Mild traumatic brain injury (m-TBI) is a public health problem, particularly in veterans and athletes. Often synonymous with “concussion,” m-TBI is head injury accompanied by acute-phase characteristics, such as alteration of consciousness. m-TBI can lead to chronic neuropsychological symptoms, known as postconcussive syndrome (PCS), and has been linked to chronic traumatic encephalopathy, a progressive neurodegenerative disorder.
Managing patients with m-TBI is challenging because of the difficulty in predicting outcomes. Furthermore, it is challenging to distinguish between the effects of m-TBI and the psychiatric conditions which frequently coexist.
Advanced neuroimaging can identify structural brain damage related to m-TBI which is not detectable with conventional brain magnetic resonance imaging. The most promising techniques are diffusion-based, such as diffusion tensor imaging (DTI), which detects changes in the diffusion properties of the white matter that reflect microstructural injury.
There are significant differences in scalar diffusion metrics in patients with m-TBI compared with controls , and these differences correlate with axonal damage in animal models of m-TBI . Diffusion measurements correlate with symptoms, objective measures of neurocognitive function, and outcomes. The research, thus far, induces hope that diffusion imaging techniques will identify individuals with structural brain injury and complement clinical decision making. Although the need for further standardization and refinement of these techniques before clinical implementation in m-TBI is recognized , it is timely to speculate on their potential impact in the real world.
The detection of disease at an earlier state, when more amenable to intervention, risks identifying disease which does not truly exist or will not impact the patient. This is known as overdiagnosis, which is widely recognized in screening for cancer, but also in nonneoplastic medical conditions.
Neuropsychiatric disorders, such as m-TBI, are particularly prone to overdiagnosis because the diagnostic criteria are often subjective and imprecise. The implications of falsely labeling individuals as having m-TBI or worse permanent “brain damage” have been recognized as problematic in this field .
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References
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