The purpose of this study is to examine the association between cerebral small vessel disease (CSVD) and neurological outcomes following traumatic brain injury (TBI).

TBI is a leading cause of morbidity and mortality resulting in significant socioeconomic burden. The pathophysiology underlying post-TBI neurocognitive deficits remains poorly understood and reliable predictors of long-term impairment are lacking. Recent evidence has identified microvascular disruption as a potential determinant of post-traumatic outcomes. We hypothesize that the presence of pre-existing CSVD is associated with poor functional impairment following TBI.

Patients who underwent neurologic evaluation for persistent neurological symptoms following TBI at Mayo Clinic Florida between 2006-2023 and had brain MRI were included. CSVD severity was ascertained using the 4-point Fazekas scale (range 0–3) on brain MRI. The primary functional outcome following TBI was the modified Rankin Scale (mRS) within 12 months of traumatic brain injury. Categorical variables were analyzed by chi-square or Fisher’s exact test as appropriate.

This retrospective analysis is ongoing with final results to be presented at the AAN Annual Meeting. We identified 151 women and 135 men (mean age, 55 years) who were evaluated for post-TBI deficits. Unadjusted predictors of poor functional outcomes (mRS=3-6) after TBI included age (p<.001), admission GCS (p=.01), intracranial hemorrhage (p<.001), mild CSVD (p<.001) and moderate CSVD (p<.001). Multivariable analysis is ongoing to determine if the degree of CSVD is independently associated with functional outcomes.

In our preliminary analysis, pre-existing CSVD was associated with worse functional outcomes following traumatic brain injury in patients with mild and moderate CSVD. Results from this study have the potential to further inform understanding of the association between cerebrovascular disease and functional impairment following TBI to improve prognostic accuracy and clinical management.