“Concussion is the number one neurological condition to affect adults , but health services don ’ t have the resources to routinely bring back every patient for a follow-up , which is why we need a way of identifying those patients at greatest risk of persistent symptoms .”
Advanced MRI Scans Help Identify One in Three Concussion Patients with ‘ Hidden Disease ’
“Concussion is the number one neurological condition to affect adults , but health services don ’ t have the resources to routinely bring back every patient for a follow-up , which is why we need a way of identifying those patients at greatest risk of persistent symptoms .”
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Offering patients with concussion a type of brain scan known as diffusion tensor imaging MRI could help identify the one in three people who will experience persistent symptoms that can be life-changing , say Cambridge researchers .
Around one in 200 people in Europe every year will suffer concussion . In the UK , more than 1 million people attend emergency departments annually with a recent head injury . It is the most common form of brain injury worldwide .
When a patient in the UK presents at an Emergency Department with a head injury , they are assessed according to the NICE head injury guidelines . Depending on their symptoms , they may be referred for a CT scan , which looks for brain injuries including bruising , bleeding and swelling .
However , CT scans identify abnormalities in fewer than one in 10 patients with concussion , yet 30 – 40 % of patients discharged from the emergency department following a scan experience significant symptoms that can last for years and be potentially life-changing . These include severe fatigue , poor memory , headaches , and mental health issues ( including anxiety , depression , and post-traumatic stress ).
Dr . Virginia Newcombe from the Department of Medicine at the University of Cambridge and an Intensive Care Medicine and Emergency Physician at Addenbrooke ’ s Hospital , Cambridge , said , “ The majority of head injury patients are sent home with a piece of paper telling them the symptoms of post-concussion to look out for and are told to seek help from their GP if their symptoms worsen .
“ The problem is that the nature of concussion means patients and their GPs often don ’ t recognize that their symptoms are serious enough to need follow-up . Patients describe it as a ‘ hidden disease ,’ unlike , say , breaking a bone . Without objective evidence of a brain injury , such as a scan , these patients often feel that their symptoms are dismissed or ignored when they seek help .”
In a study published today in eClinicalMedicine , Dr . Newcombe and colleagues show that an advanced form of MRI known as diffusion tensor imaging ( DTI ) can substantially improve existing prognostic models for patients with concussion who have been given a normal CT brain .
DTI measures how water molecules move in tissue , providing detailed images of the pathways , known as white matter tracts , that connect different parts of the brain . Standard MRI scanners can be adapted to measure this data , which can be used to calculate a DTI “ score ” based on the number of different brain regions with abnormalities .
Dr . Newcombe and colleagues studied data from more than 1,000 patients recruited to the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury ( CENTER-TBI ) study between December 2014 and December 2017 . 38 % of the patients had an incomplete recovery , meaning that three months after discharge their symptoms were still persisting .
The team assigned DTI scores to the 153 patients who had received a DTI scan . This significantly improved the accuracy of the prognosis — whereas the current clinical model would correctly predict in 69 cases