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Traumatic brain injury: neuropathological, neurocognitive and neurobehavioral sequelae

  • Dragan Pavlovic
  • Sandra Pekic
  • Marko Stojanovic
  • Vera PopovicEmail author
Article
  • 220 Downloads

Abstract

Traumatic brain injury (TBI) causes substantial neurological disabilities and mental distress. Annual TBI incidence is in magnitude of millions, making it a global health challenge. Categorization of TBI into severe, moderate and mild by scores on the Glasgow coma scale (GCS) is based on clinical grounds and standard brain imaging (CT). Recent research focused on repeated mild TBI (sport and non-sport concussions) suggests that a considerable number of patients have long-term disabling neurocognitive and neurobehavioral sequelae. These relate to subtle neuronal injury (diffuse axonal injury) visible only by using advanced neuroimaging distinguishing microstructural tissue damage. With advanced MRI protocols better characterization of TBI is achievable. Diffusion tensor imaging (DTI) visualizes white matter pathology, susceptibility weight imaging (SWI) detects microscopic bleeding while functional magnetic resonance imaging (fMRI) provides closer understanding of cognitive disorders etc. However, advanced imaging is still not integrated in the clinical care of patients with TBI. Patients with chronic TBI may experience many somatic disorders, cognitive disturbances and mental complaints. The underlying pathophysiological mechanisms occurring in TBI are complex, brain injuries are highly heterogeneous and include neuroendocrine dysfunctions. Post-traumatic neuroendocrine dysfunctions received attention since the year 2000. Occurrence of TBI-related hypopituitarism does not correlate to severity of the GCS scores. Complete or partial hypopituitarism (isolated growth hormone (GH) deficiency as most frequent) may occur after mild TBI equally as after moderate-to-severe TBI. Many symptoms of hypopituitarism overlap with symptoms occurring in patients with chronic TBI, i.e. they have lower scores on neuropsychological examinations (cognitive disability) and have more symptoms of mental distress (depression and fatigue). The great challenges for the endocrinologist are: (1) detection of hypopituitarism in patients with TBI prospectively (in the acute phase and months to years after TBI), (2) assessment of the extent of cognitive impairment at baseline, and (3) monitoring of treatment effects (alteration of cognitive functioning and mental distress with hormone replacement therapy). Only few studies recently suggest that with growth hormone (rhGH) replacement in patients with chronic TBI and with abnormal GH secretion, cognitive performance may not change while symptoms related to depression and fatigue improve. Stagnation in post-TBI rehabilitation progress is recommended as a signal for clinical suspicion of neuroendocrine dysfunction. This remains a challenging area for more research.

Keywords

Traumatic brain injury Mild TBI Neuropathology Cognitive deficits Behavioral dysfunction 

Notes

Author contributions

DP, SP, MS and VP reviewed the literature and wrote the manuscript.

Funding

This study was supported by a grant from the Ministry of Science of Republic of Serbia (Project 175033).

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Dragan Pavlovic
    • 1
  • Sandra Pekic
    • 2
    • 3
  • Marko Stojanovic
    • 2
    • 3
  • Vera Popovic
    • 3
    Email author
  1. 1.Faculty for Special Education and RehabilitationUniversity of BelgradeBelgradeSerbia
  2. 2.Neuroendocrinology Department, Clinic for Endocrinology, Diabetes and Metabolic DiseasesClinical Centre of SerbiaBelgradeSerbia
  3. 3.Medical FacultyUniversity of BelgradeBelgradeSerbia

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