Embracing chaos: the scope and importance of clinical and pathological heterogeneity in mTBI |
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Authors: | Sara B Rosenbaum Michael L Lipton |
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Institution: | (1) The Gruss Magnetic Resonance Research Center, Departments of Radiology, Psychiatry and Behavioral Sciences and The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10461, USA; |
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Abstract: | Mild traumatic brain injury (mTBI) manifests a wide array of clinical features, indicating great heterogeneity of its underlying
pathologic features. mTBI diversity is related to pre-injury inter-individual differences and differences in the characteristics
of each injury. This review summarizes key features of mTBI patients, their injuries and outcomes to give context to the scope
of complexity inherent in this disorder. These differences are underscored by heterogeneity in postmortem pathology and in
vivo imaging studies. Recognition, understanding and accounting for disease heterogeneity in mTBI are needed to enhance diagnosis
and patient management, as approaches that do not account for inter-individual variation in pathology and patient characteristics
relevant to real-life clinical trial participants, may entirely miss therapeutic targets. Refining our approach to TBI diagnosis,
in light of inter-individual differences, can facilitate the development of effective prognostic tools and algorithms. New
paradigms, which embrace heterogeneity of mTBI, in both preclinical and clinical investigation as well the appreciation of
this variability in clinical care, offer much promise for enhancing outcomes and mitigating the burden of mTBI on its victims. |
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