Great weekend… and a big week ahead.

It’s all coming at me pretty fast, but if I keep relaxed and keep breathing, it can all happen. It can all turn out pretty well.

I had a full and productive weekend. I caught up on a number of things I’ve been needing to get done for weeks, now. I also got some things done around my yard that HAD to get done before it rains later this week. I feel pretty good about getting those things done. It was not a small task, but I did it.  Woot.

Some important-but-delayed things I did not get done. But I got enough important things done, that it offsets the disappointment. And it gives me more motivation to get moving on those things I didn’t finish (or even start).

I’ve also been working on my breathing. Focusing on relaxing and feeling where my body is “at” — where I’m tense, where I need to loosen up, where my breath seems to have stopped. I need to keep it moving, not get stuck in fight-flight, which is what happens at times, when I hold my breath unconsciously.

Years ago, I was very intent on working with my breath and getting in touch with my body, so I could more effectively manage stress. It was a regular part of my daily practice, and it did wonders for me. Somehow, I got away from that. I got caught up in everything else, and I was in serious survival mode for several years, while I dealt with creditors and paid down my years-salary-worth-of-debt. I lost sight of the big picture with my approaches, and while some things improved in my life — like my job situation and my perception of myself in the professional world — other parts fell by the wayside.

Including my breathing. I’m working on that again. And swimming is a big part of it — since it involves both movement and breathing. And it’s great exercise. Just great, great exercise.

This week is a pretty big one for me. I have my weekly neuropsych appointment, when I work on problems with making progress and getting things done. I have a whole lot of things I need to get done on a regular basis. I’ve been doing them for years, I just haven’t been doing them as efficiently as I should – and it shows. I may need to take some of them off my to-do list and put them on my ‘would be nice to do’ list… and then not worry about them till later.

One project, in particular, has been drawing a lot of energy off the other projects I really need to do. It’s training materials for people who are in a certain part of the job market and don’t understand how things work.

The thing is, if I start on that, it’s going to be pretty all-consuming. It’s not just some training materials — the whole plan also involves public speaking, public appearances, and a lot of writing and publishing and networking. And I just don’t have time for that, now.

It’s a great prospect for me, and it could bring in a fair amount of money for me, but I have so many other things I want to be working on, I can’t really afford to spend the time on it, to do it full justice.

So, I’m tabling that — putting it on the “back burner” to simmer for a while. I’m really treating that like my backup-plan “B”, in case I lose my job or the 9-to-5 thing doesn’t work out for me. That would be the ideal time to cut this project loose and set it free — when I actually have time to fully devote to it.

I’m in the process of cooking up a number of other projects, many of which I find really inspiring and motivational. So, I need to make room for them, and find where I can fit them, while not burning out. I’ll work through this with my neuropsych this week — and in later weeks, as well.

In addition to that, I’ve got a town meeting this week, when we’ll discuss the fate of a company that wants to expand. I’ve had my ups and downs with the board I belong to — they don’t always seem to respect me, and they sometimes ignore me or talk over me. People in town have laughed at me, when I asked one of my “stupid” questions, which was completely disrespectful (and ill-advised, since the board I’m on makes decisions about what people want to do on their properties, and I’m not the sort of enemy you want to have). I let that go, though, and I continue to serve on the board. It connects me with the larger community, and it also puts me on good terms with the local authorities. It’s a lot easier dealing with the local police, when they run my personal details and realize I’m also an “enforcer” who serves the public good.

I probably would have gotten in more trouble, had the friction not dissipated when the cops realized who I was and what role I play in local government.

Another thing is, I’m seeing my neurologist later this week to talk about the headaches and my other issues. Actually, I’ll be seeing their assistant, as the neuro proper has kind of washed their hands of me. They didn’t find anything on the MRI (even the DTI-MRI) that gave them any clues about what was going on with me, and since they can’t diagnose me with anything, how are they supposed to treat me (and bill the insurance companies)? I feel for them, but I don’t appreciate being pushed aside.

