A closed head trauma induces incompletely characterized temporary movement and deformation of the brain, contributing to the primary traumatic brain injury. We used the pressure patterns recorded with light-operated miniature sensors in anaesthetized adult rabbits exposed to a sagittal plane rotational acceleration of the head, lasting 1?ms, as a measure of brain deformation. Two exposure levels were used and scaled to correspond to force levels reported to cause mild and moderate diffuse injury in an adult man, respectively. Flexion induced transient, strong, extended, and predominantly negative pressures while extension generated a short positive pressure peak followed by a minor negative peak. Low level flexion caused as strong, extended negative pressures as did high level extension. Time differences were demonstrated between the deformation of the cerebrum, brainstem, and cerebellum. Available X-ray and MRI techniques do not have as high time resolution as pressure recordings in demonstrating complex, sequential compression and stretching of the brain during a trauma. The exposure to flexion caused more protracted and extensive deformation of the brain than extension, in agreement with a published histopathological report. The severity and extent of the brain deformation generated at a head trauma thus related to the direction at equal force. 1. Introduction A closed head trauma may result in traumatic brain injury (TBI), and its consequences constitute a large burden for the victims, their families, and the society [1–5]. The relation between the external loading of the head and the response in the brain, resulting in damage, during an impact lasting just milliseconds needs further clarification. Inertial shearing deformation of the brain is considered to be a primary cause of injury [6–14] and generates temporary pressures in the brain parenchyma, as demonstrated in, for example, postmortem human subjects and in nonhuman primates [15–17]. Anderson et al. [18] reported correlations between applied force, dynamic pressures, and histopathological changes at a lateral head impact. The forces applied at a closed head impulse have been proposed to possibly induce cavitation at interfaces [19–23]. The aim of the present study was to elucidate the importance of the direction of a sagittal plane rotational acceleration trauma to the head and neck for the deformation of the brain, which thereby induces brain concussion, also named mild traumatic brain injury (TBI) [10, 12–14, 17]. We consider that the direction of the force at a head trauma is likely to
References
[1]
J. A. Langlois Orman, J. F. Kraus, E. Zaloshnja, and T. Miller, “Epidemiology,” in Textbook of Traumatic Brain Injury, J. M. Silver, T. W. Mcalister, and S. C. Yudofsky, Eds., pp. 3–22, American Psychiatric Publishing Inc, Washington, DC, USA, 2nd edition, 2011.
[2]
V. G. Coronado, L. Xu, S. V. Basaravaju, et al., “Surveillance for traumatic brain injury-related deaths—United States, 1997–2007,” Morbidity and Mortality Weekly Report—Surveillance Summaries, vol. 60, no. 5, pp. 1–32, 2011.
[3]
V. L. Feigin, A. Theadom, S. Barker-Collo et al., “Incidence of traumatic brain injury in New Zealand: a population-based study,” The Lancet Neurology, vol. 12, no. 1, pp. 53–64, 2013.
[4]
F. Tagliaferri, C. Compagnone, M. Korsic, F. Servadei, and J. Kraus, “A systematic review of brain injury epidemiology in Europe,” Acta Neurochirurgica, vol. 148, no. 3, pp. 255–267, 2006.
[5]
A. Kay and G. Teasdale, “Head injury in the United Kingdom,” World Journal of Surgery, vol. 25, no. 9, pp. 1210–1220, 2001.
[6]
W. N. Hardy, C. D. Foster, M. J. Mason, K. H. Yang, A. I. King, and S. Tashman, “Investigation of head injury mechanisms using neutral density technology and high-speed biplanar X-ray,” Stapp Car Crash Journal, vol. 45, pp. 337–368, 2001.
[7]
W. N. Hardy, M. J. Mason, C. D. Foster et al., “A study of the response of the human cadaver head to impact,” Stapp Car Crash Journal, vol. 51, pp. 17–80, 2007.
