{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:50:51Z","timestamp":1787028651488,"version":"build-2736575974"},"reference-count":94,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T00:00:00Z","timestamp":1724976000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"HCA Healthcare and\/or an HCA Healthcare affiliated entity"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Persistent symptoms have been reported in up to 50% of the 27 million people with mild traumatic brain injuries (mTBI) every year. MRI findings are currently limited by low diagnostic and prognostic sensitivities, constraining the value of imaging in the stratification of patients following mTBI. Limbic system structures are promising brain regions in offering prognostic factors for symptom persistence following mTBI. The objective of this study was to associate volume and symmetry of limbic system structures with the presence and persistence of common symptoms in patients with mTBI. Methods: This study focused on 524 adults (aged 18\u201382), 58% female, with 82% injured in motor vehicle accidents and 28% reporting loss of consciousness (LOC). Magnetic resonance imaging (MRI) data included a sagittal 3D T1-weighted sequence with 1.2 mm slice thickness, with voxel sizes of 0.93 mm \u00d7 0.93 mm \u00d7 1.2 mm, obtained a median of 156 days after injury. Symptom diagnosis and persistence were collected retrospectively from patient medical records. Intracranial volume-adjusted regional volumes per side utilizing automated volumetric analysis (NeuroQuant\u00ae) were used to calculate total volume, laterality index, and side-independent asymmetry. Covariates included age, sex, LOC, and days from injury. Limbic volumetrics did not relate to symptom presentation, except the (-) association between headache presence and thalamus volume (adjusted odds ratio = 0.51, 95% confidence interval = 0.32, 0.85). Headache, balance problems, anxiety, and depression persistence was (-) associated with thalamus volume (hazard ratio (HR) 1.25 to 1.94). Longer persistence of balance problems was associated with (-) lateral orbitofrontal cortex volume (HR = 1.33) and (+) asymmetry of the hippocampus (HR = 0.27). Persistence of cognitive deficits was associated with (+) asymmetry in the caudal anterior cingulate (HR = 0.67). Depression persistence was associated with (+) asymmetry in the isthmus of the cingulate gyrus (HR = 5.39). Persistence of anxiety was associated with (-) volume of the parahippocampal gyrus (HR = 1.67), orbitofrontal cortex (HR &gt; 1.97), and right-biased laterality of the entorhinal cortex (HR = 0.52). Conclusions: Relative volume and asymmetry of the limbic system structures in patients with mTBI are associated with the persistence of symptoms, particularly anxiety. The conclusions of this study are limited by the absence of a reference group with no mTBI.<\/jats:p>","DOI":"10.3390\/jcm13175154","type":"journal-article","created":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T07:45:47Z","timestamp":1725003947000},"page":"5154","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Symptom Persistence Relates to Volume and Asymmetry of the Limbic System after Mild Traumatic Brain Injury"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0497-6150","authenticated-orcid":false,"given":"Cheryl","family":"Vanier","sequence":"first","affiliation":[{"name":"Imgen Research Group, Las Vegas, NV 89118, USA"},{"name":"College of Osteopathic Medicine, Touro University Nevada, Henderson, NV 89014, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priya","family":"Santhanam","sequence":"additional","affiliation":[{"name":"Imgen Research Group, Las Vegas, NV 89118, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Rochester","sequence":"additional","affiliation":[{"name":"Imgen Research Group, Las Vegas, NV 89118, USA"},{"name":"College of Medicine, Central Michigan University, Midland, MI 48859, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Carter","sequence":"additional","affiliation":[{"name":"Imgen Research Group, Las Vegas, NV 89118, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mike","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sunrise Health Graduate Medical Education Consortium, Las Vegas, NV 89128, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Kilani","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sunrise Health Graduate Medical Education Consortium, Las Vegas, NV 89128, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivani","family":"Venkatesh","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine, Touro University Nevada, Henderson, NV 89014, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherwin","family":"Azad","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sunrise Health