Fortunately, while I was sorting through my stack of insurance statements and various papers and notices, I found a promotional flyer for one of those services that gives you access to second opinions by highly qualified physicians and healthcare experts. I’m going to check in with them, to see if they can help me, because this current neuro approach is not working. I really don’t need to take hours out of my day to drive to an office where I’m just going to be brushed off, and my concerns aren’t going to be taken seriously.

Just as an example, the neuro-in-charge told me that my concerns about falling and having a worse TBI than the one I had before, were unfounded. They told me that concussions are NOT cumulative, which contradicts just about everything I’ve read… and after weeks of consideration, I have a lot of reservations about their abilities and willingness to be of help.

Then again, I do fit the profile of someone in the “miserable minority” — I’m very much like the first individual profiled in that seminal 1996 paper, which touched off a chain-reaction of further studies and diagnostic / treatment approaches to folks with lingering post-concussive symptoms. So, maybe the neuro was referencing that profile.

My own feelings of insult and dismissal aside, the “miserable minority” approach may have done more to perpetuate misery, by steering away from the functional and structural issues that come along with traumatic brain injury, and focusing so deeply on the psychological factors.

I’m not saying psychological factors don’t come into play. I’m saying there’s more to it than that, and it’s my belief — after many, many years of unfruitful and counter-productive therapy approaches, followed by amazingly fantastic progress after far fewer years of basic functional retraining — that a focus on psychology, without addressing the underlying neurology, has done more to perpetuate PCS than anyone would guess.

Of course, people mean well. They’re just misguided. And they’re so caught up in proving that they’re right, and they deserve a place at the rehabilitative table, with all the respect due highly trained professionals, that they “circle the wagons” and get Balkanized — cut off from others, hostile and uncooperative and territorial, and always ready to battle over some piece of territory.

Unfortunately for those of us who need their help, we get sucked into that dynamic, and that’s no good for anyone.

But there it is.

There it is.

Friday is free and clear for me — no meetings, no appointments. I do need to do some shopping this week to pick up some black pants for my business trip next week. I’m going to be presenting at a client conference, and I need some black pants. Or maybe I don’t need to go shopping. I have a couple pairs of black pants I can probably wear. They’re just not as casual as the conference wants us to be. It’s definitely “dress down” — although we still need to present in a professional manner.

I also need to practice my presentation. I’m doing one technical talk that’s only about 10 minutes long, and I’m going to be “on call” to answer questions about the company’s full product line, which is a pretty extensive collection. I just need to  have a quick 2-minute “spiel” I can launch into, for a variety of topics. That’s probably the biggest undertaking of this week, and I’ll be practicing while I’m driving to and from work, as well as to and from my appointments.

Memorizing things used to be easy for me as a kid. I can still memorize things, if I go over them 30+ times. 35 times seems to be the magic number, but I don’t have that kind of time — 35 times for each of the 10 different spiels is 350 separate practice sessions. At 2 minutes apiece, that’s 700 minutes (11.66 hours), minimum. I can break it up, sure, but it’s still a lot of time to spend.

So, again, I’ve got to pick and choose.

And so, I shall.

Onward.

#TBI – more questions, more responses

A few more gleanings from my stats… here’s what people are searching for. Maybe I can provide some insights… I’ll try.

after concussion frontal felt like something split

Concussion is a tricky thing. It affects everyone differently, and this is one of the ways it can be sensed. For years after my last mild TBI, I felt like my brain was not communicating properly with itself. And that caused a huge amount of stress for me. I also have a friend who was dropped on their head as a baby. They have had a neuropsychological assessment, when they were told that the left side of their brain was not communicating properly with the right side, and they have a lot of trouble reading and comprehending. They also become angry and rigid very quickly, and it’s like you can actually seeing one side of them not sharing information freely with the other side. Interestingly, they refuse to acknowledge that their issues might be neurological. They are paranoid about the government spying on them, and they are convinced they’re being followed. They grew up in a traumatic environment, and they work in trauma counseling, and everything for them is about trauma. But not about neurology. I often think they could benefit from working with a rehabitative neuropsychologist, but they never want to talk about “brain stuff”.