[8]
E. D. Bigler and W. L. Maxwell, “Neuropathology of mild traumatic brain injury: relationship to neuroimaging findings,” Brain Imaging and Behavior, vol. 6, no. 2, pp. 108–136, 2012.
[9]
A. K. Ommaya, W. Goldsmith, and L. Thibault, “Biomechanics and neuropathology of adult and paediatric head injury,” British Journal of Neurosurgery, vol. 16, no. 3, pp. 220–242, 2002.
[10]
P. Reilly and R. Bullock, Head Injury—Pathophysiology and Management, Hodder Arnold, London, UK, 2nd edition, 2005.
[11]
A. A. Sabet, E. Christoforou, B. Zatlin, G. M. Genin, and P. V. Bayly, “Deformation of the human brain induced by mild angular head acceleration,” Journal of Biomechanics, vol. 41, no. 2, pp. 307–315, 2008.
[12]
D. F. Meaney and D. H. Smith, “Biomechanics of concussion,” Clinics in Sports Medicine, vol. 30, no. 1, pp. 19–31, 2011.
[13]
M. E. Shenton, H. M. Hamoda, J. S. Schneiderman et al., “A review of magnetic resonance imaging and diffusion tensor imaging findings in mild traumatic brain injury,” Brain Imaging and Behavior, vol. 6, no. 2, pp. 137–192, 2012.
[14]
D. R. Namjoshi, C. Good, W. H. Cheng et al., “Towards clinical management of traumatic brain injury: a review of models and mechanisms from a biomechanical perspective,” Disease Models & Mechanisms, vol. 6, no. 6, pp. 1325–1338, 2013.
[15]
S. S. Margulies, L. E. Thibault, and T. A. Gennarelli, “Physical model simulations of brain injury in the primate,” Journal of Biomechanics, vol. 23, no. 8, pp. 823–836, 1990.
[16]
G. S. Nusholtz, P. S. Kaiker, and W. S. Gould, “Two factors critical in the pressure response of the impacted head,” Aviation, Space, and Environmental Medicine, vol. 58, no. 12, pp. 1157–1164, 1987.
[17]
L. Zhang, K. H. Yang, and A. I. King, “Biomechanics of neurotrauma,” Neurological Research, vol. 23, no. 2-3, pp. 144–156, 2001.
[18]
R. W. G. Anderson, C. J. Brown, P. C. Blumbergs, A. J. McLean, and N. R. Jones, “Impact mechanics and axonal injury in a sheep model,” Journal of Neurotrauma, vol. 20, no. 10, pp. 961–974, 2003.
[19]
J. Goeller, A. Wardlaw, D. Treichler, J. O'Bruba, and G. Weiss, “Investigation of cavitation as a possible damage mechanism in blast-induced traumatic brain injury,” Journal of Neurotrauma, vol. 29, no. 10, pp. 1970–1981, 2012.
[20]
J. E. Leestma, Forensic Neuropathology, CRC Press, Boca Raton, Fla, USA, 2nd edition, 2008.
[21]
G. S. Nusholtz, E. B. Wylie, and L. G. Glascoe, “Internal cavitation in simple head impact model,” Journal of Neurotrauma, vol. 12, no. 4, pp. 707–714, 1995.
[22]
M. Oehmichen, R. N. Auer, and H. G. K?nig, Forensic Neuropathology and Associated Neurology, Springer, Heidelberg, Germany, 2009.
[23]
M. B. Panzer, B. S. Myers, B. P. Capehart, and C. R. Bass, “Development of a finite element model for blast brain injury and the effects of CSF cavitation,” Annals of Biomedical Engineering, vol. 40, no. 7, pp. 1530–1544, 2012.
[24]
S. A. Eucker, C. Smith, J. Ralston, S. H. Friess, and S. S. Margulies, “Physiological and histopathological responses following closed rotational head injury depend on direction of head motion,” Experimental Neurology, vol. 227, no. 1, pp. 79–88, 2011.