Graduate Medical Education Consortium, Las Vegas, NV 89128, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Knoblauch","sequence":"additional","affiliation":[{"name":"Imgen Research Group, Las Vegas, NV 89118, USA"},{"name":"Department of Interdisciplinary Health Sciences, University of Nevada, Las Vegas, NV 89557, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tapasya","family":"Surti","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Texas Health Science Center, Houston, TX 78701-2982, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7613-3657","authenticated-orcid":false,"given":"Colin","family":"Brown","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine, Touro University Nevada, Henderson, NV 89014, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin Roy","family":"Sanchez","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine, Touro University Nevada, Henderson, NV 89014, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leon","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Loyola University Medical Center, Maywood, IL 60153, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaunaq","family":"Parikh","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leo","family":"Germin","sequence":"additional","affiliation":[{"name":"Clinical Neurology Specialists, Las Vegas, NV 89147, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Fazzini","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine, Touro University Nevada, Henderson, NV 89014, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Travis H.","family":"Snyder","sequence":"additional","affiliation":[{"name":"Imgen Research Group, Las Vegas, NV 89118, USA"},{"name":"College of Osteopathic Medicine, Touro University Nevada, Henderson, NV 89014, USA"},{"name":"Department of Radiology, Sunrise Health Graduate Medical Education Consortium, Las Vegas, NV 89128, USA"},{"name":"Department of Radiology, HCA Healthcare, Mountain View Hospital, Las Vegas, NV 89166, USA"},{"name":"SimonMed Imaging, Las Vegas, NV 89121, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1097\/00001199-200609000-00001","article-title":"The epidemiology and impact of traumatic brain injury: A brief overview","volume":"21","author":"Langlois","year":"2006","journal-title":"J. Head Trauma Rehabil."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"281","DOI":"10.2147\/CEOR.S44625","article-title":"The costs of traumatic brain injury: A literature review","volume":"5","author":"Humphreys","year":"2013","journal-title":"Clinicoecon. Outcomes Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1177\/0963689717714102","article-title":"Traumatic brain injury: Current treatment strategies and future endeavors","volume":"26","author":"Galgano","year":"2017","journal-title":"Cell Transpl."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1017\/S135561770808017X","article-title":"Neuropsychology and clinical neuroscience of persistent post-concussive syndrome","volume":"14","author":"Bigler","year":"2008","journal-title":"J. Int. Neuropsychol. Soc."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"McInnes, K., Friesen, C.L., MacKenzie, D.E., Westwood, D.A., and Boe, S.G. (2017). Mild Traumatic Brain Injury (MTBI) and chronic cognitive impairment: A scoping review. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0174847"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e180210","DOI":"10.1001\/jamanetworkopen.2018.0210","article-title":"Assessment of follow-up care after emergency department presentation for mild traumatic brain injury and concussion: Results from the Track-Tbi Study","volume":"1","author":"Seabury","year":"2018","journal-title":"JAMA Netw. Open"},{"key":"ref_7","unstructured":"WHO (1993). Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research, World Health Organization."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1001\/jamaneurol.2019.1313","article-title":"Recovery after mild traumatic brain injury in patients presenting to US Level I trauma centers: A transforming research and clinical knowledge in traumatic brain injury (Track-Tbi) study","volume":"76","author":"Nelson","year":"2019","journal-title":"JAMA Neurol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1089\/neu.2013.2984","article-title":"Symptomatology and functional outcome in mild traumatic brain injury: Results from the prospective Track-Tbi study","volume":"31","author":"McMahon","year":"2014","journal-title":"J. Neurotrauma"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1097\/JNN.0000000000000570","article-title":"A meta-analysis of dynamic prevalence of cognitive deficits in the acute, subacute, and chronic phases after traumatic brain injury","volume":"53","author":"Tsai","year":"2021","journal-title":"J. Neurosci. Nurs."