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Women’s brains respond differently to TBI and concussion

May 16, 2014 by Steven M. Gursten

After a concussion, how long it takes you to recover could depend on your sex, according to a new brain injury study


Did you know your gender can affect the amount of time it takes you to recover from a concussion?

And did you know that women tend to recover faster than men?

According to a recent University of Pittsburgh School of Medicine study published in NCBI, both statements above appear surprisingly to be true.

You can read the study here: “Sex Differences in White Matter Abnormalities after Mild Traumatic Brain Injury: Localization and Correlation with Outcome.”

Using diffusion tensor imaging (DTI), an advanced form of MRI, researchers studied 47 male and 22 female patients diagnosed with concussions, also known as mild traumatic brain injury. They also studied the results of 22 control participants, 11 women and 10 men.

I’ve written (and lectured) about DTI testing before, as doctors and lawyers are turning to it to help detect traumatic brain injury. DTI is being prescribed by doctors in many of the cases where I represent people who have suffered brain injuries in auto accidents. Often, I’m told by the treating doctors, it is important for the doctors to determine if these are organic brain injuries or acquired conditions, such as chronic pain syndrome and severe depression.

What is DTI?

To be more specific, DTI is an MRI (magnetic resonance imaging) that measures the way water moves in several directions through the brain’s white matter. Healthy brains have a high value of this water movement measurement, called fractional anisotropy (FA). Low FA is linked to cognitive impairment in patients with TBI.

Researchers found male patients with concussions had much lower FA levels within a white matter tract that connects the frontal and temporal lobes of the brain, called the uncinate fasciculi (UF).

Average recovery time in the study was 54 days. But the difference in recovery times between the sexes was considerable: Women’s recovery time was an average of 26.3 days, and men’s recovery time was an average of 66.9 days.

Researchers also found that FA levels in that area of the brain were the best predictor of recovery time. They stated that initial concussion symptoms are unreliable in predicting recovery time and prognosis, but the DTI findings are a strong predictor.

This stresses the importance of doctors using better imaging technology, such as DTI. Diffusion Tensor Imaging is more likely to detect concussion and mild traumatic brain injury, while other common imaging tools such as MRI and CT scans that are often used in emergency rooms miss it.

As I’ve previously discussed, the problem with normal MRI is that the results are almost always “normal,” even when people are severely impaired from a traumatic brain injury. Of course, MRI is also normal when people are in a coma or when people are dead, which is why defense attorneys love to talk about normal MRIs in court to imply that a person with a TBI can’t be seriously injured because he or she has normal MRIs. As an attorney, I’ve tried a number of brain injury cases in court. I still find many juries have trouble understanding how someone can be severely disabled with normal imaging studies, even when the medical experts confirm it to be true.

Dr. Saeed Fakhran, assistant professor of neuroradiology at the University of Pittsburgh School of Medicine, agrees. “Before the use of DTI in concussion, we had patients who were obviously suffering significant symptoms, but simply couldn’t understand why because we couldn’t see the injuries in the brain with the imaging tools we commonly use,” he said in a recent article published on outsideonline.com, “How Sex Affects Concussion Recover.”

So, why do women recover faster, according to this study?

Dr. Fakhran says it’s possible that the female hormone progesterone has something to do with the disparity. He explained that the UF connects the two areas of the brain with the most progesterone receptors, which “may suggest a protective role of progesterone in concussion, putting males at a disadvantage.”

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