Abstract Details

Title Microhemorrhage Pathology in Traumatic Brain Injury (TBI): Clinical and Radiologic Features

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) Sports Neurology and Neuro Trauma Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 006

Objective To characterize subcortical microhemorrhages in patients hospitalized for TBI.

Background Mechanical shearing forces impacting the brain can result in stretching of axons and small blood vessels, resulting in traumatic axonal and microvascular injury, respectively. Traumatic microbleeds (TMBs) are often microscopic and can be reliably detected using magnetic resonance imaging (MRI) techniques such as gradient echo (GRE) T2* and susceptibility-weighted imaging (SWI), which amplify the susceptibility effect of iron. This study was designed to characterize the prevalence, regional distribution, and clinical correlations of TMBs in patients hospitalized for management of TBI.

Design/Methods 70 patients who were admitted to the hospital for TBI were enrolled in the Longitudinal Assessment of Microvascular Injury (LATMI) study at the University of Pennsylvania. 18 (26%) were identified as having TMBs on SWI sequences. The number and locations of the microbleeds were recorded, as was the admission Glasgow Coma Scale (GCS) score and findings on cranial CT.

Results The age for the 52 TBI patients without signs of TMB was 34 + 16 (mean + SD) years, and 38 (73%) were male. For the 18 TMB +ve patients, age was 45 + 17 years (p < 0.001), and 17 (94%) were male (p = 0.09, Fisher’s exact test). 89% of the TBI patients with microbleeds also had a positive head CT scan. The median GCS score was 15 for both TMB +ve and TMB-ve patients. The frontal lobes were most commonly affected, followed by the parietal, occipital, and temporal lobes. 76% of TMB +ve had frontal TMBs, 41% had parietal TMBs, 12% had occipital TMBs, and 6% had temporal TMBs.

Conclusions TMBs are common in patients with TBI, including those with predominantly mild injuries. Prevalence of TMBs is associated with older age. The regional distribution of TMBs may be a function of selective regional vulnerability.

Authors/Disclosures
PRESENTER	No disclosure on file
	No disclosure on file
James J. Gugger, Jr., MD, PharmD (University of Rochester)	Dr. Gugger has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Ceribell. The institution of Dr. Gugger has received research support from American Epilepsy Society.
Erika Silverman (University of Pennsylvania)	Ms. Silverman has nothing to disclose.
	No disclosure on file
Cian Dabrowski, MS	Cian Dabrowski has nothing to disclose.
Justin A. Morrison (Penn Presbyterian Medical Center)	Mr. Morrison has nothing to disclose.
Brigid A. Magdamo	Ms. Magdamo has nothing to disclose.
	No disclosure on file
	No disclosure on file
Danielle Sandsmark, MD	The institution of Dr. Sandsmark has received research support from NINDS. The institution of Dr. Sandsmark has received research support from BrainBox Solutions Inc. The institution of Dr. Sandsmark has received research support from Department of Defense.
	No disclosure on file
Ramon R. Diaz-Arrastia, MD, PhD, FAAN (University of Pennsylvania)	Dr. Diaz-Arrastia has stock in BrainBox, LLC. Dr. Diaz-Arrastia has stock in Nia Therpeutics. The institution of Dr. Diaz-Arrastia has received research support from National Institutes of Health. The institution of Dr. Diaz-Arrastia has received research support from Department of Defense.

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