[25]
E. J. Pellman, D. C. Viano, A. M. Tucker, et al., “Concussion in professional football: reconstruction of game impacts and injuries,” Neurosurgery, vol. 53, no. 4, pp. 799–814, 2003.
[26]
S. Rowson and S. M. Duma, “Brain injury prediction: assessing the combined probability of concussion using linear and rotational head acceleration,” Annals of Biomedical Engineering, vol. 41, no. 5, pp. 873–882, 2013.
[27]
A. A. Weaver, K. A. Danelson, and J. D. Stitzel, “Modeling brain injury response for rotational velocities of varying directions and magnitudes,” Annals of Biomedical Engineering, vol. 40, no. 9, pp. 2005–2018, 2012.
[28]
R. H. Pudenz and C. H. Shelden, “The lucite calvarium-a method for direct observation of the brain; cranial trauma and brain movement,” Journal of Neurosurgery, vol. 3, no. 6, pp. 487–505, 1946.
[29]
Y. Feng, T. M. Abney, R. J. Okamoto, R. B. Pless, G. M. Genin, and P. V. Bayly, “Relative brain displacement and deformation during constrained mild frontal head impact,” Journal of the Royal Society Interface, vol. 7, no. 53, pp. 1677–1688, 2010.
[30]
E. B. Yan, V. P. A. Johnstone, D. S. Alwis, M.-C. Morganti-Kossmann, and R. Rajan, “Characterising effects of impact velocity on brain and behaviour in a model of diffuse traumatic axonal injury,” Neuroscience, vol. 248, pp. 17–29, 2013.
[31]
V. R. Hodgson, E. S. Gurdjian, and L. M. Thomas, “Experimental skull deformation and brain displacement demonstrated by flash x-ray technique.,” Journal of Neurosurgery, vol. 25, no. 5, pp. 549–552, 1966.
[32]
H. Zou, J. P. Schmiedeler, and W. N. Hardy, “Separating brain motion into rigid body displacement and deformation under low-severity impacts,” Journal of Biomechanics, vol. 40, no. 6, pp. 1183–1191, 2007.
[33]
R. K. Gupta and A. Przekwas, “Mathematical models of blast-induced TBI: current status, challenges, and prospects,” Frontiers in Neurology, vol. 4, pp. 1–21, 2013.
[34]
U. Krave, S. H?jer, and H.-A. Hansson, “Transient, powerful pressures are generated in the brain by a rotational acceleration impulse to the head,” European Journal of Neuroscience, vol. 21, no. 10, pp. 2876–2882, 2005.
[35]
U. Krave, M. Al-Olama, and H.-A. Hansson, “Rotational acceleration closed head flexion trauma generates more extensive diffuse brain injury than extension trauma,” Journal of Neurotrauma, vol. 28, no. 1, pp. 57–70, 2011.
[36]
E. Gutierrez, Y. Huang, K. Haglid et al., “A new model for diffuse brain injury by rotational acceleration: I. model, gross appearance, and astrocytosis,” Journal of Neurotrauma, vol. 18, no. 3, pp. 247–257, 2001.
[37]
S. Rowson, S. M. Duma, J. G. Beckwith et al., “Rotational head kinematics in football impacts: An injury risk function for concussion,” Annals of Biomedical Engineering, vol. 40, no. 1, pp. 1–13, 2012.
[38]
J. W. Shek, G. Y. Wen, and H. M. Wisniewski, Atlas of the Rabbit Brain and Spinal Cord, Karger, Basel, Switzerland, 1986.
[39]
P. Blumbergs, P. Reilly, and R. Vink, “Trauma,” in Greenfields Neuropathology, S. Love, D. N. Louis, and D. W. Ellison, Eds., pp. 733–832, Arnold, London, UK, 8th edition, 2008.
[40]
A. Hamberger, Y.-L. Huang, H. Zhu, et al., “Redistribution of neurofilaments and accumulation of β-amyloid protein after brain injury by rotational acceleration of the head,” Journal of Neurotrauma, vol. 20, no. 2, pp. 169–178, 2003.
