Planning Target Volume Margin in Linac-Based Stereotactic Radiosurgery for Brain Metastases

Background: The treatment of brain metastases with radiotherapy has shifted to the use of Stereotactic Radio-surgery (SRS). The technical issue of expanding the treatment volume around the Gross Tumor Volume (GTV) is a current debate. Radiotherapy centers use variable GTV-PTV margins, ranging from one to 2 mm. Material and Methods: We performed a dosimetric comparison in plans of twenty patients using three margins: PTV zero, PTV1, and PTV2. We also developed imaginary Peel volumes. These volumes are described as follows: Peel1 = PTV1 − GTV, Peel2 = PTV2 − GTV. Results: Our results showed that the mean PTV volume differed significantly across the different margins (p = 0.000). The V12 of the brain significantly varied as a function of PTV margin (p = 0.000). The target coverage and plan quality indices were not significantly different. The Peel volume dosimetric analysis showed that the mean dose was significantly higher in the nearby normal brain tissue: Peel1 (p = 0.022) and Peel 2 (p = 0.013). Conclusion: According to our dosimetric analysis, expanding the GTV into a PTV by 1 mm margin is more convenient than 2 mm.

Regional volume changes of the brain in migraine chronification

The pathophysiology of migraine is complex.Neuroimaging studies reveal functional and structural changes in the brains of migraine patients.We sought to explore regional volume differences in intracranial structures in patients with episodic and chronic migraine.Sixteen episodic migraine patients,16 chronic migraine patients,and 24 normal controls were recruited and underwent 3.0 T MRI scanning.The volumes of 142 brain regions were calculated by an automatic volumetric algorithm and compared with clinical variables.Results demonstrated that the volumes of specific regions in the frontal and occipital lobes,and the right putamen,were increased and the volume of the fourth ventricle was decreased in the episodic migraine patients compared with controls.The volumes of the left basal forebrain,optic chiasm,and,the fourth ventricle were decreased in the chronic migraine patients,while the occipital cortex and the right putamen were larger.Compared to episodic migraine patiants,chronic migraine patients displayed larger left thalamus and smaller frontal regions.Correlation analysis showed that headache frequency was negatively correlated with the volume of the right frontal pole,right lateral orbital gyrus,and medial frontal lobes and positively correlated with the volume of the left thalamus.The sleep disturbance score was negatively correlated with the volume of the left basal forebrain.This suggests that migraine patients have structural changes in regions associated with pain processing and modulation,affective and cognitive processing,and visual perception.The remodeling of selective intracranial structures may be involved in migraine attacks.This study was approved by the Ethics Committee of Chinese PLA General Hospital(approval No.S2018-027-02)on May 31,2018.

Volume transmission and receptor-receptor interactions in heteroreceptor complexes:understanding the role of new concepts for brain communication

The discovery of the central monoamine neurons not only demonstrated novel types of brain stem neurons forming global terminal networks all over the brain and the spinal cord,but also to a novel type of communication called volume transmission.It is a major mode of communication in the central nervous system that takes places in the extracellular fluid and the cerebral spinal fluid through diffusion and flow of molecules,like neurotransmitters and extracellular vesicles.The integration of synaptic and volume transmission takes place through allosteric receptor-receptor interactions in heteroreceptor complexes.These heterocomplexes represent major integrator centres in the plasma membrane and their protomers act as moonlighting proteins undergoing dynamic changes and their structure and function.In fact,we propose that the molecular bases of learning and memory can be based on the reorganization of multiples homo and heteroreceptor complexes into novel assembles in the post-junctional membranes of synapses.

Automated Brain Hemorrhage Classification and Volume Analysis

Brain hemorrhage is a serious and life-threatening condition. It cancause permanent and lifelong disability even when it is not fatal. The wordhemorrhage denotes leakage of blood within the brain and this leakage ofblood from capillaries causes stroke and adequate supply of oxygen to thebrain is hindered. Modern imaging methods such as computed tomography(CT) and magnetic resonance imaging (MRI) are employed to get an idearegarding the extent of the damage. An early diagnosis and treatment can savelives and limit the adverse effects of a brain hemorrhage. In this case, a deepneural network (DNN) is an effective choice for the early identification andclassification of brain hemorrhage for the timely recovery and treatment of anaffected person. In this paper, the proposed research work is divided into twonovel approaches, where, one for the classification and the other for volumecalculation of brain hemorrhage. Two different datasets are used for twodifferent techniques classification and volume. A novel algorithm is proposedto calculate the volume of hemorrhage using CT scan images. In the firstapproach, the ‘RSNA’ dataset is used to classify the brain hemorrhage typesusing transfer learning and achieved an accuracy of 93.77%. Furthermore,in the second approach, a novel algorithm has been proposed to calculate thevolume of brain hemorrhage and achieved tremendous results as 1035.91mm3and 9.25 cm3, using the PhysioNet CT scan tomography dataset.