But back to the stats — that feeling that something is not functioning properly is quite common after concussion / mild TBI. As a matter of fact, things are NOT functioning properly. Here’s a great graphic that shows what the deal is:

From Giza and Hovda’s work on the Neurometabolic Cascade of Concussion – click the pic to download the paper

Basically, you’ve got a sudden increase in your brain’s demand for glucose, combined with a sudden decrease in the flow of blood – that’s a pretty significant mismatch, considering that blood is how the brain gets its energy. On top of that, you’ve got a lowered metabolic rate for oxygen — so just when the brain needs more energy to heal, it gets even less energy than it needs. It’s literally not able to function properly to produce the fuel it requires. And that can leave you feeling pretty fogged-up and messed up.

Another thing that can happen, is that your axons can be sheared and twisted. Depending on the injury, axons can be twisted like this:

From Knocking Heads. Brain Damage vs NFL – click to read the article

That keeps the axons from communicating, and it can even kill them. So, you end up with a “Swiss-cheese” effect, where there are little tiny gaps in the connections in all the networks in your brain.

Or axons can get sheared like this:

From After Brain Injury: A Guide for Patients and their Families – click to read the guide

And that literally disconnects them from themselves and from everything else.

So, on a microscopic level, stuff is separated and disconnected. And that can leave you feeling separated and disconnected from yourself, as well as everyone else. Your same old processes are not functioning the way they used to, and your personality may change. And the people around you may not recognize “the old you” anymore… and slowly drift away. It can be tough. But it doesn’t always happen that way.

Every brain injury is different. And everyone’s social situation is different. So, you have to just take it as it comes… and understand that A) it takes the brain a while to get back — sometimes several weeks, for it to clear out the gunk… and B) you can rebuild the connections in your brain — that’s what the brain does… constantly… and C) worry is going to make things worse, so just settle in, take good care of yourself, and keep an eye out for things that might get you injured again.

link between fibromyalgia and tbi

I’ve heard there may be a link between these. I’ve heard that there’s a link between PTSD and fibromaylgia. And there’s a link between TBI and PTSD. The three could very well go hand-in-hand.

I know a number of people with “fibro”, including one of my siblings, and they all have a history of trauma. Some of them have histories of car accidents. We’re still learning about fibromyalgia, but if I understand it correctly, it has to do with the brain sending off pain signals in specific parts of the body. Sometimes the signals are debilitating. And the whole deal can be exhausting. It’s a brain thing, so why wouldn’t it be potentially triggered by TBI?

One of my friends with “fibro” suggested (after I told them about my TBI experiences) that they might have had a TBI. Or two. Or three. They’d been rear-ended in traffic a number of times, and they were nearly disabled because of it. After all those years of telling me about their pain in a certain context, suddenly having the TBI information seemed to clarify a lot for them. I lost touch with them, when I moved away, years ago, so I have no idea if anything changed for them. I hope it did.

I’ve had chronic pain issues for many years, and even though I’ve been hypersensitive to touch since I was a little kid, the debilitating pain  started in earnest after a car accident in 1987. Some folks have suggested I might have “fibro”.  I’m not so sure. My pain is pretty much all over, and it can subside and abate for extended periods of time. It also responds well to exercise, which apparently “fibro” does not(?) Also, the crippling fatigue has gotten much, much better over time, and it fluctuates, so I think it’s more related to my mild TBIs than “fibro”. It’s a big old puzzle, that one. I hope they can figure things out before too terribly long.

advantages of bad memory

The pieces are all there. We just have to put them in their places.

This is one of my favorite subjects, because it’s so close to home. I joke that “the secret to happiness is good health and a bad memory”, but my friends don’t think that’s funny. Too bad for them. I think it’s hilarious. My memory tends to be awful. I forget things I did earlier in the day, I forget what day it is, I forget where I put things, and I forget things I was supposed to do. I have a whole system built up to keep me on track and mitigate the problems of my spotty memory.  It can really be a problem.

