Traumatic microbleeds persist for up to five years following traumatic brain injury despite resolution of other acute findings on MRI

ABSTRACT

Objective

The primary objective of this study was to track the incidence and progression of traumatic microbleeds (TMBs) for up to five years following traumatic brain injury (TBI).

Methods

Thirty patients with mild, moderate, or severe TBI received initial MRI within 48 h of injury and continued in a longitudinal study for up to five years. The incidence and progression of MRI findings was assessed across the five year period. In addition to TMBs, we noted the presence of other imaging findings including diffusion weighted imaging (DWI) lesions, extra-axial and intraventricular hemorrhage, hematoma, traumatic meningeal enhancement (TME), fluid-attenuated inversion recovery (FLAIR) hyperintensities, and encephalomalacia.

Results

TMBs were observed in 60% of patients at initial presentation. At one-year follow-up, TMBs were more persistent than other neuroimaging findings, with 83% remaining visible on MRI. In patients receiving serial MRI 2–5 years post-injury, acute TMBs were visible on all follow-up scans. In contrast, most other imaging markers of TBI had either resolved or evolved into ambiguous abnormalities on imaging by one year post-injury.

Conclusions

These findings suggest that TMBs may serve as a uniquely persistent indicator of TBI and reinforce the importance of acute post-injury imaging for accurate characterization of persistent imaging findings.

KEYWORDS:

• Traumatic brain injury
• microbleed
• MRI
• neuroimaging
• biomarker

Disclosure statement

This work was supported by the Department of Defense in the Center for Neuroscience and Regenerative Medicine as well as the Intramural Research Programs at the NIH Clinical Center and NINDS. The contents of this article are solely the responsibility of the authors and do not represent the official views of the Department of Defense or the Center for Neuroscience and Regenerative Medicine. No competing financial interests exist.

Additional information

Funding

This work was supported by the Center for Neuroscience and Regenerative Medicine.