Modified technique for volumetric brain tumor measurements

Quantitative measurements of tumor response rate in three dimensions (3D) become more re-alistic with the use of advanced technology im-aging during therapy, especially when the tumor morphological changes remain subtle, irregular and difficult to assess by clinical examination. These quantitative measurements depend strongly on the accuracy of the segmentations methods used. Improvements on such methods yield to increase the accuracy of the segmentation process. Recently, the essential modification in the Traditional Region Growing (T-RG) method has been developed and a “Modified Region Growing Method” (MRGM) has been presented and gives more accurate boundary detection and holes filling after segmentation. In this pa-per, the new automatic calculation of the volu-metric size of brain tumor has been imple-mented based on Modified Region Growing Method. A comparative study and statistical analysis performed in this work show that the modified method gives more accurate and better performance for 3D volume measurements. The method was tested by 7 fully investigated pa-tients of different tumor type and shape, and better accurate results were reported using MRGM.

The effects of decompressive craniectomy on cerebral blood flow volume and brain metabolism in different aged patients with severe traumatic brain injury

Objective To explore effects of decompressive craniectomy on cerebral blood flow volume and brain metabolism in different aged patients with severe traumatic brain injury. Methods 71 cases were divided into three groups according age: group A( 【 30 years) ,group B ( 30 ～ 50 years) 。

Numerical study on dynamic mechanism of brain volume and shear deformation under blast loading

Blast-induced traumatic brain injury(b-TBI)is a kind of significant injury to soldiers in the current military conflicts.However,the mechanism of b-TBI has not been well understood,and even there are some contradictory conclusions.It is crucial to reveal the dynamic mechanism of brain volume and shear deformations under blast loading for better understanding of b-TBI.In this paper,the numerical simulation method is adopted to carry out comprehensive and in-depth researches on this issue for the first time.Based on the coupled Eulerian-Lagrangian method,the fluid-structure coupling model of the blast wave and human head is developed to simulate two situations,namely the head subjected to the frontal and lateral impacts.The simulation results are analyzed to obtain the underlying dynamic mechanisms of brain deformation.The brain volume deformation is dominated by the local bending vibration of the skull,and the corresponding frequency for the forehead skull under the frontal impact and the lateral skull faced to the lateral impact is as high as 8 kHz and 5 kHz,respectively.This leads to the high-frequency fluctuation of brain pressure and the large pressure gradient along the skull,totally different from the dynamic response of brain under head collisions.While the brain shear deformation mainly depends on the relative tangential displacement between the skull and brain and the anatomical structure of inner skull,being not related to the brain pressure and its gradient.By further comparing the medical statistics,it is inferred that diffuse axonal injury and brain contusion,the two most common types of b-TBI,are mainly attributed to brain shear deformations.And the von Mises stress can be adopted as the indicator for these two brain injuries.This study can provide theoretical guidance for the diagnosis of b-TBI and the development of protective equipment.

Value of serial magnetic resonance imaging in the assessment of brain metastases volume control during stereotactic radiosurgery

AIM To evaluate brain metastases volume control capabilities of stereotactic radiosurgery(SRS) through serial magnetic resonance(MR) imaging follow-up. METHODS MR examinations of 54 brain metastases in 31 patients before and after SRS were reviewed. Patients were included in this study if they had a pre-treatment MR examination and serial follow-up MR examinations at 6 wk, 9 wk, 12 wk, and 12 mo after SRS. The metastasis volume change was categorized at each follow-up as increased(> 20% of the initial volume), stable(± 20% of the initial volume) or decreased(< 20% of the initial volume). RESULTS A local tumor control with a significant(P < 0.05) volume decrease was observed in 25 metastases at 6-wk follow-up. Not significant volume change was observed in 23 metastases and a significant volume increase was observed in 6 metastases. At 9-wk followup, 15 out of 25 metastases that decreased in size at 6 wk had a transient tumor volume increase, followed by tumor regression at 12 wk. At 12-wk follow-up there was a significant reduction in volume in 45 metastases, and a significant volume increase in 4 metastases. At 12-mo follow-up, 19 metastases increased significantly in size(up to 41% of the initial volume). Volume tumor reduction was correlated to histopathologic subtype.CONCLUSION SRS provided an effective local brain metastases volume control that was demonstrated at follow-up MR imaging.