On the other hand, forgetting things that are weighing me down provides a much-needed break from the intensity of life.  And it’s been very helpful for me to let old grudges and hurts slip away, as though they never happened. It frees me up to interact with people who may have said or done stupid things in a moment of carelessness or thoughtlessness. Often, they feel bad about it, afterwards, and they’re afraid I’ll hold a grudge.

But I’ve forgotten all about it. And that’s a good thing. It lets us get on with our lives like normal people, instead of a bundle of grudges rolling around, bumping into everyone else’s grudges.

brain mri

I’ve had three of these. No, four. (That memory thing again 😉

I’ve had 2 of them with contrast and 2 without. I’ve gotten sick after 2 of the 4 — but not every time I had contrast. I don’t care for contrast — gadolinium is a heavy metal that has been connected with serious health issues, and I don’t like the feeling of it going into my veins. It makes me feel weird. Uncomfortable.

 

Some of my MRI imaging

I have had a DTI MRI, which was interesting, but it didn’t show nearly as much as I was hoping. Part of that is due to the radiologist. They were doing the bare minimum on the job, and they were probably reading a ton of images, so there was no time to dwell on my own case. I’ve gotten some software that will supposedly let me see my own DTI tractography, but I have yet to learn how to use it. Eventually, I will. Just not today.

My DTI MRI

Anyway, that’s it for today.

I’m working from home today — I had a busy weekend, and I’m still wiped out. I have no meetings in the office today, and I think a lot of other folks will be working remotely, as the weather is terrible, and schools may be either delayed or closed. So, I’m taking the space and just kicking back to do my work in peace.

Away from the cubicle.

Away from the crowds.

In the peace and quiet of my own home.

Ahhhhh….

 

Modeling of Large-Scale Functional Brain Networks Based on Structural Connectivity from DTI: Comparison with EEG Derived Phase Coupling Networks and Evaluation of Alternative Methods along the Modeling Path

New findings from Holger Finger, Marlene Bönstrup, Bastian Cheng, Arnaud Messé, Claus Hilgetag, Götz Thomalla, Christian Gerloff, Peter König

doi: http://dx.doi.org/10.1101/043109

This article is a preprint and has not been peer-reviewed [what does this mean?].

Abstract

Here we use computational modeling of fast neural dynamics to explore the relationship between structural and functional coupling in a population of healthy subjects. We use DTI data to estimate structural connectivity and subsequently model phase couplings from band-limited oscillatory signals derived from multichannel EEG data. Our results show that about 23.4% of the variance in empirical networks of resting-state fast oscillations is explained by the underlying white matter architecture. By simulating functional connectivity using a simple reference model, the match between simulated and empirical functional connectivity further increases to 45.4%. In a second step, we use our modeling framework to explore several technical alternatives along the modeling path. First, we find that an augmentation of homotopic connections in the structural connectivity matrix improves the link to functional connectivity while a correction for fiber distance slightly decreases the performance of the model. Second, a more complex computational model based on Kuramoto oscillators leads to a slight improvement of the model fit. Third, we show that the comparison of modeled and empirical functional connectivity at source level is much more specific for the underlying structural connectivity. However, different source reconstruction algorithms gave comparable results. Of note, as the fourth finding, the model fit was much better if zero-phase lag components were preserved in the empirical functional connectome, indicating a considerable amount of functionally relevant synchrony taking place with near zero or zero-phase lag. The combination of the best performing alternatives at each stage in the pipeline results in a model that explains 54.4% of the variance in the empirical EEG functional connectivity. Our study shows that large-scale brain circuits of fast neural network synchrony strongly rely upon the structural connectome and simple computational models of neural activity can explain missing links in the structure-function relationship.

Watch: Wiring the human brain – Slicing fiber tractography

All the pretty MRI pictures…

Click the image to see full-size

So, I got my MRI pictures back – including the DTI. This is my latest thing – looking through the pictures to see what I can see, and also compare my brain to how it was back in 2009, when I had my first MRI (for the seizure-like experiences).

