Hyperacute pathophysiology of traumatic and vascular brain injury captured by ultrasound, photoacoustic, and magnetic resonance imaging

Abstract: Cerebrovascular dynamics and pathomechanisms that evolve in the minutes and hours following traumatic vascular injury in the brain remain largely unknown. We investigated the pathophysiology evolution within the first three hours after closed-head traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH), two common traumatic vascular injuries, in mice. We took a multi-modal imaging approach using photoacoustic, color Doppler, and magnetic resonance imaging (MRI) in mice. Brain oxygenation (%sO2) and velocity-weighted volume of blood flow (VVF) values significantly decreased from baseline to fifteen minutes after both TBI and SAH. TBI resulted in 19.2% and 41.0% ipsilateral %sO2 and VVF reductions 15 minutes post injury while SAH resulted in 43.9% %sO2 and 85.0% VVF reduction ipsilaterally (p<0.001). We found partial recovery of %sO2 from 15 minutes to 3-hours after injury for TBI but not SAH. Hemorrhage, edema, reduced perfusion, and altered diffusivity were evident from MRI scans acquired 90-150 minutes after injury in both models although the spatial distribution was mostly focal for TBI and diffuse for SAH. The results reveal that the cerebral %sO2 deficits immediately following injuries are reversible for TBI and irreversible for SAH. Our findings can inform future studies on mitigating these early responses to improve long-term recovery.