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• W4225103624 abstract "To the Editor: We thank Abdulla et al1 for their letter response to our article “Blood Biomarkers and Structural Imaging Correlations Post-Traumatic Brain Injury: A Systematic Review.”2 The authors make a number of interesting points on the prognostic potential of serum biomarkers in traumatic brain injury (TBI) and present a limited review of several key publications on the subject. Our review focused on the biomarker imaging associations in the acute phase after injury, without analysis of the relation between clinical outcomes and biomarker concentrations or indeed the prognostic potential of biomarkers. Alongside diagnostic potential for predicting acute computed tomography (CT) abnormality3,4 and for detecting patients with MRI abnormality after a normal acute CT scan,5 serum biomarkers of TBI may aid prognostication. Perhaps most promising is the neurofilament light (NFL). NFL levels have been demonstrated to peak 7 to 10 days after repetitive head trauma6 and remain raised in plasma samples years after injury.7 Furthermore, there is increasing but limited evidence of association between higher elevations of NFL and chronic symptoms including postconcussive symptoms, post-traumatic stress, and depression.7 For wider clinical utilization of serum biomarkers in TBI and to aid in clinical decision making, it is important to understand the factors that drive higher biomarker concentrations. We demonstrated in our review an association between burden of intracranial disease and blood–biomarker concentrations and hypothesize that this is related to the degree of parenchymal disruption after injury causing greater neuronal damage and release of biomarkers.2 The greater degree of parenchymal disruption on neuroimaging, either focal mass lesions or diffuse injury (Marshall CT score III-VI), has also been demonstrated to be associated with worse outcomes after injury.8 Similarly on a microstructural level, the odds of recovery after injury have been shown to be associated with a degree of neuronal damage on diffusion tensor imaging.9 Although, as highlighted by Abdulla et al, there is potential utility in mild TBI/sports concussion for the use of prognostic biomarkers where neuroimaging is unlikely to be performed,10 the additive benefit of biomarkers to neuroimaging techniques for prognostication in more severe injury requires further clarification. Both diagnostics and prognostication in TBI are key areas where the use of blood-based biomarkers offer significant promise. Our review provides important information concerning the pathophysiology of these biomarkers and offers context for future research to shape the application of these biomarkers into clinical practice." @default.
• W4225103624 created "2022-04-30" @default.
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• W4225103624 date "2022-05-02" @default.
• W4225103624 modified "2023-10-18" @default.
• W4225103624 title "In Reply: Blood Biomarkers and Structural Imaging Correlations Post-Traumatic Brain Injury: A Systematic Review" @default.
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• W4225103624 doi "https://doi.org/10.1227/neu.0000000000002011" @default.
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