Neuroimaging of concussion patients in an outpatient clinic

Abstract

ObjectiveTo evaluate the use of neuroimaging safety, diagnoses, and potential treatment of patients with concussion.MethodsThis retrospective study took advantage of a concussion database to analyze neuroimaging in concussion patients of all ages. Details of neuroimaging orders were tracked and categorized as hospital emergency rooms, primary care physicians, neurologists at DENT, or by other specialists. Neuroimaging consisted of MRI and/or CT scans, which were classified as normal or abnormal. Abnormal MRI scans consisted of white matter changes, brain hemorrhage, chiari malformation, cyst arachnoid, hydrocephalus, incidental unrelated finding, or a developmental venous anomaly. Abnormal was further defined as abnormal due to head injury, unrelated to the concussion but unlikely to prolong recovery time, or unrelated to the concussion but may prolong recovery time.ResultsAmong the 835 diagnosed with concussion, 715 (86%) patients ages 1–78 had neuroimaging completed (615 MRI and 422 CT). Among these patients 401 (95%) had a CT order prior to coming to Dent, 319 (80%) from emergency rooms, 64 (16%) from primary care physicians, and 18 (4%) from other physician specialists. The rate of ordering an MRI was 46% greater than the rate of ordering a CT scans, while the rate of discovering an abnormality within MRI scans was 3 times greater than CTs (24.3% vs 7.8%).ConclusionsThere exists a remarkable discrepancy between the rate of ordering neuroimaging in concussion patients (46% more MRI vs CT orders) and the rate at which neuroimaging in these patients discovered brain abnormalities (×2.11 more in MRI vs CT reads). We acknowledge that improvement is required in the length of time in the MRI scanner and cost of MRI technology. However, additional consideration is required in abnormality detection effectiveness, cost efficiency, and radiation safety in balancing the use of MRI and CT technology.

Effects of Marijuana Use in Patients with Orthopaedic Trauma

“…TBI and PTSD following major trauma can be debilitating and have a high prevalence. While human studies on the effects of marijuana use on TBI and PTSD are lacking, some 24 have shown improvement in symptoms. Other aspects of TBI, including cognitive function and motor function recovery, have not demonstrated improvement with marijuana use in the current body of literature 28 .…”

“…Retrospective studies have shown promising results in terms of alleviating TBI-associated symptoms with the use of medical marijuana. One such study of patients with mild TBI showed that the use of medical cannabis was associated with improvements in sleep, headache, mood, and quality of life compared with the outcomes in patients not using medical cannabis following mild TBI 24 . Patients who used medical cannabis also showed a 38% decrease in opioid use or discontinued using opioids altogether.…”

“…Much research is needed in the realm of TBI; however, a single study demonstrated positive effects with medical cannabis in terms of reducing the severity of symptoms associated with TBI such as sleep disturbances and headaches while at the same time improving mood 24 . The current body of literature has not demonstrated that cannabis results in significant improvement in physical rehabilitation recovery in the form of advanced brain imaging findings, cognitive function, or motor function.…”

“…The focus of our study includes the effects associated with preexisting use as well as any possible therapeutic potential associated with this increasingly used drug. Specifically, we focused on the effects that cannabis use and specific phytocannabinoids may have on traumatic brain 20 Human/animal Schurman and Lichtman 21 Animal Panikashvili et al 22 Animal van der Stelt et al 23 Animal McVige et al 24 Human Lawrence et al 25 Human Yoles et al 27 Animal Knoller et al 26 Human Maas et al 28 Human Bone healing Idris et al 29 Animal Bab 30 Animal Bab et al 31 Animal Tam et al 32 Animal Gowran et al 33 Animal Idris et al 34 Animal Ofek et al 35 Animal Karsak et al 36 Human Kogan et al 37 Animal Kamali et al 38 Animal Whyte et al 39 Animal Nogueira-Filho et al 40 Animal Hudson et al 41 Animal Law et al 42 Human Burgdorf et al 43…”

The modulatory role of cannabis use in subconcussive neural injury

“…These measures were chosen because of their sensitivity in detecting subconcussive injury, 24 , 25 , 26 , 27 , 28 , 29 , 30 as compared to other measures, such as balance and cognition. Since studies demonstrate cannabis’s potent beneficial effects in brain injury, 2 , 33 we hypothesized that chronic cannabis use would mitigate elevations of NPC, S100B, and NfL levels after 20 acute headings, whereas non-cannabis users would show significant elevations in NPC, S100B, and NfL.…”