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Whiplash injury
(2012)
The study from Mehrazin et al. in HJNM 2011; 14(3): 243-50 on the neuropsychology, morphological computerized tomography (CT) and functional neuroimaging with 99mTc-labelled ethylene cystein-ate dimer single-photon emission tomography (SPET) in mild trau-matic brain injury (MTBI) is an interesting new approach to a disease condition which is often neglected or denied. Related to the above, we may note that the French composer Maurice Ravel (1875-1937), who suffered from Pick ́s disease with primary progressive apha-sia, had a taxi accident in 1932, with a mild concussion, perhaps an MTBI. Apart from the dysphasia and beginning apraxia, which Rav-el had already 5 years prior to the taxi accident, these symptoms exacerbated-the dysphasia became a progressive aphasia-and he developed additional severe deficits in concentration and atten-tion after the accident. It has also been suspected that this accident may have triggered Ravel ́s agraphia the unability to write down any new composition beyond the date of the taxi accident, a condi-tion that Ravel himself described as unacceptable and which made him feel very sad as his mind was full of ideas. Due to the deterio-ration of his health, which can also be seen in his appearance on late photographs, Ravel consulted the famous neurosurgeon Prof. Clovis Vincent. Vincent, who suspected a hydrocephalus, opened Ravel ́s skull on December 19, 1937, showing a normal brain. Soon after surgery Ravel died. In conclusion, a SPET/CT approach com-bined with a brain perfusion analysis using statistical parametric mapping might be the recommendable approach today for mild traumatic brain injury.
In the brain-cell microenvironment, diffusion plays an important role: apart from delivering glucose and oxygen from the vascular system to brain cells, it also moves informational substances between cells. The brain is an extremely complex structure of interwoven, intercommunicating cells, but recent theoretical and experimental works showed that the classical laws of diffusion, cast in the framework of porous media theory, can deliver an accurate quantitative description of the way molecules are transported through this tissue. The mathematical modeling and the numerical simulations are successfully applied in the investigation of diffusion processes in tissues, replacing the costly laboratory investigations. Nevertheless, modeling must rely on highly accurate information regarding the main parameters (tortuosity, volume fraction) which characterize the tissue, obtained by structural and functional imaging. The usual techniques to measure the diffusion mechanism in brain tissue are the radiotracer method, the real time iontophoretic method and integrative optical imaging using fluorescence microscopy. A promising technique for obtaining the values for characteristic parameters of the transport equation is the direct optical investigation using optical fibers. The analysis of these parameters also reveals how the local geometry of the brain changes with time or under pathological conditions. This paper presents a set of computations concerning the mass transport inside the brain tissue, for different types of cells. By measuring the time evolution of the concentration profile of an injected substance and using suitable fitting procedures, the main parameters characterizing the tissue can be determined. This type of analysis could be an important tool in understanding the functional mechanisms of effective drug delivery in complex structures such as the brain tissue. It also offers possibilities to realize optical imaging methods for in vitro and in vivo measurements using optical fibers. The model also may help in radiotracer biomarker models for the understanding of the mechanism of action of new chemical entities.