Virginia Research Day 2022

Medical Student Research Cl inical

06 Delay In Clearance Of Labeled Protons In Patients With Acute Head Trauma Utilizing MRI 3D TGSE PASL (Arterial Spin Labeling) Is Consistent With The Clearance Results Shown In Patient With Alzheimer’s Disease

Bless Jung; Jubin Kang; Stephan Kim; Bryce Grohol; Marija Zivcevska; Dr. Charles Joseph Corresponding author: mzivcevska@liberty.edu

Liberty University College of Osteopathic Medicine

Introduction: Concussive-brain injury is thought to accompany neuroinflammation with the disruption of the blood brain barrier (BBB). Gliosis may occur subsequently, and the neuroglia may impair the clearance of cerebral spinal fluid. Currently, concussion is largely a clinical diagnosis that utilizes subjective questionnaires as supplemental aids; however, 3D TGSE MRI PASL may serve as an objective way to assess brain health by measuring changes in glymphatic clearance. The aim of this study is twofold: 1) to use glymphatic flow as a tool to measure change in brain function following head injury and 2) to assess whether normal glymphatic flow returns once individuals are cleared to return to normal activities. Methods: 3D TGSE PASL MRI with long T1s was used to assess the clearance of ultra- filtered labeled protons 2800-4000 ms post- perfusion in frontal, temporal and parietal regions bilaterally following acute traumatic

brain injury at 3 different visits. The Sport concussion assessment tool version 5 (SKAT5) and Brief oculomotor/vestibular Assessment (VOMS) were used as cognitive adjuncts to MRI protocol. Subjects fulfilled the clinical diagnostic criteria for mild traumatic injury. Results: Comparing one concussive subject to two activity-matched controls, frontal and bilateral regions had reduced glymphatic clearance bilaterally. Although preliminary statistical significance is too early to assess between subjects at this point, the reduction in clearance among post-concussion groups presents a strong trend that will be explored further. Discussion: Acute head trauma can disrupt the paravascular system, damage the blood brain barrier, and in turn reduce glymphatic flow, allowing potentially damaging restricted substances to remain in the neuropil. We

observed reduced signal clearance of signal decay in our concussive head trauma subject compared to our controls. This raises the question of what healing time is needed after acute head trauma. Moreover, these acute brain injury changes are similar to our pilot study in patients with Alzheimer’s disease. This technique may provide insightful physiologic data as to the recovery time following acute head injury.

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