I have yet to find out what they all mean, but one of my nagging concerns has subsided. I was worried that they would not find anything to explain my dizziness and other symptoms. But apparently, there are some ROIs (regions of interest) on my pictures (they are outlined in the picture above), and there are some apparent differences between the two sides of my brain.

Overall, the radiologist’s report came back looking quite good. At least, as far as I can tell… who knows what it really means? I’ll find out next Tuesday — less than a week, now — when I meet with them again and they have all my data in hand and have done the analysis.

The other thing I’m digging into is the DTI tractography, where you can see the actual connections between the different parts of the brain. I need a better viewer, because the one I have is 2D. I need a 3D viewer. But to do that, I need to have a more powerful computer, because this old clunker is still running Windows XP, from 2002. So, it’s time for an upgrade. It’s stood me in good stead, but it’s no good for doing modern work — like properly sized videos, as well as complex 3D rendering.

The new 3D viewers available today (some of them are actually free) are pretty amazing. If you have a modern computer (with Windows 7, at least, or possibly a Mac), you can see some amazing things. For free. There are also datasets you can download to view and play with. I have done a little bit of that, but again, my computer hasn’t been strong enough to keep up.

So, I went on eBay and found myself a better computer — for a fraction of what it would normally cost. I know what to look for, and I know how to select the stuff that will serve me best, so I can get a really great deal. This computer has lasted nearly 10 years, and it cost me a little over $200, so I’d say it’s been a good value.

I hope the same is true of the next one I get.

Anyway, I’ll be researching DTI MRIs as my new hobby. Radiology has always fascinated me, and the 3D technologies we have now are nothing short of amazing. It’s a great way to pass the time — you learn a lot, and it’s all very real stuff.

So, onward…

MRI Mack Truck

Okay, I know MRIs are just magnetic. You’re not getting zapped with a bunch of radiation, like with X-rays and PET scans. It’s just high-powered magnets flying around you.

But after two MRIs in the space of three days, I feel like crap.

The MRI place called me back, because the doctor ordered another type of image, so back I went, yesterday afternoon, through Friday afternoon traffic. Apparently, everyone was fleeing work early, because the traffic was terrible. And the MRI place is off in West Bumblef*ck, so it took a while to get there. This cut into time I really needed to spend on a couple of my projects at work, which I wanted to get done before the day was up. I ended up waiting around for nearly an hour, before they finally got me in (I’d thought if I got there earlier in the day, they’d finish up with me early – ’twas not to be.)

Anyway, they just needed to get a couple of images, which took all of15 minutes, tops. So, that wasn’t bad. I was able to hold still, and they said the images looked good. That was a relief. I tend to twitch and have tremors, which can screw things up. They put foam wedges in beside my head, so it would be propped in place, so I don’t think I moved at all.

Compared to the waiting, the MRI was the easy part. And the wait was easy, compared to my drive home.

I had a 90-minute trip through evening rush hour traffic, and it was interminable. I did manage to find some music to keep me going, but it was pretty rough. And I started to feel pretty sick after about 20 minutes in the car. I was aching all over, feeling hot and fevered, and my stomach was hurting me. I’ve gotten sick after MRIs before, but I assumed it was the gadolinium – the contrast agent. Yesterday, though, I was feeling pretty rough. I made it home safely, and promptly took a shower and went to bed.

I took my temperature a couple of times — 99.3, 99.4, 100.4 before my nap. After I woke up, I checked again, and it was 99.4, which was a 1 degree improvement. Then I lay in bed and surfed the web on my tablet for a while. I try to avoid doing that as much as possible. It’s bad sleep hygiene to look at devices in bed, and it totally messes up my sleeping schedule after a while, but I just couldn’t get up. I felt like I’d been run over — completely wiped out.

After another hour, I checked my temperature again, and it was normal – 98.6. I still wasn’t feeling great, but I went out and picked up some take-out food, so I didn’t have to cook. I got in bed before 11:00, and when I checked my temperature, it was 96.5, which is normal for me.

Today, my fever is gone, but every cell in my body hurts. I feel like I have the flu – without the chills and fever. My head is throbbing in a different way than normal. I don’t know how to describe it. It’s like a low-level pulsing all through it. Usually, my headaches are localized to the front of my skull, but this is an all-over headache.

