A Preliminary Study On The Relationship Between Post-traumatic Headache And Cerebral Blood Flow Alterations Attributed To Mild Traumatic Brain Injury

Objectives:The changes of cerebral blood flow(CBF)in post-traumatic headache(PTH)patients were measured by 3-dimensional arterial spin labeling(3D ASL),and to explore the clinical application value of 3D ASL to PTH attributed to mTBI.Methods:A total of 50 subjects were collected,including 30 PTH patients group(PTHG)and 20 healthy control group(HCG)matched with age,gender,and education level.Routine MRI and 3D ASL were performed during the acute stage of the injury(<7 days),headache attack,or the same day of the attack.HCG was performed by routine MRI and 3D ASL with the same equipment and parameters.The severity of PTHG headache was followed up 15 days and 2 months after injury.Results:Among the 30 patients with PTH,the average regional cerebral blood flow(rCBF)in the central area of abnormal perfusion(the region of interest,ROI)(34.62±13 ml/(100 g·min))was significantly lower than that the mean cerebral blood flow in the contralateral mirror area(48.95±90 ml/(100 g·min))in 18(60%)patients.CBF changes were mainly concentrated in dorsolateral frontal lobe(3,10.0%),ventromedial frontal lobe(3,10.0%),temporal lobe(2,6.7%),occipital lobe(2,6.7%),insular lobe(1,3.3%),hypothalamus(1,3.3%),middle cingulate gyrus(1,3.3%),superior marginal gyrus(1,3.3%),upper parietal lobe(1,3.3%),lingual gyrus(1,3.3%),anterior central area(1,3.3%)and amygdala(1,3.3%).CBF was normal in 12(40%)PTH patients.Mild,moderate,and severe headache in 30 PTH patients were 23 cases,6 cases,and 1 case,respectively,accounting for 76.7%,20.0%,and 3.3%of the total mTBI.Among the 18 PTH patients with r-CBF hypoperfusion,17 patients had mild,1 moderate,and 0 severe headaches,accounting for 56.7%,3.3%,and 0.0%of the total mTBI,respectively.Among the 12 patients without abnormal r-CBF perfusion,6 patients had a mild headache,5 patients had a moderate headache and 1 patient had a severe headache,accounting for 20.0%,16.7%,and 3.3%of the total mTBI,respectively.HCG 3d-ASL showed that cerebral blood flow perfusion was uniform and symmetrical,and no abnormal CBF perfusion area was found.There was no significant difference in mean cerebral blood flow between PTHG and HCG(P=0.56).Conclusion:The brain blood flow in specific brain areas of PTH patients associated with mTBI was decreased,and the majority of patients with mild headache were found.This finding may provide useful clues for the prediction and mechanism of PTH.