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Relation between injury of the hypothalamus and subjective excessive daytime sleepiness in patients with mild traumatic brain injury
  1. Sung Ho Jang1,
  2. Ji Hyun Yi2,
  3. Seong Ho Kim3,
  4. Hyeok Gyu Kwon1
  1. 1 Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
  2. 2 The department of Diagnostic Radiology, College of Medicine, Yeungnam University, Daegu, Republic of Korea
  3. 3 Department of Neurosurgery, College of Medicine Yeungnam University, Daegu, Republic of Korea
  1. Correspondence to Hyeok Gyu Kwon, Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University 317-1, Daemyungdong, Namku, Daegu 705-717, Republic of Korea; khg0715{at}

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Subjective excessive daytime sleepiness (SEDS) is a common sequela following traumatic brain injury (TBI) and occupies 14–57% of patients with TBI.1 Post-TBI, SEDS is related to daytime function, reduced cognitive function, and psychiatric disorders such as depression and anxiety; thus, elucidation of its pathogenetic mechanism is clinically important.1 Although the pathogenesis of post-TBI SEDS has not been clearly elucidated, injury of several neural structures, including the hypothalamus, ascending reticular activating system and pontine nuclei, has been suggested as the pathogenetic mechanism of SEDS following TBI.1 Among these neural structures, injury of the hypothalamus, a key regulator of sleep and wakefulness, has been suggested as a convincing pathogenetic mechanism of post-TBI SEDS; however, this has not been clearly demonstrated.

TBI is classified as mild, moderate and severe according to the severity, and mild TBI has been reported in 75–85% of cases of TBI. Patients with mild TBI frequently experience various neurological symptoms derived from neural injury. Diffusion tensor imaging (DTI) has enabled quantitative estimation of neural structures and many studies have demonstrated injury of neural structures following mild TBI. However, no study on injury of the hypothalamus has been reported.

In this study, using DTI, we investigated the relation between SEDS and injury of the hypothalamus in patients with mild TBI.



Fifty-three patients with TBI and 33 age-matched and sex-matched healthy control subjects with no history of neurological, physical or psychiatric illness were recruited for this study. …

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  • SHJ and JHY are co-first authors and contributed equally to this work.

  • Contributors SHJ was involved in the conceiving of and designing the study, funding, and manuscript development and writing. JHY was involved in the conceiving of and designing the study, and manuscript writing. SHK participated in the data acquisition and provided technical support. HGK contributed to the data analysis; and manuscript development, writing and authorisation.

  • Funding The National Research Foundation (NRF) of Korea Grant funded by the Korean Government (MSIP) (grant number 2015R1A2A2A01004073).

  • Competing interests None declared.

  • Ethics approval The study protocol was approved by the Institutional Review Board of Yeungnam University hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.