[41]
M. Runnerstam, F. Bao, Y.-L. Huang, et al., “A new model for diffuse brain injury by rotational acceleration: II. Effects on extracellular glutamate, intracranial pressure, and neuronal apoptosis,” Journal of Neurotrauma, vol. 18, no. 3, pp. 259–273, 2001.
[42]
L. E. Goldstein, A. M. Fisher, C. A. Tagge, et al., “Chronic traumatic encephalopathy in blast-exposed military veterans and a blast neurotrauma mouse model,” Science Translational Medicine, vol. 4, no. 134, Article ID 134ra60, 2012.
[43]
M. S. Chafi, G. Karami, and M. Ziejewski, “Biomechanical assessment of brain dynamic responses due to blast pressure waves,” Annals of Biomedical Engineering, vol. 38, no. 2, pp. 490–504, 2010.
[44]
A. S?lj?, F. Bao, K. G. Haglid, and H.-A. Hansson, “Blast exposure causes redistribution of phosphorylated neurofilament subunits in neurons of the adult rat brain,” Journal of Neurotrauma, vol. 17, no. 8, pp. 719–726, 2000.
[45]
A. S?lj?, Y.-L. Huang, and H.-A. Hansson, “Impulse noise transiently increased the permeability of nerve and glial cell membranes, an effect accentuated by a recent brain injury,” Journal of Neurotrauma, vol. 20, no. 8, pp. 787–794, 2003.
[46]
R. C. Turner, Z. J. Naser, A. F. Logsdon et al., “Modeling clinically relevant blast parameters based on scaling principles produces functional & histological deficits in rats,” Experimental Neurology, vol. 248, pp. 520–529, 2013.
[47]
C. Giordano, R. J. H. Cloots, J. A. W. van Dommelen, and S. Kleiven, “The influence of anisotropy on brain injury prediction,” Journal of Biomechanics, vol. 47, no. 5, pp. 1052–1059, 2014.
[48]
A. Suneson, H.-A. Hansson, and T. Seeman, “Pressure wave injuries to the nervous system caused by high-energy missile extremity impact: Part II. Distant effects on the central nervous system—a light and electron microscopic study of pigs,” Journal of Trauma, vol. 30, no. 3, pp. 295–306, 1990.
[49]
A. Suneson, H. A. Hansson, E. Lycke, and T. Seeman, “Pressure wave injuries to rat dorsal root ganglion cells in culture caused by high-energy missiles,” Journal of Trauma, vol. 29, no. 1, pp. 10–18, 1989.
[50]
J. J. Iliff, M. Wang, Y. Liao et al., “A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitial solutes, including amyloid β,” Science Translational Medicine, vol. 4, no. 147, Article ID 147ra111, 2012.
[51]
J. Nolte, The Human Brain, Mosby, St. Louis, Mo, USA, 6th edition, 2008.
[52]
M. L. Rennels, T. F. Gregory, O. R. Blaumanis, K. Fujimoto, and P. A. Grady, “Evidence for a paravascular fluid circulation in the mammalian central nervous system, provided by the rapid distribution of tracer protein throughout the brain from the subarachnoid space,” Brain Research, vol. 326, no. 1, pp. 47–63, 1985.
[53]
V. R. Thrane, A. S. Thrane, B. A. Plog, et al., “Paravascular microcirculation facilitates rapid lipid transport and astrocyte signaling in the brain,” Scientific Reports, vol. 3, article 2582, 2013.
[54]
R. O. Weller, E. Djuanda, H.-Y. Yow, and R. O. Carare, “Lymphatic drainage of the brain and the pathophysiology of neurological disease,” Acta Neuropathologica, vol. 117, no. 1, pp. 1–14, 2009.
[55]
J. Ho and S. Kleiven, “Can sulci protect the brain from traumatic injury?” Journal of Biomechanics, vol. 42, no. 13, pp. 2074–2080, 2009.