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1176\/jnp.17.3.350","article-title":"Diagnostic Criteria for Postconcussional Syndrome after Mild to Moderate Traumatic Brain Injury","volume":"17","author":"Boake","year":"2005","journal-title":"J. Neuropsych. Clin. Neurosci."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Vogt, B.A. (2019). Chapter 3\u2014Cingulate cortex in the three limbic subsystems. Handbook of Clinical Neurology, Elsevier.","DOI":"10.1016\/B978-0-444-64196-0.00001-7"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Vogt, B.A. (2019). Chapter 1\u2014The cingulate cortex in neurologic diseases: History, structure, overview. Handbook of Clinical Neurology, Elsevier.","DOI":"10.1016\/B978-0-444-64196-0.00001-7"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.cortex.2013.12.005","article-title":"Limbic systems for emotion and for memory, but no single limbic system","volume":"62","author":"Rolls","year":"2015","journal-title":"Cortex"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"fcaa196","DOI":"10.1093\/braincomms\/fcaa196","article-title":"The orbitofrontal cortex: Reward, emotion and depression","volume":"2","author":"Rolls","year":"2020","journal-title":"Brain Commun."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Banwinkler, M., Theis, H., Prange, S., and van Eimeren, T. (2022). Imaging the limbic system in Parkinson\u2019s Disease- A review of limbic pathology and clinical symptoms. Brain Sci., 12.","DOI":"10.3390\/brainsci12091248"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s11065-020-09474-0","article-title":"Volumetric MRI findings in mild traumatic brain injury (mTBI) and neuropsychological outcome","volume":"33","author":"Bigler","year":"2023","journal-title":"Neuropsychol. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1056\/NEJMcp064645","article-title":"Clinical practice: Concussion","volume":"356","author":"Ropper","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Zhou, Z., Li, X., Domel, A.G., Dennis, E.L., Georgiadis, M., Liu, Y., Raymond, S.J., Grant, G., Kleiven, S., and Camarillo, D. (2022). The presence of the temporal horn exacerbates the vulnerability of hippocampus during head impacts. Front. Bioeng. Biotechnol., 10.","DOI":"10.3389\/fbioe.2022.754344"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"47","DOI":"10.3109\/02699052.2014.947628","article-title":"A longitudinal evaluation of diffusion kurtosis imaging in patients with mild traumatic brain injury","volume":"29","author":"Stokum","year":"2015","journal-title":"Brain Inj."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1089\/neu.2020.7475","article-title":"Verbal Episodic Memory Alterations and Hippocampal Atrophy in Acute Mild Traumatic Brain Injury","volume":"38","author":"Jobin","year":"2021","journal-title":"J. Neurotrauma"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1089\/neu.2016.4591","article-title":"Microstructural Integrity of Hippocampal Subregions Is Impaired after Mild Traumatic Brain Injury","volume":"34","author":"Leh","year":"2017","journal-title":"J. Neurotrauma"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1310\/L3XF-DV7D-VQ56-TUNX","article-title":"Laterality of Motor Control Revisited: Directionality of Callosal Traffic and Its Rehabilitative Implications","volume":"12","author":"Derakhshan","year":"2005","journal-title":"Top Stroke Rehabil."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Ledig, C., Kamnitsas, K., Koikkalainen, J., Posti, J.P., Takala, R.S.K., KReatila, A., Frantzen, J., Ala-Seppala, H., Kyllonen, A., and Maanpaa, H.R. (2017). Regional brain morphometry in patients with traumatic brain injury based on acute- and chronic-phase magnetic resonance imaging. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0188152"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2059700220947194","DOI":"10.1177\/2059700220947194","article-title":"Interval-censored survival analysis of mild traumatic brain injury with outcome based neuroimaging clinical applications","volume":"4","author":"Vanier","year":"2020","journal-title":"J. Concussion"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"463","DOI":"10.3233\/NRE-130869","article-title":"Special tools for the assessment of balance and dizziness in individuals with mild traumatic brain injury","volume":"32","author":"Sutera","year":"2013","journal-title":"NeuroRehabilitation"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e26360","DOI":"10.2196\/26360","article-title":"Neurocognitive assessment tools for military personnel with mild traumatic brain injury: Scoping literature review","volume":"8","author":"Jones","year":"2021","journal-title":"JMIR Ment. Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1176\/appi.neuropsych.13040088","article-title":"Man versus Machine part 2: Comparison of radiologists\u2019 interpretations and NeuroQuant measures of brain asymmetry and progressive atrophy in patients with traumatic brain injury","volume":"27","author":"Ross","year":"2015","journal-title":"J. Neuropsychiatry Clin. Neurosci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1176\/appi.neuropsych.11120377","article-title":"Man versus machine: Comparison of radiologists\u2019 interpretations and NeuroQuant(R) volumetric analyses of brain MRIs in patients with traumatic brain injury","volume":"25","author":"Ross","year":"2013","journal-title":"J. Neuropsychiatry Clin. Neurosci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"CNC101","DOI":"10.2217\/cnc-2022-0003","article-title":"Journey to the other side of the brain: Asymmetry in patients with chronic mild or moderate traumatic brain injury","volume":"8","author":"Ross","year":"2022","journal-title":"Concussion"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Voevodskaya, O., Simmons, A., Nordenskj\u00f6ld, R., Kullberg, J., Ahlstr\u00f6m, H., Lind, L., Wahlund, L.O., Larsson, E.M., and Westman, E. (2014). The effects of intracranial volume adjustment approaches on multiple regional MRI volumes in healthy aging and Alzheimer\u2019s disease. Front. Aging Neurosci., 6.","DOI":"10.3389\/fnagi.2014.00264"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/j.mri.2007.10.010","article-title":"Laterality index in functional MRI: Methodological issues","volume":"26","author":"Seghier","year":"2008","journal-title":"Magn. Reson. Imaging"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1111\/j.2517-6161.1996.tb02080.x","article-title":"Regression shrinkage and selection via the lasso","volume":"58","author":"Tibshirani","year":"1996","journal-title":"J. R. Stat. Soc. Ser. B"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v033.i01","article-title":"Regularization paths for generalized linear models via coordinate descent","volume":"33","author":"Friedman","year":"2010","journal-title":"J. Stat. Softw."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"h3868","DOI":"10.1136\/bmj.h3868","article-title":"How to develop a more accurate risk prediction model when there are few events","volume":"351","author":"Pavlou","year":"2015","journal-title":"BMJ"},{"key":"ref_37","first-page":"1","article-title":"Icenreg: Regression models for interval censored data in R","volume":"81","year":"2017","journal-title":"J. Stat. Softw."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1038\/s41586-022-04492-9","article-title":"Reproducible brain-wide association studies require thousands of individuals","volume":"603","author":"Marek","year":"2022","journal-title":"Nature"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"3484","DOI":"10.1093\/brain\/awad056","article-title":"Acute thalamic connectivity precedes chronic post-concussive symptoms in mild traumatic brain injury","volume":"146","author":"Woodrow","year":"2023","journal-title":"Brain"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.nicl.2013.04.009","article-title":"Reduced cortical thickness with increased lifetime burden of PTSD in OEF\/OIF Veterans and the impact of comorbid TBI","volume":"2","author":"Lindemer","year":"2013","journal-title":"NeuroImage Clin."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1089\/neu.2017.5541","article-title":"Decreases in white matter integrity of ventro-limbic pathway linked to post-traumatic stress disorder in mild traumatic brain injury","volume":"36","author":"Santhanam","year":"2019","journal-title":"J. Neurotrauma"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"102190","DOI":"10.1016\/j.nicl.2020.102190","article-title":"Mild traumatic brain injury impacts associations between limbic system microstructure and post-traumatic stress disorder symptomatology","volume":"26","author":"Sydnor","year":"2020","journal-title":"NeuroImage Clin."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.nicl.2016.06.012","article-title":"Connectome-scale assessment of structural and functional connectivity in mild traumatic brain injury at the acute stage","volume":"12","author":"Iraji","year":"2016","journal-title":"NeuroImage Clin."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Wolf, J.A., and Koch, P.F. (2016). Disruption of network synchrony and cognitive dysfunction after traumatic brain injury. Front. Syst. Neurosci., 10.","DOI":"10.3389\/fnsys.2016.00043"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"239","DOI":"10.4103\/0972-2327.104323","article-title":"Hippocampus in health and disease: An overview","volume":"15","author":"Anand","year":"2012","journal-title":"Ann. Indian Acad. Neurol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1038\/jcbfm.2014.75","article-title":"Repeated mild traumatic brain injury causes chronic neuroinflammation, changes in hippocampal synaptic plasticity, and associated cognitive deficits","volume":"34","author":"Aungst","year":"2014","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e00581","DOI":"10.1002\/brb3.581","article-title":"Orbitofrontal cortical thinning and aggression in mild traumatic brain injury patients","volume":"6","author":"Epstein","year":"2016","journal-title":"Brain Behav."