Neuroimaging findings in pediatric sports-related concussion

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>The goal in this review was to summarize the results of clinical neuroimaging studies performed in patients with sports-related concussion (SRC) who were referred to a multidisciplinar ypediatric concussion program.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors conducted a retrospective review of medical records and neuroimaging findings for all patients referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Inclusion criteria were as follows: 1) age ≤ 19 years; and 2) physician-diagnosed SRC. All patients underwent evaluation and follow-up by the same neurosurgeon. The 2 outcomes examined in this review were the frequency of neuroimaging studies performed in this population (including CT and MRI) and the findings of those studies. Clinical indications for neuroimaging and the impact of neuroimaging findings on clinical decision making were summarized where available. This investigation was approved by the local institutional ethics review board.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>A total of 151 patients (mean age 14 years, 59% female) were included this study. Overall, 36 patients (24%) underwent neuroimaging studies, the results of which were normal in 78% of cases. Sixteen percent of patients underwent CT imaging; results were normal in 79% of cases. Abnormal CT findings included the following: arachnoid cyst (1 patient), skull fracture (2 patients), suspected intracranial hemorrhage (1 patient), and suspected hemorrhage into an arachnoid cyst (1 patient). Eleven percent of patients underwent MRI; results were normal in 75% of cases. Abnormal MRI findings included the following: intraparenchymal hemorrhage and sylvian fissure arachnoid cyst (1 patient); nonhemorrhagic contusion (1 patient); demyelinating disease (1 patient); and posterior fossa arachnoid cyst, cerebellar volume loss, and nonspecific white matter changes (1 patient).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Results of clinical neuroimaging studies are normal in the majority of pediatric patients with SRC. However, in selected cases neuroimaging can provide information that impacts decision making about return to play and retirement from the sport.</jats:p></jats:sec>

Retirement-from-sport considerations following pediatric sports-related concussion: case illustrations and institutional approach

“…In this population, neuroimaging plays an important role not only in defining the extent of structural injury but also in the evaluation of other neurological disorders that can coexist with SRC and present with focal neurological deficits. 38,113 Understanding the pathophysiology of focal neurological deficits following SRC not only is important to allow physicians to initiate prompt, evidencebased management of underlying neurological conditions but also can be helpful in minimizing the risk of future or recurrent brain and spine injuries. In our experience, focal neurological deficits following pediatric SRC most commonly present as coexisting cranial nerve, cervical spine, or peripheral nerve injuries.…”

“…40 Although neuroimaging is commonly normal even in cases of severe cranial nerve deficits, these studies can also be helpful to rule out other conditions responsible for these deficits (neoplasm, inflammatory conditions, etc.). 38 The prognosis of traumatic cranial nerve palsies is largely dependent on the severity of injury at initial presentation. Most patients with traumatic optic, oculomotor, trochlear, and abducens neuropathies that present with mild deficits improve with conservative management, while those with complete injuries rarely experience a complete recovery.…”

“…1C and D). 38 Because clinical neuroimaging studies show normal findings in the vast majority of SRC patients, recent studies have applied numerous advanced neuroimaging techniques to this population including diffusion tensor imaging, task-based and resting-state functional MRI, resting cerebral blood flow imaging, and cerebrovascular reactivity mapping. 36,79,114 Although they have increased our insight into this condition, at present, none of the aforementioned techniques has advanced beyond research use to impact the routine clinical management of individual concussion patients.…”

“…30 Neuroimaging can also be helpful to evaluate whether there are any structural findings that may contribute to a prolonged recovery or neuropsychological deficits. 38 At present, there is insufficient empirical data to mandate sports retirement in pediatric patients based on the duration of PCS symptoms, total number of lifetime concussions, or number of concussions sustained over any given time period. There is also no empirical evidence to establish thresholds of concussions or subconcussive injuries that places children and adolescents at an elevated risk of developing mental health disorders, persistent neuropsychological deficits, or neurodegenerative conditions such as CTE.…”

Neurovascular Coupling: A Unifying Theory for Post-Concussion Syndrome Treatment and Functional Neuroimaging

“…Standard structural clinical neuroimaging studies have no abnormal findings for the majority of PCS patients as the clinical presentations of PCS are thought to be caused by cerebrovascular dysregulation and neuronal dysfunction [9][10][11]. However, functional MRI (fMRI), which uses blood oxygen-level dependent (BOLD) signaling, has shown abnormalities in patients with PCS [12,13].…”