DETECTION OF Ca^(2+)-DEPENDENT NEURONAL ACTIVITY SIMULTANEOUSLY WITH DYNAMIC CHANGES IN CEREBRAL BLOOD VOLUME AND TISSUE OXYGENATION FROM THE LIVE RAT BRAIN

We present a catheter-based optical diffusion and fluorescence(ODF)probe to study the functional changes of the brain in vivo.This ODF probe enables the simultaneous detection ofthe multi-wavelength absorbance and fluorescence emission from the living rat brain.Our previous studies,including a transient stroke experiment of the rat brain as well as the brainresponse to cocaine,have established the feasibility of simultaneously determining changes incerebral blood volume(CBV),tissue oxygenation(StO2)and intracellular calcium([Ca^(2+)]i,using the fluorescence indicator Rhod2).Here,we present our preliminary results of somatosensory response to electrical forepaw stimulation obtained from the rat cortical brain by using theODF probe,which indicate that the probe could track brain activation by directly detecting[Ca^(2+)]i along with separately distinguishing CBV and StO2 in real time.The changes of CBV,StO2 and[Ca^(2+)]i are comparable with the blood-oxygen-level-dependent(BOLD)response tothe stimulation obtained using functional magnetic resonance imaging(fMRI).However,thehigh temporal resolution of the optical methodology is advanced,thus providing a new modalityfor brain functional studies to understand the hemodynamic changes that underlie the neuronalactivity.

Effect of Chronic DL-Amphetamine Exposure on Brain Volume, Anxiogenic, Locomotor, and Social Behaviors in Male SD Rats

Research examining the long-term effects of drugs such as AdderallTM, a mixed DL-amphetamine, as a first-line treatment strategy for those diagnosed with attention deficit hyperactivity disorder (ADHD), is very much lacking. In order to address this, the present study sought to examine possible behavioral and neuroanatomical effects of chronic oral exposure to DL-amphetamine administered at a relatively low dose to the developing male Sprague Dawley rat. Animals were administered a mixture of chocolate drink and DL-amphetamine at a dose of 1.6 mg/kg for 36 days, beginning at PD 24 and ending at PD 60. Anxiety, a potential side effect of stimulant treatment, was assessed using three paradigms: The open field test (OF), the social interaction test (SI), and the elevated plus maze (EPM). The OF and SI were conducted using repeated testing over the course of five weeks. Testing occurred immediately after drug administration on a given day. The EPM was used only once on the penultimate day of treatment, before the drug was administered. Following drug treatment on PD 60, brain-to-body weight ratios were obtained. Results indicated that there were no group differences in brain-to-body weight ratios nor were differences in locomotor and social behaviors observed. However, rats treated with DL-amphetamine did show an anxiogenic response in the EPM. This was represented as a significant reduction in open arm entries. Overall our findings suggest that while chronic drug treatment fails to alter multiple measures of behavior, or reliable changes in brain volume, such treatment may impact a behavioral index of anxiety. Future research should seek to examine the implications of this heightened anxiogenic response in animals treated chronically with oral, low-dose DL-amphetamine.

Hypidone hydrochloride(YL-0919)ameliorates functional deficits after traumatic brain injury in mice by activating the sigma-1 receptor for antioxidation