And my body is just in pain. Everything hurts. When I move. When I hold still. When I sit. When I stand. And it hurts all through.

My stomach is upset, and I’m having gastrointestinal distress. This time, I had no contrast agent, so I’m not sure why my system is acting up, but it is. I felt pretty good after the first MRI – no noticeable side-effects, that I could tell. But today, I’m really feeling it.

I supposed it might have helped, if I’d waited longer between the scans. Even though it’s just magnets, it’s still sending something through your body – waves or whatever.  And if MRI were 100% benign, there wouldn’t be all those warning signs around the center. They have different zones, I assume to indicate different levels of exposure to whatever is in the airwaves, so there must be something about it that urges caution.

Now what do I do? I wasn’t able to sleep past 4 a.m.  I just lay in bed and listened to the owls hooting in the woods behind my house. I got up about 5 and did a little exercise, got my breakfast, and started my day as I normally do. I just need to get my body back on schedule, get it normalized, and make sure I get plenty of rest this weekend.

It’s light outside, now, so I’ll go for a walk in the woods. That’s always good for what ails me. And if I don’t feel great, I’ll just come home and go back to bed. I just need to get back to normal, and get my body feeling human again.

I just hope they find something useful. Because if they don’t, that’s two days lost — no, three, counting today.

I hope it will be worth it, and I’ll get some DTI results back that show something that my doctors can use. Here’s hoping.

Now, about that walk…

DTI went well – now I need to figure out how to look at it

I took the afternoon off yesterday to go get my DTI MRI. It went pretty well. I had time in advance to sit and read and hang out… and also rally, because I was incredibly tired.

The test went well – I had imaging in two separate machines, but I didn’t have to get a contrast injection, so that was good. I get sick from the gadolinium, plus it’s nasty radioactive stuff, and I can do without that.

I’m now looking at the images on my computer – and I’m trying to find a DTI viewer that shows the fiber networks that DTI is all about.

That’s the reason this whole thing is happening, and I really need to find some software that will let me do that before the doctors meet with me, just so I have some familiarity with the situation and I’m prepared for whatever they tell me.

Supposedly the viewer that comes with the CD can show it, but I haven’t been able to figure that out. I’ll have to take another crack at it. There must be something there. Or I would think they wouldn’t provide a viewer.

One of the problems is that I have a really old computer. It’s taking forever to just load the images – I left it on overnight and when I got up, it still wasn’t done, so there’s something wrong with that picture. I need a new computer, anyway — one that isn’t Windows XP, which is no longer supported (by pretty much everyone). And now I can find a Windows 7 computer for very low cost. So, that’s my next project. I really need to tool up properly all across the board — and not only for viewing MRI images. For everything.

Onward.

Keeping it fresh

I’m up early today, with my head spinning about so many different ideas. It’s good – but it has its drawbacks. I could have used a few more hours of sleep, but I’d rather just get up and take advantage of the time while I can. Having an extra hour at the start of the day gives me a lot more room to move and breathe.

I’m taking a break from my daily workouts, to let my body rest. I’ve had a lot of tightness in my back, shoulders, and hips, thanks to my muscles getting a good workout (and how my posture while I’m driving makes my left leg tighter than the right).  I was supposed to get a massage last night, but my appointment got moved, so I’ll need to figure out another way to loosen things up in the meantime. The pain is pretty intense, at times.

It’s important to break things up and keep things fresh, so that my system doesn’t acclimate to doing things the same way, every single day. I love my routine… but if I never break things up, eventually it doesn’t love me.

I think I’ll go out for a walk in the woods. It’s getting light earlier and earlier, and I have plenty of time for a leisurely hike before I go into the office. It will help me clear my mind and get things straightened out in my thinking. With so much going on in my head, it’s easy to lose track of what’s what. I have a list of all the stuff I need to do… but sometimes it’s easier to just back off and clear my head… then dive back in with a fresh eye.