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1089\/neu.2014.3600","article-title":"Systematic review of multivariable prognostic models for mild traumatic brain injury","volume":"32","author":"Silverberg","year":"2015","journal-title":"J. Neurotrauma"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2396","DOI":"10.1089\/neu.2016.4819","article-title":"Development of a prediction model for post-concussive symptoms following mild traumatic brain injury: A Track-Tbi pilot study","volume":"34","author":"Cnossen","year":"2017","journal-title":"J. Neurotrauma"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Polinder, S., Cnossen, M.C., Real, R.G.L., Covic, A., Gorbunova, A., Voormolen, D.C., Master, C.L., Haagsma, J.A., Diaz-Arrastia, R., and Von Steinbuechel, N. (2018). A multidimensional approach to post-concussion symptoms in mild traumatic brain injury. Front. Neurol., 9.","DOI":"10.3389\/fneur.2018.01113"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Verboon, L.N., Patel, H.C., and Greenhalgh, A.D. (2021). The Immune System\u2019s Role in the Consequences of Mild Traumatic Brain Injury (Concussion). Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.620698"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1089\/089771501750170976","article-title":"Cellular inflammatory response associated with breakdown of the blood-brain barrier after closed head injury in rats","volume":"18","author":"Lu","year":"2001","journal-title":"J. Neurotrauma"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"4524","DOI":"10.1038\/s41467-020-18113-4","article-title":"Meningeal lymphatic dysfunction exacerbates traumatic brain injury pathogenesis","volume":"11","author":"Bolte","year":"2020","journal-title":"Nat. Commun."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1111\/head.14446","article-title":"Thalamic subfield iron accumulation after acute mild traumatic brain injury as a marker of future post-traumatic headache intensity","volume":"63","author":"Chong","year":"2023","journal-title":"Headache"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1007\/s11682-019-00095-7","article-title":"Decreased grey matter volume in mTBI patients with post-traumatic headache compared to headache-free mTBI patients and healthy controls: A longitudinal MRI study","volume":"14","author":"Burrowes","year":"2020","journal-title":"Brain Imaging Behav."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1089\/neu.1996.13.35","article-title":"Lesion volume, injury severity, and thalamic integrity following head injury","volume":"13","author":"Anderson","year":"1996","journal-title":"J. Neurotrauma"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1080\/02699052.2021.1906445","article-title":"Early stage longitudinal subcortical volumetric changes following mild traumatic brain injury","volume":"35","author":"Zhuo","year":"2021","journal-title":"Brain Inj."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1097\/HTR.0000000000000213","article-title":"Neuroimaging in blast-related mild traumatic brain injury","volume":"32","author":"Mu","year":"2017","journal-title":"J. Head Trauma Rehabil."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1080\/02699050903014899","article-title":"Assessment of thalamic perfusion in patients with mild traumatic brain injury by true FISP arterial spin labelling MR imaging at 3T","volume":"23","author":"Ge","year":"2009","journal-title":"Brain Inj."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1212\/WNL.0b013e3181b8791a","article-title":"Gray matter changes related to chronic posttraumatic headache","volume":"73","author":"Obermann","year":"2009","journal-title":"Neurology"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Schwedt, T.J. (2019). Structural and functional brain alterations in post-traumatic headache attributed to mild traumatic brain injury: A narrative review. Front. Neurol., 10.","DOI":"10.3389\/fneur.2019.00615"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1186\/s10194-017-0796-0","article-title":"Persistent post-traumatic headache vs. migraine: An MRI study demonstrating differences in brain structure","volume":"18","author":"Schwedt","year":"2017","journal-title":"J. Headache Pain"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.gaitpost.2019.05.011","article-title":"Balance and the brain: A review of structural brain correlates of postural balance and balance training in humans","volume":"71","author":"Surgent","year":"2019","journal-title":"Gait Posture"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"11670","DOI":"10.1523\/JNEUROSCI.2567-10.2010","article-title":"Dynamic properties of human brain structure: Learning-related changes in cortical areas and associated fiber connections","volume":"30","author":"Taubert","year":"2010","journal-title":"J. Neurosci."