1. Male patients with mild traumatic brain injury demonstrated increased white matter abnormalities in the uncinate fasciculus compared to female-matched controls in brain MRI scans.
2. Uncinate fasciculus (UF) abnormalities detected by MRI was an independent risk factor for persistent post-concussion syndromes.
Evidence Rating Level: 3 (Fair)
Study Rundown: The effect of gender on outcomes in mild traumatic brain injury (mTBI) is currently unclear; previous controlled and observational studies have demonstrated conflicting results. The authors of this paper analyzed the changes in brain white matter integrity as an objective measure to analyze sex differences in mTBI outcomes. The MRI scans of male patients with mTBI demonstrated significantly decreased uncinate fasciculus (UF) white matter integrity compared to female patients with mTBI and male controls. Additionally, UF integrity was associated with increased time to concussion symptom resolution (TSR). Multi-variate analysis demonstrated that gender and UF integrity (2.38, p<0.001) and gender (OR: 2.27, p=0.04) are independently correlated with persistent post-concussion syndrome. The limitations of the study are the small sample size and the heterogeneous nature of the traumatic brain injuries and further investigation is warranted.
In-Depth [retrospective cohort]: This study analyzed MRI brain scans to determine gender differences in white matter integrity of patients with mTBI and its effect on clinical outcomes. Using a retrospective design, the MRI of 69 mTBI patients (22 female, 47 male) were compared with 21 control patients (11 female, 10 male) and correlated with time to concussion symptom resolution (TSR). The uncinate fasciculus (UF) is a bidirectional white matter tract that has been previous associated with memory performance in both normal and mTBI subjects, which supports the potential use of this MRI biomarker in stratifying outcomes in mTBI. Brain MRI images with diffusion-tensor imaging were analyzed for fractional anisotropy (FA) values of white matter. There was a statistically significant decrease in FA in the UF in male patients with mTBI compared to female mTBI patients (p<0.05) and male/female controls (p<0.05). Multivariate analysis demonstrated significant correlation for male gender with increase time to symptom resolution (p<0.04) and a significant negative correlation of UF fractional anisotropy with TSR for both genders (r= -0.583, p<0.001).
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