Hostname: page-component-6bf8c574d5-qdpjg Total loading time: 0 Render date: 2025-02-20T05:44:45.218Z Has data issue: false hasContentIssue false
  • English
  • Français

Altered Brain Activation in Military Personnel with One or More Traumatic Brain Injuries Following Blast

Published online by Cambridge University Press:  02 December 2011

Randall S. Scheibel ,
Mary R. Newsome ,
Maya Troyanskaya ,
Xiaodi Lin ,
Joel L. Steinberg ,
Majdi Radaideh  and
Harvey S. Levin
Randall S. Scheibel*
Affiliation:
Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
Mary R. Newsome
Affiliation:
Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
Maya Troyanskaya
Affiliation:
Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
Xiaodi Lin
Affiliation:
Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
Joel L. Steinberg
Affiliation:
Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, Texas
Majdi Radaideh
Affiliation:
Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Department of Radiology, Baylor College of Medicine, Houston, Texas
Harvey S. Levin
Affiliation:
Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
*
Correspondence and reprint requests to: Randall S. Scheibel, Cognitive Neuroscience Laboratory, Baylor College of Medicine, 1709 Dryden Road, Suite 1200, Houston, TX 77030. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Explosive blast is a frequent cause of traumatic brain injury (TBI) among personnel deployed to Afghanistan and Iraq. Functional magnetic resonance imaging (fMRI) with an event-related stimulus-response compatibility task was used to compare 15 subjects with mild, chronic blast-related TBI with 15 subjects who had not experienced a TBI or blast exposure during deployment. Six TBI subjects reported multiple injuries. Relative to the control group, TBI subjects had slightly slower responses during fMRI and increased somatic complaints and symptoms of post-traumatic stress disorder (PTSD) and depression. A between-group analysis indicated greater activation during stimulus-response incompatibility in TBI subjects within the anterior cingulate gyrus, medial frontal cortex, and posterior cerebral areas involved in visual and visual-spatial functions. This activation pattern was more extensive after statistically controlling for reaction time and symptoms of PTSD and depression. There was also a negative relationship between symptoms of PTSD and activation within posterior brain regions. These results provide evidence for increased task-related activation following mild, blast-related TBI and additional changes associated with emotional symptoms. Limitations of this study include no matching for combat exposure and different recruitment strategies so that the control group was largely a community-based sample, while many TBI subjects were seeking services. (JINS, 2012, 18, 89–100)

