Traumatic Brain Injury A Roadmap for Accelerating Progress (2022) / Chapter Skim
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Appendix B: Biomarker Development for Diagnosis, Prognosis, and Monitoring of Traumatic Brain Injury
Appendix B: Biomarker Development for Diagnosis, Prognosis, and Monitoring of Traumatic Brain Injury
Pages 193-208
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From page 193... ...
. In patients with more severe injuries, head CT is preferable in characterizing the type and extent of specific TBI pathologies (e.g., diffuse axonal injury)
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. Change in cerebral blood flow following a vasoactive stimulus is defined as cerebrovascular reactivity and can be measured by imaging techniques including CT, MRI, positron emission tomography (PET)
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-based fMRI sequences are employed, and involve interpretations of neurological activity related to the oxygenation state of blood and hemodynamic response to the activity-related metabolic task. These sequences have been used to identify regions of brain activation that occur under both task-oriented and restingstate conditions that relate to brain injury, and possible symptoms and deficits related to the injury.
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test for predicting traumatic intracranial injuries on head CT scan acutely after TBI, and distinguishing CT-positive, more severely injured from CT-negative, mild TBI patients (Anderson et al., 2020)
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. Recent studies of plasma tau in acute sports concussion collected within the first 6–24 hours after injury suggest that higher levels of tau may be prognostic biomarkers of prolonged recovery (Pattinson et al., 2020)
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Finally, researchers recently combined transcranial magnetic stimulation (TMS) with EEG to study connectivity changes post-TBI, which may offer a promising avenue for investigating the neural substrates of connectivity dysfunction and reorganization after mild TBI (Coyle et al., 2018)
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. In a recent study, MEG demonstrated sensitivity in detection of changes in individuals with sub-acute/chronic mild TBI (identifying abnormal brain activity in 87 percent of mild TBI patients in delta wave [1–4 Hz]
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Biomarkers can also be used to monitor and assess treatment effectiveness by narrowly determining target engagement or broadly tracking progressive atrophy and neurodegeneration, reflecting brain cell injury or death. Biomarkers reflecting functional compromise and reversible injury would be powerful tools for monitoring patient status and injury severity in the acute and sub-acute periods, especially after mild TBI, when objective indicators of injury are lacking (e.g., absence of focal lesions)
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. The concept of metabolic vulnerability is broadly accepted as an important mechanism of TBI progression and is a contributor to exacerbated symptoms after repeated mild TBI (Greco et al., 2019)
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. Neurophysiological Biomarkers to Monitor TBI Clinicians usually use EEG in the acute stage to monitor seizures in TBI patients but have also used this tool to detect changes in mild TBI over time (months to years)
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2021. A critical review of radiotracers in the positron emission tomography imaging of traumatic brain injury: FDG, tau, and amyloid imaging in mild traumatic brain injury and chronic traumatic encephalopathy. European Journal of Nuclear Medicine and Molecular Imaging 48(2)
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2017. Update in mild traumatic brain injury.
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2015. Using transcranial magnetic stimulation to quantify electrophysi ological changes following concussive brain injury: a systematic review.
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2020. Point-of-care platform blood biomarker testing of glial fibrillary acidic protein versus S100 calcium-binding protein B for prediction of traumatic brain injuries: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study. Journal of Neurotrauma 37(23)
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2017. Abnormal injury response in spontaneous mild ventriculomegaly wistar rat brains: A pathological correlation study of diffusion tensor and magnetization transfer imaging in mild traumatic brain injury. Journal of Neurotrauma 34(1)
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2020a. Statistical cerebrovascular reactivity signal properties after secondary decompressive craniectomy in traumatic brain injury: A CENTER-TBI pilot analysis. Journal of Neurotrauma 37(11)
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