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Enlarged Perivascular Spaces in Patients with Mild Traumatic Brain Injury: Characterization with 7T MRI and Relationship with Neurobehavioral Outcome

Traumatic brain injury (TBI) is a growing epidemic in the population that is caused by blunt force trauma or sudden acceleration and deceleration to the head. This sudden impact of trauma has been found to create implications for the waste-removing function of the glymphatic system. In this current study, we examined the development of enlarged perivascular spaces (ePVS), a biomarker of glymphatic function, during the acute post-injury period as well as the 30-day and 90-day post-injury periods using 7T MRI. Imaging sequences included T2*, MP2RAGE, T2 FLAIR, SWI, and SPACE. mTBI participants at each of the post-injury time periods also completed the Neurobehavioral Symptom Inventory and the Pittsburgh Sleep Quality Index assessments to identify their neurobehavioral symptoms and sleeping patterns during the post-injury period. The ePVS were identified and counted by a blind reviewer and the severity of the ePVS burden was rated on a scale based on the number of ePVS identified in each hemisphere. When scored, 83% of the healthy individuals were rated as being “none” or “mild” while 78% of mTBI participants were rated as being “moderate”, “frequent”, or "severe”. There was a significant difference in ePVS burden in mTBI participants when compared to the healthy controls at the acute time point. Both the total number of ePVS (p = 0.02) and number of linear ePVS (p = 0.01) were significantly higher in the mTBI group. Preliminary analysis revealed that there is a relationship between ePVS burden and the neurobehavioral symptoms that develop at the post-injury time periods (p < 0.02). There was found to be no significant difference in the number of ePVS between the mTBI participants who were identified as being good or bad quality sleepers under the PSQI (p = 0.27).  Overall, the greater ePVS burden observed in mTBI participants suggests acute disruption to the brain’s waste clearance system following a mTBI.

Author: 
Pedro Martinez Jr.
School: 
Wartburg College
Department: 
Neuroscience
Research Advisor: 
Dr. Mark Whiting
Department of Research Advisor: 
Clinical Sciences
Year of Publication: 
2022