Diffuse axonal injury in moderate to severe TBI patients: prognostic factors and impact on neural network integrity

Traumatic brain injury (TBI) causes different primary lesions, such as
intracranial hematomas, cortical contusions as well as diffuse axonal injury
(DAI). DAI is typically identified on T2* or SWI MRI scans and frequently
present in severe TBI patients.
The axonal injury results from the stretching and deformation of the brain
tissue caused by acceleration-deceleration forces.
DAI can be graded in 3 categories (1 to 3). Whereas stage 3 is often associated
with a poor outcome, the outcome in stage 1 and stage 2 shows conflicting
results. Furthermore, DAI abnormalities seem to have a predilection for certain
brain locations (cerebral white matter, corpus callosum and rostral brainstem).
These DAI lesions probably cause a disruption in local neural networks but the
long-term effect on cognitive functions is unclear. It is expected that a
higher number of DAI and/or DTI lesions result in more cognitive deficits.

The primary objective is to study the relationship between DAI lesions on
conventional MRI, clinical parameters and prognosis.
As secondary objective is the additive value of more advanced MR Imaging in
which white matter tracts are analysed (as measured using diffusion tensor
imaging (DTI)) to predict long term functional outcome and cognitive
dysfunction in patients with DAI.

This will be a prospective observational study in four level 1 trauma centres
(Tilburg, Groningen, The Hague and Enschede).

There is no associated risk for participating patients. The observational
character of this study allows supervising doctors to provide best care. An
MRI-scan is part of standard care in this patient group. The performing of a
DWI with Diffusion tensor Imaging processing is not part of standard care, but
will be performed at the same time as the standard MRI-scan. Therefore there is
no extra risk or burden. This extra MRI sequence will not be performed on
participants in the MCH.
The GOSE at discharge means no extra burden for the patient. The GOSE at 6
months will be conducted by a telephone interview and will take 5 minutes. The
GOSE measured at 6 months will be combined with a standard outpatient clinic
visit or the CNS Vital Signs.
The QOLIBRI is a short questionnaire, which takes 7-10 minutes to complete.
(von Steinbuechel, et al., 2012). This questionnaire can be fulfilled during an
outpatient clinic visit, online via a link sent by e-mail or can be sent by
posting.
The HADS questionnaire consist 14 questions, which takes 5-10 minutes to
complete. This questionnaire can be fulfilled during an outpatient clinic
visit, online via a link sent by e-mail or can be sent by posting.
The CNS Vital Signs (30 minutes) is a computerized set of neuropsychological
tests. The patient will have to perform the CNS Vitals in the hospital. The
IQCODE will be fulfilled by a family member or caretaker (10 minutes).
These measurements altogether have a minimal burden for the patient and his/her
caretaker. The results can have valuable conclusions for the treatment of the
individual patients and subsequently can be used in deciding to consult extra
caretakers, for example a psychologist in case of depressive symptoms or a
rehabilitation physician in case of cognitive dysfunction.