Research Article

Effects of chronic mild traumatic brain injury on white matter integrity in Iraq and Afghanistan war veterans

  1. Rajendra A. Morey1,2,3,*,
  2. Courtney C. Haswell1,3,
  3. Elizabeth S. Selgrade1,3,
  4. Dino Massoglia4,
  5. Chunlei Liu1,
  6. Jonathan Weiner3,
  7. Christine E. Marx2,3,
  8. Ibolja Cernak5,
  9. Gregory McCarthy3,6,
  10. MIRECC Work Group †

Article first published online: 15 JUN 2012

DOI: 10.1002/hbm.22117

Additional Information

How to Cite

Morey, R. A., Haswell, C. C., Selgrade, E. S., Massoglia, D., Liu, C., Weiner, J., Marx, C. E., Cernak, I., McCarthy, G. and MIRECC Work Group (2012), Effects of chronic mild traumatic brain injury on white matter integrity in Iraq and Afghanistan war veterans. Hum. Brain Mapp.. doi: 10.1002/hbm.22117

Author Information

  1. 1

    Duke-UNC Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina

  2. 2

    Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina

  3. 3

    Mental Illness Research Education and Clinical Center for Post Deployment Mental Health, Durham VA Medical Center, Durham, North Carolina

  4. 4

    Division of Neuroradiology, Duke University Medical Center, Durham, North Carolina

  5. 5

    National Security Technology Department, John Hopkins University Applied Physics Laboratory, Laurel, Maryland

  6. 6

    Department of Psychology, Yale University, New Haven, Connecticut

  1. †

    MIRECC Work Group: Katherine H. Taber, Ph.D., Robin Hurley, M.D., Jasmeet Pannu Hayes, Ph.D., Jessica D. Nasser, Shristi Seth, Shannon K. Beall, Jean C. Beckham, Ph.D., Larry A. Tupler, Ph.D., Richard Weiner,M.D., Ph.D., John Fairbank, Patrick S. Calhoun, Kimberly T. Green., Mira Brancu, Ph.D., Jeffrey M. Hoerle, M.S., Mary Pender, Ph.D., Jennifer L. Strauss, Ph.D., Harold Kudler, M.D., Angela M. Eggleston, Ph.D., Vito S. Guerra, Ph.D., Victoria Payne, M.D., Scott D. McDonald, Ph.D., ElizabethVanVoorhees, Ph.D., Rita Davison, B.A.

*Durham VA Medical Center, 508 Fulton Street, Bldg #5, Durham, NC 27705

  1. †

    MIRECC Work Group: Katherine H. Taber, Ph.D., Robin Hurley, M.D., Jasmeet Pannu Hayes, Ph.D., Jessica D. Nasser, Shristi Seth, Shannon K. Beall, Jean C. Beckham, Ph.D., Larry A. Tupler, Ph.D., Richard Weiner,M.D., Ph.D., John Fairbank, Patrick S. Calhoun, Kimberly T. Green., Mira Brancu, Ph.D., Jeffrey M. Hoerle, M.S., Mary Pender, Ph.D., Jennifer L. Strauss, Ph.D., Harold Kudler, M.D., Angela M. Eggleston, Ph.D., Vito S. Guerra, Ph.D., Victoria Payne, M.D., Scott D. McDonald, Ph.D., ElizabethVanVoorhees, Ph.D., Rita Davison, B.A.

Publication History

  1. Article first published online: 15 JUN 2012
  2. Manuscript Accepted: 9 APR 2012
  3. Manuscript Revised: 6 MAR 2012
  4. Manuscript Received: 2 DEC 2011

Funded by

  • National Institutes of Health. Grant Number: K23 MH073091
  • Department of Veterans Affairs, Mental Illness Research Education and Clinical Center Grant for Post-Deployment Mental Health
  • Department of Veterans Health Affairs, from Rehabilitation Research and Development (RR&D). Grant Number: RX000389-01

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Keywords:

  • mild traumatic brain injury;
  • high angular resolution diffusion imaging;
  • white matter;
  • crossing fibers;
  • posttraumatic stress disorder

Abstract

Mild traumatic brain injury (TBI) is a common source of morbidity from the wars in Iraq and Afghanistan. With no overt lesions on structural MRI, diagnosis of chronic mild TBI in military veterans relies on obtaining an accurate history and assessment of behavioral symptoms that are also associated with frequent comorbid disorders, particularly posttraumatic stress disorder (PTSD) and depression. Military veterans from Iraq and Afghanistan with mild TBI (n = 30) with comorbid PTSD and depression and non-TBI participants from primary (n = 42) and confirmatory (n = 28) control groups were assessed with high angular resolution diffusion imaging (HARDI). White matter-specific registration followed by whole-brain voxelwise analysis of crossing fibers provided separate partial volume fractions reflecting the integrity of primary fibers and secondary (crossing) fibers. Loss of white matter integrity in primary fibers (P < 0.05; corrected) was associated with chronic mild TBI in a widely distributed pattern of major fiber bundles and smaller peripheral tracts including the corpus callosum (genu, body, and splenium), forceps minor, forceps major, superior and posterior corona radiata, internal capsule, superior longitudinal fasciculus, and others. Distributed loss of white matter integrity correlated with duration of loss of consciousness and most notably with “feeling dazed or confused,” but not diagnosis of PTSD or depressive symptoms. This widespread spatial extent of white matter damage has typically been reported in moderate to severe TBI. The diffuse loss of white matter integrity appears consistent with systemic mechanisms of damage shared by blast- and impact-related mild TBI that involves a cascade of inflammatory and neurochemical events. Hum Brain Mapp , 2012. © 2012 Wiley Periodicals, Inc.

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