I’ve got my MRI later today. I’m taking the afternoon off, so I have plenty of time to get there. I often take a wrong turn at the very last minute, making myself late, when I was so, so close… and I’ve given myself enough time to find my way back on track. I’ve studied the map a bunch of different ways, and I’ve calculated the time it will take me to get there.

I’m nervous, because I want it to go right. I want to make sure I don’t twitch and move, like I did on my last MRI, which screwed up one of the main images. That was really disappointing and frustrating, so I need to make sure they know I tend to do that. Ideally, they’d strap my head in place so it can’t move, but I’m not sure they can do that, so… here’s hoping it goes okay. I’ll just keep myself calm, do my deep breathing, and rest.

And all the while, keep myself fresh throughout the day, so I’m not too tired, when I get to the imaging place later this afternoon. I have a lot of miles to cover to get there, and I need to be safe.

Safe. And fresh. And incredibly grateful for this opportunity in front of me.

It’s turning out to be a lovely day. Time for a walk.

Onward.

YES. My DTI MRI is scheduled for next week

And here I thought they’d forgotten about me…

But this afternoon, I got a call from the MRI place to schedule my DTI MRI. They can see me next Wednesday afternoon, which is pretty awesome.

DTI MRI shows white matter connections in the brain — all the “cables” that communicate between the different sections, showing how everything is “talking to each other”.

Tomorrow, I have my EEG and autonomic function testing first thing in the morning. I’m not sure what I was thinking, scheduling it for 9:30 a.m. on a workday, when I have to deal with metro area traffic.

But there it is. I’ve got my appointments for tomorrow. And I’m looking forward to actually getting some data about my situation, instead of personal accounts and impressions. I need measurements. If you can’t measure it, you can’t manage it.

And after that, I have my neuropsych appointment at noon. There are only four more sessions with them, and it seems strange that after eight years, they’re going away.

But this happens all the time. And after being all torn up over it last weekend, I’m dealing.

Just get on with it.

So, that’s the news. I’m really excited to be getting all this done. It’s going to cost me some more money, but that’s what my flexible spending account is for at work. To offset this cost. So, it will.

Onward.

White Matter Injuries in Mild Traumatic Brain Injury and Posttraumatic Migraines: Diffusion Entropy Analysis

From Radiology:

Original Research in Neuroradiology

White Matter Injuries in Mild Traumatic Brain Injury and Posttraumatic Migraines: Diffusion Entropy Analysis

Abstract

Purpose

To determine the performance of Shannon entropy (SE) as a diagnostic tool in patients with mild traumatic brain injury (mTBI) with posttraumatic migraines (PTMs) and those without PTMs on the basis of analysis of fractional anisotropy (FA) maps.

Materials and Methods

The institutional review board approved this retrospective study, with waiver of informed consent. FA maps were obtained and neurocognitive testing was performed in 74 patients with mTBI (57 with PTM, 17 without PTM). FA maps were obtained in 22 healthy control subjects and in 20 control patients with migraine headaches. Mean FA and SE were extracted from total brain FA histograms and were compared between patients with mTBI and control subjects and between patients with and those without PTM. Mean FA and SE were correlated with clinical variables and were used to determine the areas under the receiver operating characteristic curve (AUCs) and likelihood ratios for mTBI and development of PTM.

Results

 Patients with mTBI had significantly lower SE (P < .001) and trended toward lower mean FA (P = .07) compared with control subjects. SE inversely correlated with time to recovery (TTR) (r = −0.272, P = .02). Patients with mTBI with PTM had significantly lower SE (P < .001) but not mean FA (P = .15) than did other patients with mTBI. SE provided better discrimination between patients with mTBI and control subjects than mean FA (AUC = 0.92; P = .01), as well as better discrimination between patients with mTBI with PTM and those without PTM (AUC = 0.85; P < .001). SE of less than 0.751 resulted in a 16.1 increased likelihood of having experienced mTBI and a 3.2 increased likelihood of developing PTM.

Conclusion

SE more accurately reveals mTBI than mean FA, more accurately reveals those patients with mTBI who develop PTM, and inversely correlates with TTR.