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.jagp.2013.04.011","article-title":"Shape abnormalities of the caudate nucleus correlate with poorer gait and balance: Results from a subset of the LADIS study","volume":"23","author":"Macfarlane","year":"2015","journal-title":"Am. J. Geriatr. Psychiatry"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.neurobiolaging.2016.10.024","article-title":"Individual differences in brainstem and basal ganglia structure predict postural control and balance loss in young and older adults","volume":"50","author":"Boisgontier","year":"2017","journal-title":"Neurobiol. Aging"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Dean, P.J., and Sterr, A. (2013). Long-term effects of mild traumatic brain injury on cognitive performance. Front. Hum. Neurosci., 7.","DOI":"10.3389\/fnhum.2013.00030"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.acn.2006.03.003","article-title":"Information processing following mild head injury","volume":"21","author":"Ryan","year":"2006","journal-title":"Arch. Clin. Neuropsychol."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Sterr, A., Herron, K.A., Hayward, C., and Montaldi, D. (2006). Are mild head injuries as mild as we think? Neurobehavioral concomitants of chronic post-concussion syndrome. BMC Neurol., 6.","DOI":"10.1186\/1471-2377-6-7"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1017\/S0033291710001728","article-title":"Long-term cognitive and emotional consequences of mild traumatic brain injury","volume":"41","author":"Konrad","year":"2011","journal-title":"Psychol. Med."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1089\/neu.2009.1110","article-title":"Evaluating the relationship between memory functioning and cingulum bundles in acute mild traumatic brain injury using diffusion tensor imaging","volume":"27","author":"Wu","year":"2010","journal-title":"J. Neurotrauma"},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Wilde, E.A., Hyseni, I., Lindsey, H.M., Faber, J., McHenry, J.M., Bigler, E.D., Biekman, B.D., Hollowell, L.L., McCauley, S.R., and Hunter, J.V. (2021). A Preliminary DTI Tractography Study of Developmental Neuroplasticity 5\u201315 Years After Early Childhood Traumatic Brain Injury. Front. Neurol., 12.","DOI":"10.3389\/fneur.2021.734055"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1080\/87565641003696940","article-title":"Diffusion tensor imaging of the cingulum bundle in children after traumatic brain injury","volume":"35","author":"Wilde","year":"2010","journal-title":"Dev. Neuropsychol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1176\/jnp.14.4.416","article-title":"Traumatic brain injury and atrophy of the cingulate gyrus","volume":"14","author":"Yount","year":"2002","journal-title":"J. Neuropsychiatry Clin. Neurosci."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1148\/radiol.13122542","article-title":"Mild traumatic brain injury: Longitudinal regional brain volume changes","volume":"267","author":"Zhou","year":"2013","journal-title":"Radiology"},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Xue, Q., Wang, L., Zhao, Y., Tong, W., Wang, J., Li, G., Cheng, W., Gao, L., and Dong, Y. (2022). Cortical and subcortical alterations and clinical correlates after traumatic brain injury. J. Clin. Med., 11.","DOI":"10.3390\/jcm11154421"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.bandc.2013.06.007","article-title":"Regional cortical volume and cognitive functioning following traumatic brain injury","volume":"83","author":"Spitz","year":"2013","journal-title":"Brain Cogn."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1956","DOI":"10.1016\/j.neuropsychologia.2005.11.007","article-title":"Hippocampal head atrophy after traumatic brain injury","volume":"44","author":"Ariza","year":"2006","journal-title":"Neuropsychologia"},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Monti, J.M., Voss, M.W., Pence, A., McAuley, E., Kramer, A.F., and Cohen, N.J. (2013). History of mild traumatic brain injury is associated with deficits in relational memory, reduced hippocampal volume, and less neural activity later in life. Front. Aging Neurosci., 5.","DOI":"10.3389\/fnagi.2013.00041"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/j.nicl.2018.05.014","article-title":"The relationship between brain atrophy and cognitive-behavioural symptoms in retired Canadian football players with multiple concussions","volume":"19","author":"Misquitta","year":"2018","journal-title":"NeuroImage Clin."