Keywords

Brain concussionBrain mappingExecutive functionfMRIPost-concussion syndromePTSD
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 18 , Issue 1 , January 2012 , pp. 89 - 100
Copyright
Copyright © The International Neuropsychological Society 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Armistead-Jehle, P. (2010). Symptom validity test performance in U.S. veterans referred for evaluation of mild TBI. Applied Neuropsychology, 17, 52–59.CrossRefGoogle ScholarPubMed
Barona, A., Reynolds, C.R., Chastain, R. (1984). A demographically based index of premorbid intelligence for the WAIS-R. Journal of Consulting and Clinical Psychology, 52, 885–887.CrossRefGoogle Scholar
Belanger, H.G., Kretzmer, T., Yoash-Gantz, R., Pickett, T., Tupler, L.A. (2009). Cognitive sequelae of blast-related versus other mechanisms of brain injury. Journal of the International Neuropsychological Society, 15, 1–8.CrossRefGoogle Scholar
Bhattacharjee, Y. (2008). Shell shock revisited: Solving the puzzle of blast trauma. Science, 319, 406–408.CrossRefGoogle ScholarPubMed
Binder, L.M., Rohling, M.L., Larrabee, G.J. (1997). A review of mild head trauma, Part I: Meta-analytic review of neuropsychological studies. Journal of Clinical and Experimental Neuropsychology, 19, 421–431.CrossRefGoogle ScholarPubMed
Blake, D.D., Weathers, F.W., Nagy, L.M., Kaloupek, D.G., Gusman, F.D., Charney, D.S., Keane, T.M. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8, 75–90.Google ScholarPubMed
Brenner, L.A., Vanderploeg, R.D., Terrio, H. (2009). Assessment and diagnosis of mild traumatic brain injury, posttraumatic stress disorder, and other polytrauma conditions: Burden of adversity hypothesis. Rehabilitation Psychology, 54, 239–246.CrossRefGoogle ScholarPubMed
Bryant, R.A. (2008). Disentangling mild traumatic brain injury and stress reactions. The New England Journal of Medicine, 358, 525–527.CrossRefGoogle ScholarPubMed
Cernak, I. (2005). Penetrating and blast injury. Restorative Neurology and Neuroscience, 23, 139–143.Google Scholar
Cernak, I., Noble-Haeusslein, L.J. (2010). Traumatic brain injury: An overview of pathobiology with emphasis on military populations. Journal of Cerebral Blood Flow and Metabolism, 30, 255–266.CrossRefGoogle ScholarPubMed
Chen, J.K., Johnson, K.M., Collie, A., McCrory, P., Ptito, A. (2007). A validation of the post concussion symptom scale in the assessment of complex concussion using cognitive testing and functional MRI. Journal of Neurology, Neurosurgery, and Psychiatry, 78, 1231–1238.CrossRefGoogle ScholarPubMed
Chen, J.K., Johnson, K.M., Petrides, M., Ptito, A. (2008a). Recovery from mild head injury in sports: Evidence from serial functional magnetic resonance imaging studies in male athletes. Clinical Journal of Sport Medicine, 18, 241–247.CrossRefGoogle ScholarPubMed
Chen, J.K., Johnson, K.M., Petrides, M., Ptito, A. (2008b). Neural substrates of symptoms of depression following concussion in male athletes with persisting postconcussive symptoms. Archives of General Psychiatry, 65, 81–89.CrossRefGoogle Scholar
Christodoulou, C., DeLuca, J., Ricker, J.H., Madigan, N.K., Bly, B.M., Lange, G. Ni, A.C. (2001). Functional magnetic resonance imaging of working memory impairment after traumatic brain injury. Journal of Neurology, Neurosurgery, and Psychiatry, 71, 161–168.CrossRefGoogle ScholarPubMed
Cicerone, K.D., Kalmar, K. (1995). Persistent postconcussion syndrome: The structure of subjective complaints after mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 10, 1–17.CrossRefGoogle Scholar
Cicerone, K., Levin, H., Malec, J., Stuss, D., Whyte, J. (2006). Cognitive rehabilitation interventions for executive function: Moving from bench to bedside in patients with traumatic brain injury. Journal of Cognitive Neuroscience, 18, 1212–1222.CrossRefGoogle ScholarPubMed
Courtney, A.C., Courtney, M.W. (2009). A thoracic mechanism of mild traumatic brain injury due to blast pressure waves. Medical Hypotheses, 72, 76–83.CrossRefGoogle ScholarPubMed
Derogatis, L.R. (1975). Brief symptom inventory. Baltimore: Clinical Psychometric Research.Google Scholar
Dobie, D.J., Kivlahan, D.R., Maynard, C., Bush, K.R., McFall, M.E., Epler, A.J., Bradley, K.A. (2002). Screening for post-traumatic stress disorder in female Veteran's Affairs patients: Validation of the PTSD Checklist. General Hospital Psychiatry, 24, 367–374.CrossRefGoogle ScholarPubMed
Fear, N.T., Jones, E., Groom, M., Greenberg, N., Hull, L., Hodgetts, T.J., Wesseley, S. (2009). Symptoms of post-concussive syndrome are non-specifically related to mild traumatic brain injury in UK armed forces personnel on return from deployment in Iraq: An analysis of self-reported data. Psychological Medicine, 39, 1379–1387.CrossRefGoogle ScholarPubMed
Finkel, M.F. (2006). The neurological consequences of explosives. Journal of the Neurological Sciences, 249, 63–67.CrossRefGoogle ScholarPubMed
French, L.M., Parkinson, G.W. (2008). Assessing and treating veterans with traumatic brain injury. Journal of Clinical Psychology, 64, 1004–1013.CrossRefGoogle ScholarPubMed
Galati, G., Pelle, G., Berthoz, A., Committeri, G. (2010). Multiple reference frames used by the human brain for spatial perception and memory. Experimental Brain Research, 20, 109–120.CrossRefGoogle Scholar
