Emotional Processing after Severe Traumatic Brain Injury: Insights from Functional MRI and Pupillometry

Objective: Emotional dysfunction is a common consequence of severe traumatic brain injury (TBI), yet the mechanisms underlying these symptoms remain poorly understood. This study investigated whether brain network and autonomic mechanisms involved in emotional processing are abnormal in TBI. Methods: We conducted a cross-sectional study of chronic severe TBI (n=26) and healthy control participants (n=15). We analysed functional MRI (fMRI) data to assess brain processing of emotionally salient music (joyful and fearful stimuli; n=15 TBI, n=15 controls), and resting-state fMRI (rsfMRI) to measure the functional connectivity of relevant intrinsic brain networks (limbic, salience, and default mode networks; n=16 TBI, n=15 controls). We additionally measured the pupillary light reflect (PLR) to assess parasympathetic and sympathetic function (n=14 TBI, n=11 controls). Results: Individuals with severe TBI did not demonstrate the left insula activation elicited by joyful versus fearful musical stimuli seen in healthy controls. rsfMRI revealed decreased connectivity between the salience network, caudate and hippocampus in severe TBI compared to controls. Exploratory analyses identified reduced connectivity between default mode (bilateral medial prefrontal cortex) and limbic (bilateral amygdala) nodes in TBI compared to controls. PLR measurements revealed blunted dark-adaptation responses in individuals with severe TBI compared to controls (F(1,24)=27.4, p