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"102783","DOI":"10.1016\/j.nicl.2021.102783","article-title":"Fatigue following mild traumatic brain injury relates to visual processing and effort perception in the context of motor performance","volume":"32","author":"Prak","year":"2021","journal-title":"NeuroImage Clin."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1528","DOI":"10.3109\/02699052.2010.531687","article-title":"Mild traumatic brain injury and fatigue: A prospective longitudinal study","volume":"24","author":"Norrie","year":"2010","journal-title":"Brain Inj."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1097\/HTR.0000000000000377","article-title":"Fatigue is associated with global and regional thalamic morphometry in veterans with a history of mild traumatic brain injury","volume":"33","author":"Clark","year":"2018","journal-title":"J. Head Trauma Rehabil."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1097\/HTR.0000000000000340","article-title":"Using functional magnetic resonance imaging to detect chronic fatigue in patients with previous traumatic brain injury: Changes linked to altered striato-thalamic-cortical functioning","volume":"33","author":"Berginstrom","year":"2018","journal-title":"J. Head Trauma Rehabil."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.jad.2011.06.003","article-title":"Structural correlates of trait anxiety: Reduced thickness in medial orbitofrontal cortex accompanied by volume increase in nucleus accumbens","volume":"134","author":"Kuhn","year":"2011","journal-title":"J. Affect. Disord."},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Hellewell, S.C., Beaton, C.S., Welton, T., and Grieve, S.M. (2020). Characterizing the Risk of Depression Following Mild Traumatic Brain Injury: A Meta-Analysis of the Literature Comparing Chronic mTBI to Non-mTBI Populations. Front. Neurol., 11.","DOI":"10.3389\/fneur.2020.00350"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.pscychresns.2010.10.003","article-title":"Brain morphometry changes and depressive symptoms after traumatic brain injury","volume":"191","author":"Hudak","year":"2011","journal-title":"Psychiatry Res."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.bbr.2014.05.047","article-title":"Volumetrics relate to the development of depression after traumatic brain injury","volume":"271","author":"Maller","year":"2014","journal-title":"Behav. Brain Res."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1089\/neu.2021.0374","article-title":"Neuroimaging correlates of depression after traumatic brain injury: A systematic review","volume":"39","author":"Medeiros","year":"2022","journal-title":"J. Neurotrauma"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1503\/jpn.190156","article-title":"Volumetric brain differences in clinical depression in association with anxiety: A systematic review with meta-analysis","volume":"45","author":"Daniela","year":"2020","journal-title":"J. Psych. Neurosci."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1016\/j.jaclp.2022.05.004","article-title":"Behavioral and emotional dyscontrol following traumatic brain injury: A systematic review of neuroimaging and electrophysiological correlates","volume":"63","author":"Bryant","year":"2022","journal-title":"J Acad. Consult. Liaison Psychiatry"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1089\/neu.2014.3449","article-title":"Noninvasive Brain Stimulation for Persistent Postconcussion Symptoms in Mild Traumatic Brain Injury","volume":"32","author":"Koski","year":"2014","journal-title":"J. Neurotrauma"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1590\/1980-57642018dn13-020005","article-title":"Transcranial direct current stimulation (tDCS) effects on traumatic brain injury (TBI) recovery: A systematic review","volume":"13","author":"Zaninotto","year":"2019","journal-title":"Dement. Neuropsychol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"S89","DOI":"10.1016\/j.apmr.2014.09.019","article-title":"It takes two: Noninvasive brain stimulation combined with neurorehabilitation","volume":"96","author":"Page","year":"2015","journal-title":"Arch. Phys. Med. Rehabil."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/17\/5154\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:45:42Z","timestamp":1760111142000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/17\/5154"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,30]]},"references-count":94,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2024,9]]}},"alternative-id":["jcm13175154"],"URL":"https:\/\/doi.org\/10.3390\/jcm13175154","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,30]]}}}