Hoge, C.W., McGurk, D., Thomas, J.L., Cox, A.L., Engel, C.C., Castro, C.A. (2008). Mild traumatic brain injury in U.S. soldiers returning from Iraq. The New England Journal of Medicine, 358, 453–463.CrossRefGoogle ScholarPubMed
Huang, M.X., Theilmann, R.J., Robb, A., Angeles, A., Nichols, S., Drake, A. Lee, R.R. (2009). Integrated imaging approach with MEG and DTI to detect mild traumatic brain injury in military and civilian patients. Journal of Neurotrauma, 26, 1213–1226.CrossRefGoogle ScholarPubMed
Jantzen, K.J., Anderson, B., Steinberg, F.L., Kelso, J.A. (2004). A prospective functional MR imaging study of mild traumatic brain injury in college football players. AJNR American Journal of Neuroradiology, 25, 738–745.Google ScholarPubMed
Jorge, R.E., Robinson, R.G., Moser, D., Tateno, A., Crespo-Facorro, B., Arndt, S. (2004). Major depression following traumatic brain injury. Archives of General Psychiatry, 61, 42–50.CrossRefGoogle ScholarPubMed
Kleinbaum, D.G., Kupper, L.L., Muller, K.E., Nizam, A. (1998). Applied regression analysis and other multivariate methods. Pacific Grove, CA: Brooks/Cole Publishing Company.Google Scholar
Levin, H.S., Wilde, E.A., Troyanskaya, M., Petersen, N.J., Scheibel, R., Newsome, M. Li, X. (2010). Diffusion tensor imaging of mild to moderate blast-related traumatic brain injury and its sequelae. Journal of Neurotrauma, 27, 683–694.CrossRefGoogle ScholarPubMed
Ling, G., Bandak, F., Armonda, R., Grant, G., Ecklund, J. (2009). Explosive blast neurotrauma. Journal of Neurotrauma, 26, 815–825.CrossRefGoogle ScholarPubMed
Long, J.B., Bentley, T.L., Wessner, K.A., Cerone, C., Sweeney, S., Bauman, R.A. (2009). Blast overpressure in rats: Recreating a battlefield injury in the laboratory. Journal of Neurotrauma, 26, 827–840.CrossRefGoogle ScholarPubMed
MacDonald, C.L., Johnson, A.M., Cooper, D., Nelson, E.C., Werner, N.J., Shimony, J.S. Brody, D.L. (2011). Detection of blast-related traumatic brain injury in U.S. military personnel. The New England Journal of Medicine, 364, 2091–2100.CrossRefGoogle Scholar
McAllister, T.W., Saykin, A.J., Flashman, L.A., Sparling, M.B., Johnson, S.C., Guerin, S.J. Yanofsky, N. (1999). Brain activation during working memory 1 month after mild traumatic brain injury: A functional MRI study. Neurology, 53, 1300–1308.CrossRefGoogle ScholarPubMed
McAllister, T.W., Sparling, M.B., Flashman, L.A., Guerin, S.J., Mamourian, A.C., Saykin, A.J. (2001). Differential working memory load effects after mild traumatic brain injury. Neuroimage, 14, 1004–1012.CrossRefGoogle ScholarPubMed
Morey, R.A., Petty, C.M., Cooper, D.A., LaBar, K.S., McCarthy, G. (2008). Neural systems for executive and emotional processing are modulated by symptoms of posttraumatic stress disorder in Iraq War veterans. Psychiatry Research, 162, 59–72.CrossRefGoogle ScholarPubMed
Orban, G.A., Van Essen, D., Vanduffel, W. (2004). Comparative mapping of higher visual areas in monkeys and humans. Trends in Cognitive Sciences, 8, 315–324.CrossRefGoogle ScholarPubMed
Owens, B.D., Kragh, J.F., Wenke, J.C., Macaitis, J., Wade, C.E., Holcomb, J.B. (2008). Combat wounds in operation Iraqi Freedom and operation Enduring Freedom. Journal of Trauma, 64, 295–299.Google ScholarPubMed
Price, C.J., Friston, K.J. (2002). Functional imaging studies of neuropsychological patients: Applications and limitations. Neurocase, 8, 345–354.CrossRefGoogle ScholarPubMed
Rabadi, M.H., Jordan, B.D. (2001). The cumulative effect of repetitive concussion in sports. Clinical Journal of Sport Medicine, 11, 194–198.CrossRefGoogle ScholarPubMed
Ricker, J.H., Hillary, F.G., DeLuca, J. (2001). Functionally activated brain imaging (O-15 PET and fMRI) in the study of learning and memory after traumatic brain injury. Journal of Head Trauma Rehabilitation, 16, 191–205.CrossRefGoogle Scholar
Scheibel, R.S., Newsome, M.R., Steinberg, J.L., Pearson, D.A., Rauch, R.A., Mao, H. Levin, H.S. (2007). Altered brain activation during cognitive control in patients with moderate to severe traumatic brain injury. Neurorehabilitation and Neural Repair, 21, 36–45.CrossRefGoogle ScholarPubMed
Scheibel, R.S., Newsome, M.R., Troyanskaya, M., Steinberg, J.L., Goldstein, F.C., Mao, H., Levin, H.S. (2009). Effects of severity of traumatic brain injury and brain reserve on cognitive-control related brain activation. Journal of Neurotrauma, 26, 1447–1461.CrossRefGoogle ScholarPubMed
Taber, K.H., Warden, D.L., Hurley, R.A. (2006). Blast-related traumatic brain injury: What is known? Journal of Neuropsychiatry and Clinical Neuroscience, 218, 141–145.CrossRefGoogle Scholar
Teasdale, G.M., Pettigrew, L.E., Wilson, J.T., Murray, G., Jennett, B. (1998). Analyzing outcome of treatment of severe head injury: A review and update on advancing the use of the Glasgow Outcome Scale. Journal of Neurotrauma, 15, 587–597.CrossRefGoogle ScholarPubMed
Warden, D. (2006). Military TBI during the Iraq and Afghanistan wars. Journal of Head Trauma Rehabilitation, 21, 398–402.CrossRefGoogle ScholarPubMed
Ware, J.E., Kosinski, M., Turner-Bowker, D.M., Gandek, B. (2004). How to score version 2 of the SF-12 Health Survey. Lincoln, RI: QualityMetric Incorporated.Google Scholar