Traumatic brain injury involves complex pathophysiological mechanisms,among which oxidative stress significantly contributes to the occurrence of secondary injury.In this study,we evaluated hypidone hydrochloride(YL-0919),a self-developed antidepressant with selective sigma-1 receptor agonist properties,and its associated mechanisms and targets in traumatic brain injury.Behavioral experiments to assess functional deficits were followed by assessment of neuronal damage through histological analyses and examination of blood-brain barrier permeability and brain edema.Next,we investigated the antioxidative effects of YL-0919 by assessing the levels of traditional markers of oxidative stress in vivo in mice and in vitro in HT22 cells.Finally,the targeted action of YL-0919 was verified by employing a sigma-1 receptor antagonist(BD-1047).Our findings demonstrated that YL-0919 markedly improved deficits in motor function and spatial cognition on day 3 post traumatic brain injury,while also decreasing neuronal mortality and reversing blood-brain barrier disruption and brain edema.Furthermore,YL-0919 effectively combated oxidative stress both in vivo and in vitro.The protective effects of YL-0919 were partially inhibited by BD-1047.These results indicated that YL-0919 relieved impairments in motor and spatial cognition by restraining oxidative stress,a neuroprotective effect that was partially reversed by the sigma-1 receptor antagonist BD-1047.YL-0919 may have potential as a new treatment for traumatic brain injury.

Understanding the link between type 2 diabetes mellitus and Parkinson's disease:role of brain insulin resistance

Type 2 diabetes mellitus and Parkinson's disease are chronic diseases linked to a growing pandemic that affects older adults and causes significant socio-economic burden.Epidemiological data supporting a close relationship between these two aging-related diseases have resulted in the investigation of shared pathophysiological molecular mechanisms.Impaired insulin signaling in the brain has gained increasing attention during the last decade and has been suggested to contribute to the development of Parkinson's disease through the dysregulation of several pathological processes.The contribution of type 2 diabetes mellitus and insulin resistance in neurodegeneration in Parkinson's disease,with emphasis on brain insulin resistance,is extensively discussed in this article and new therapeutic strategies targeting this pathological link are presented and reviewed.

Bidirectional regulation of the brain-gut-microbiota axis following traumatic brain injury

Traumatic brain injury is a prevalent disorder of the central nervous system.In addition to primary brain parenchymal damage,the enduring biological consequences of traumatic brain injury pose long-term risks for patients with traumatic brain injury;however,the underlying pathogenesis remains unclear,and effective intervention methods are lacking.Intestinal dysfunction is a significant consequence of traumatic brain injury.Being the most densely innervated peripheral tissue in the body,the gut possesses multiple pathways for the establishment of a bidirectional“brain-gut axis”with the central nervous system.The gut harbors a vast microbial community,and alterations of the gut niche contribute to the progression of traumatic brain injury and its unfavorable prognosis through neuronal,hormonal,and immune pathways.A comprehensive understanding of microbiota-mediated peripheral neuroimmunomodulation mechanisms is needed to enhance treatment strategies for traumatic brain injury and its associated complications.We comprehensively reviewed alterations in the gut microecological environment following traumatic brain injury,with a specific focus on the complex biological processes of peripheral nerves,immunity,and microbes triggered by traumatic brain injury,encompassing autonomic dysfunction,neuroendocrine disturbances,peripheral immunosuppression,increased intestinal barrier permeability,compromised responses of sensory nerves to microorganisms,and potential effector nuclei in the central nervous system influenced by gut microbiota.Additionally,we reviewed the mechanisms underlying secondary biological injury and the dynamic pathological responses that occur following injury to enhance our current understanding of how peripheral pathways impact the outcome of patients with traumatic brain injury.This review aimed to propose a conceptual model for future risk assessment of central nervous system-related diseases while elucidating novel insights into the bidirectional effects of the“brain-gut-microbiota axis.”

Engendered nanoparticles for treatment of brain tumors

Brain metastasis and primary glioblastoma multiforme represent the most common and lethal malignant brain tumors.Its median survival time is typically less than a year after diagnosis.One of the major challenges in treating these cancers is the efficiency of the transport of drugs to the central nervous system.The blood-brain barrier is cooperating with advanced stages of malignancy.The blood-brain barrier poses a significant challenge to delivering systemic medications to brain tumors.Nanodrug delivery systems have emerged as promising tools for effectively crossing this barrier.Additionally,the development of smart nanoparticles brings new hope for cancer diagnosis and treatment.These nanoparticles improve drug delivery efficiency,allowing for the creation of targeted and stimuli-responsive delivery methods.This review highlights recent advancements in nanoparticle and smart nanoparticle technologies for brain cancer treatment,exploring the range of nanoparticles under development,their applications,targeting strategies,and the latest progress in enhancing transport across the blood-brain barrier.It also addresses the ongoing challenges and potential benefits of these innovative approaches.

