Brain scans predict post-traumatic stress disorder after mild TBI

Post-traumatic stress disorder (PTSD) is a complex psychiatric disorder caused by physical and / or psychological trauma. The way its symptoms, including anxiety, depression, and cognitive impairment arise, remains incompletely understood and unpredictable. Treatments and outcomes could be improved if doctors could better predict who would develop PTSD. Now, researchers using magnetic resonance imaging (MRI) have discovered potential brain biomarkers of PTSD in people with head trauma (TBI).

The study appears in Biological psychiatry: cognitive neuroscience and neuroimaging, published by Elsevier.

The relationship between TBI and PTSD has gained increased attention in recent years, as studies have shown a considerable overlap in risk factors and symptoms. In this study, we were able to use data from TRACK-TBI, a large longitudinal study of patients who present to the emergency room with TBI severe enough to warrant computed tomography (CT) scans.

Murray Stein, MD, MPH, FRCPC, Senior Author, Emeritus Professor of Psychiatry and Family Medicine and Public Health, University of California at San Diego, San Diego, La Jolla, California, USA

Researchers followed more than 400 of these TBI patients, evaluating them for PTSD 3 and 6 months after their brain injury. At 3 months, 77 participants, or 18 percent, probably had PTSD; at 6 months, 70 participants or 16 percent had done so. All subjects underwent brain imaging after injury.

“MRI studies conducted within two weeks of injury were used to measure the volumes of key structures in the brain believed to be involved in PTSD,” said Dr. Stein. “We found that the volume of several of these structures was predictive of PTSD 3 months after injury.”

Specifically, a smaller volume in regions of the brain called the cingulate cortex, superior frontal cortex, and insula predicted PTSD at 3 months. Regions are associated with arousal, attention, and emotional regulation. Structural imaging did not predict PTSD at 6 months.

The results are in line with previous studies showing a smaller volume in several of these brain regions in people with PTSD and studies suggesting that the reduced cortical volume may be a risk factor for developing PTSD. Taken together, the results suggest that a “brain reserve”, or higher cortical volumes, may provide some resilience against PTSD.

Although the brain volume difference biomarker is not yet robust enough to provide clinical advice, Dr Stein said, “It paves the way for future studies to examine even more carefully how these brain regions may contribute to ( or protect against) health problems such as PTSD. “

Cameron Carter, MD, editor of Biological psychiatry: cognitive neuroscience and neuroimaging, said of the work, “This very important study uses magnetic resonance imaging to take the field one step further to understand why some people develop PTSD after trauma and others don’t. bases for future research to use brain imaging to help predict that a person is at increased risk and may benefit from targeted interventions to reduce the clinical impact of a traumatic event. “