Meningeal enhancement following traumatic brain injury: a mini review

Abstract

Traumatic brain injury (TBI) is a significant cause of neurological morbidity, often leading to blood–brain barrier (BBB) dysfunction and secondary injury mechanisms. Recent advancements in neuroimaging have highlighted traumatic meningeal enhancement (TME) on contrast-enhanced fluid-attenuated inversion recovery (FLAIR) MRI as a promising biomarker for detecting BBB disruption following TBI. TME, which is hypothesized to arise from vascular injury and inflammatory cascades that compromise the blood-meningeal barrier, has been associated with both acute trauma and long-term neurovascular dysfunction. Its presence, particularly when linked to subdural hematomas and delayed contrast extravasation, not only reflects the immediate severity of the injury but may also indicate chronic neuroinflammatory processes and persistent cognitive deficits. In this review, we gather current evidence on the pathophysiology of TME including its associations with vascular permeability, subdural hematoma, and prolonged inflammatory responses. We explore its potential as a biomarker for injury severity and prognosis in TBI patients. Finally, we further discuss the critical need for standardized imaging protocols and longitudinal studies to determine the clinical implications of persistent TME.