Treadmill exercise in combination with acousto-optic and olfactory stimulation improves cognitive function in APP/PS1 mice through the brain-derived neurotrophic factor-and Cygb-associated signaling pathways

A reduction in adult neurogenesis is associated with behavioral abnormalities in patients with Alzheimer's disease.Consequently,enhancing adult neurogenesis represents a promising therapeutic approach for mitigating disease symptoms and progression.Nonetheless,nonpharmacological interventions aimed at inducing adult neurogenesis are currently limited.Although individual non-pharmacological interventions,such as aerobic exercise,acousto-optic stimulation,and olfactory stimulation,have shown limited capacity to improve neurogenesis and cognitive function in patients with Alzheimer's disease,the therapeutic effect of a strategy that combines these interventions has not been fully explored.In this study,we observed an age-dependent decrease in adult neurogenesis and a concurrent increase in amyloid-beta accumulation in the hippocampus of amyloid precursor protein/presenilin 1 mice aged 2-8 months.Amyloid deposition became evident at 4 months,while neurogenesis declined by 6 months,further deteriorating as the disease progressed.However,following a 4-week multifactor stimulation protocol,which encompassed treadmill running(46 min/d,10 m/min,6 days per week),40 Hz acousto-optic stimulation(1 hour/day,6 days/week),and olfactory stimulation(1 hour/day,6 days/week),we found a significant increase in the number of newborn cells(5'-bromo-2'-deoxyuridine-positive cells),immature neurons(doublecortin-positive cells),newborn immature neurons(5'-bromo-2'-deoxyuridine-positive/doublecortin-positive cells),and newborn astrocytes(5'-bromo-2'-deoxyuridine-positive/glial fibrillary acidic protein-positive cells).Additionally,the amyloid-beta load in the hippocampus decreased.These findings suggest that multifactor stimulation can enhance adult hippocampal neurogenesis and mitigate amyloid-beta neuropathology in amyloid precursor protein/presenilin 1 mice.Furthermore,cognitive abilities were improved,and depressive symptoms were alleviated in amyloid precursor protein/presenilin 1 mice following multifactor stimulation,as evidenced by Morris water maze,novel object recognition,forced swimming test,and tail suspension test results.Notably,the efficacy of multifactor stimulation in consolidating immature neurons persisted for at least 2weeks after treatment cessation.At the molecular level,multifactor stimulation upregulated the expression of neuron-related proteins(NeuN,doublecortin,postsynaptic density protein-95,and synaptophysin),anti-apoptosis-related proteins(Bcl-2 and PARP),and an autophagyassociated protein(LC3B),while decreasing the expression of apoptosis-related proteins(BAX and caspase-9),in the hippocampus of amyloid precursor protein/presenilin 1 mice.These observations might be attributable to both the brain-derived neurotrophic factor-mediated signaling pathway and antioxidant pathways.Furthermore,serum metabolomics analysis indicated that multifactor stimulation regulated differentially expressed metabolites associated with cell apoptosis,oxidative damage,and cognition.Collectively,these findings suggest that multifactor stimulation is a novel non-invasive approach for the prevention and treatment of Alzheimer's disease.

A new horizon for neuroscience:terahertz biotechnology in brain research

Terahertz biotechnology has been increasingly applied in various biomedical fields and has especially shown great potential for application in brain sciences.In this article,we review the development of terahertz biotechnology and its applications in the field of neuropsychiatry.Available evidence indicates promising prospects for the use of terahertz spectroscopy and terahertz imaging techniques in the diagnosis of amyloid disease,cerebrovascular disease,glioma,psychiatric disease,traumatic brain injury,and myelin deficit.In vitro and animal experiments have also demonstrated the potential therapeutic value of terahertz technology in some neuropsychiatric diseases.Although the precise underlying mechanism of the interactions between terahertz electromagnetic waves and the biosystem is not yet fully understood,the research progress in this field shows great potential for biomedical noninvasive diagnostic and therapeutic applications.However,the biosafety of terahertz radiation requires further exploration regarding its two-sided efficacy in practical applications.This review demonstrates that terahertz biotechnology has the potential to be a promising method in the field of neuropsychiatry based on its unique advantages.

