Neuroimaging and Its Application in the Diagnosis and Early Prognostication of Traumatic Brain Injury (TBI)

Neuroimaging in traumatic brain injury dates to not more than half a century ago. Although attempts to appraise and gauge the contents of the skull have been in situ since 300 BC, when Aristotle attached brain with a secondary role of just being a medium of heat dissipation. He stressed heart to be the seat of all actions. However, progress to gander this mystique entity continued, albeit at a lackadaisical pace. Not until 1664 when Oxford physiologist Thomas Willis promulgated the first diagram of brain that it was considered a hollow space filled with humorous fluid. Guesstimating the skull contents was constrained due to a lack of imaging and autopsies. The archetypal anecdote of Phineas Gage’s impalement injury to brain in 1848 provides some clues into this realm and cannot be underestimated. Theoretical Neuroimaging (Phrenology) proposed by Franz Joseph Gall by estimating the attributes or virtues based on contours of skull although termed ersatz by many, formed one of the earliest bases for functional organisation in brain. It was in 1880 that the world saw its first realistic attempt at neuroimaging by Italian physiologist Angelo Mosso of which few transcripts and drawings remain. It was an endeavour proposing that parts of the brain during functional load draw increased blood supply, which forms the bases of modern-day functional MRI (fMRI). Pursuit for better neuroimaging continued after the invention of X-rays by William Roentgen, a physicist in 1895 with Walter Dandy introducing Pneumoencephalography in 1918, Egas Moniz inventing cerebral angiography in 1920, Hans Berger devising EEG in 1924, Gordon Brownell and colleagues developing positron emission tomography (PET) in the 1950s. The groundbreaking discovery of computerised tomography (CT) conceived by William Oldendorf and applied by Hounsfield in 1973 opened new vistas into those parts of brain that remained unwitnessed till date. It was followed by the most promising discovery of current human imaging research by Paul Lauterbur in 1971. He developed magnetic resonance imaging (MRI), which would not only provide intricate anatomic details but also form the basis of molecular imaging in brain giving insights into functional, physiological and electrical roleplay. In the same year, clinical application of MRI in diagnosing brain cancer by Raymond Damadian would lay the foundation of diagnostic and prognostic neuroimaging.