treatment.”

“Injury to the cerebellar vermis in patients with mTBI and anxiety may indicate underlying dysfunction in primitive fear conditioning circuits in the cerebellum,” the researchers concluded. “Involvement of the nucleus accumbens in depression after mTBI may suggest an underlying dysfunctional reward circuit that affects the prognosis in these patients.”