Decoding molecular mechanisms:brain aging and Alzheimer's disease

The complex morphological,anatomical,physiological,and chemical mechanisms within the aging brain have been the hot topic of research for centuries.The aging process alters the brain structure that affects functions and cognitions,but the worsening of such processes contributes to the pathogenesis of neurodegenerative disorders,such as Alzheimer's disease.Beyond these observable,mild morphological shifts,significant functional modifications in neurotransmission and neuronal activity critically influence the aging brain.Understanding these changes is important for maintaining cognitive health,especially given the increasing prevalence of age-related conditions that affect cognition.This review aims to explore the age-induced changes in brain plasticity and molecular processes,differentiating normal aging from the pathogenesis of Alzheimer's disease,thereby providing insights into predicting the risk of dementia,particularly Alzheimer's disease.

Unraveling brain aging through the lens of oral microbiota

The oral cavity is a complex physiological community encompassing a wide range of microorganisms.Dysbiosis of oral microbiota can lead to various oral infectious diseases,such as periodontitis and tooth decay,and even affect systemic health,including brain aging and neurodegenerative diseases.Recent studies have highlighted how oral microbes might be involved in brain aging and neurodegeneration,indicating potential avenues for intervention strategies.In this review,we summarize clinical evidence demonstrating a link between oral microbes/oral infectious diseases and brain aging/neurodegenerative diseases,and dissect potential mechanisms by which oral microbes contribute to brain aging and neurodegeneration.We also highlight advances in therapeutic development grounded in the realm of oral microbes,with the goal of advancing brain health and promoting healthy aging.

Beyond wrecking a wall:revisiting the concept of blood–brain barrier breakdown in ischemic stroke

The blood–brain barrier constitutes a dynamic and interactive boundary separating the central nervous system and the peripheral circulation.It tightly modulates the ion transport and nutrient influx,while restricting the entry of harmful factors,and selectively limiting the migration of immune cells,thereby maintaining brain homeostasis.Despite the well-established association between blood–brain barrier disruption and most neurodegenerative/neuroinflammatory diseases,much remains unknown about the factors influencing its physiology and the mechanisms underlying its breakdown.Moreover,the role of blood–brain barrier breakdown in the translational failure underlying therapies for brain disorders is just starting to be understood.This review aims to revisit this concept of“blood–brain barrier breakdown,”delving into the most controversial aspects,prevalent challenges,and knowledge gaps concerning the lack of blood–brain barrier integrity.By moving beyond the oversimplistic dichotomy of an“open”/“bad”or a“closed”/“good”barrier,our objective is to provide a more comprehensive insight into blood–brain barrier dynamics,to identify novel targets and/or therapeutic approaches aimed at mitigating blood–brain barrier dysfunction.Furthermore,in this review,we advocate for considering the diverse time-and location-dependent alterations in the blood–brain barrier,which go beyond tight-junction disruption or brain endothelial cell breakdown,illustrated through the dynamics of ischemic stroke as a case study.Through this exploration,we seek to underscore the complexity of blood–brain barrier dysfunction and its implications for the pathogenesis and therapy of brain diseases.

Inflammasome links traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease

Traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease are three distinct neurological disorders that share common pathophysiological mechanisms involving neuroinflammation. One sequela of neuroinflammation includes the pathologic hyperphosphorylation of tau protein, an endogenous microtubule-associated protein that protects the integrity of neuronal cytoskeletons. Tau hyperphosphorylation results in protein misfolding and subsequent accumulation of tau tangles forming neurotoxic aggregates. These misfolded proteins are characteristic of traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease and can lead to downstream neuroinflammatory processes, including assembly and activation of the inflammasome complex. Inflammasomes refer to a family of multimeric protein units that, upon activation, release a cascade of signaling molecules resulting in caspase-induced cell death and inflammation mediated by the release of interleukin-1β cytokine. One specific inflammasome, the NOD-like receptor protein 3, has been proposed to be a key regulator of tau phosphorylation where it has been shown that prolonged NOD-like receptor protein 3 activation acts as a causal factor in pathological tau accumulation and spreading. This review begins by describing the epidemiology and pathophysiology of traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease. Next, we highlight neuroinflammation as an overriding theme and discuss the role of the NOD-like receptor protein 3 inflammasome in the formation of tau deposits and how such tauopathic entities spread throughout the brain. We then propose a novel framework linking traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease as inflammasomedependent pathologies that exist along a temporal continuum. Finally, we discuss potential therapeutic targets that may intercept this pathway and ultimately minimize long-term neurological decline.