Abstract
The acute stage of moderate-severe traumatic brain injury (TBI) entails the rapid unfolding of pathophysiological processes secondary to biomechanical damage that eventually stabilize, typically leaving a combination of focal damage (visible as encephalomalacia) and more widespread lesions, both to the white matter (known as traumatic axonal injury) and to the microvasculature of the brain (Povlishock and Katz, 2005). It has long been assumed that following resolution of these acute neuropathological events, that the brain then remains stable throughout the chronic stages of injury. However, a growing body of research, much of it from the groups represented in this special topic, has revealed ongoing losses to volume and white matter integrity of the brain (Bendlin et al., 2008; Ng et al., 2008; Farbota et al., 2012a,b; Adnan et al., 2013). Findings from these longitudinal studies do not appear to reflect simply the brain's healing for example, the process of gliosis or the resolution of edema. Rather, deterioration is observed in a number of studies between two time points that are well within the chronic stages of injury (e.g., Greenberg et al., 2008; Green et al., 2014), thereby representing progressive and possibly neurodegenerative changes. With these important scientific developments in mind, the broad aims of this special topic of Frontiers in Human Neuroscience were three-fold: (i) To challenge the assumption of stability of the brain in chronic TBI and to advance a reconceptualization of moderate-severe TBI as a progressive, deteriorative disorder; (ii) to provide preliminary data on the characteristics and causes of deteriorative changes; and, (iii) to open a discussion about the clinical implications of these progressive changes observed in the chronic stages of TBI. The overarching goal of the issue is to stimulate further research into decline in the chronic stages of TBI, with a longer-term view to intervention research aimed at prevention or mitigation.
Highlights
The acute stage of moderate-severe traumatic brain injury (TBI) entails the rapid unfolding of pathophysiological processes secondary to biomechanical damage that eventually stabilize, typically leaving a combination of focal damage and more widespread lesions, both to the white matter and to the microvasculature of the brain (Povlishock and Katz, 2005)
With these important scientific developments in mind, the broad aims of this special topic of Frontiers in Human Neuroscience were three-fold: (i) To challenge the assumption of stability of the brain in chronic TBI and to advance a reconceptualization of moderate-severe TBI as a progressive, deteriorative disorder; (ii) to provide preliminary data on the characteristics and causes of deteriorative changes; and, (iii) to open a discussion about the clinical implications of these progressive changes observed in the chronic stages of TBI
The special topic focuses on research in patients with moderate-severe TBI, illustrating progressive losses to both white matter (Farbota et al, 2012a; Green et al, 2014) and gray matter (Green et al, 2014)
Summary
The acute stage of moderate-severe traumatic brain injury (TBI) entails the rapid unfolding of pathophysiological processes secondary to biomechanical damage that eventually stabilize, typically leaving a combination of focal damage (visible as encephalomalacia) and more widespread lesions, both to the white matter (known as traumatic axonal injury) and to the microvasculature of the brain (Povlishock and Katz, 2005). Deterioration is observed in a number of studies between two time points that are well within the chronic stages of injury (e.g., Greenberg et al, 2008; Green et al, 2014), thereby representing progressive and possibly neurodegenerative changes.
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