Impact of mild traumatic brain injury on cingulate functions

Handb Clin Neurol. 2019;166:151-162. doi: 10.1016/B978-0-444-64196-0.00010-8.

Abstract

Mild traumatic brain injury (mTBI) is a condition of normal neuroimaging, because conventional MRI is not sensitive to brain lesions. Neurocognitive deficits persist for years after injury in 15% of patients. Persistent TAI can continue after the trauma and contribute to progressive disability. Neuropathologic studies underestimate the total axonal damage, by failure to identify fine-caliber unmyelinated fiber. Swollen axons represent the "tip of the iceberg" of damage. Progression of molecular changes, including mitochondrial dysfunction, leads to secondary injuries. Primary low-intensity "invisible injury" is solely detectable at ultrastructural levels. Over the long term, mTBI is not a static event but a progressive injury, increasing risk of neurodegenerative diseases. Lack of evidence of brain injury has led to the development of more sensitive methods: morphometric MRI (VBM, DTI) and functional techniques (fMRI, PET, SPECT). By deformation of the surface of gray matter cingulate gyrus and disruption of long-coursing WM of CB structures, striking the falx, mTBI causes alteration of cingulate functions. Postconcussion, blast, and whiplash-associated disorders are the main mechanisms providing behavior and cognitive symptoms after mTBI.

Keywords: Blast; Cingulate gyrus; Cingulum bundle; Concussion; Mild traumatic brain injury; Traumatic axonal injury; Whiplash-associated disorder.

Publication types

  • Review

MeSH terms

  • Brain Concussion / complications
  • Brain Concussion / physiopathology*
  • Gyrus Cinguli / injuries*
  • Gyrus Cinguli / physiopathology*
  • Humans
  • Post-Concussion Syndrome / etiology
  • Post-Concussion Syndrome / physiopathology