Pediatric Sports-Related Concussion Produces Cerebral Blood Flow Alterations

Maugans, Todd A.; Farley, Chad W.; Altaye, Mekibib; Leach, James; Cecil, Kim M.

doi:10.1542/peds.2011-2083

Cited by 304 publications

(258 citation statements)

References 93 publications

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“…Other pathological mechanisms to consider for explaining cortical thinning at an early stage after mTBI would include vascular changes, 65 and acute (less than 72 h) hypoperfusion, as has been reported in the cortex of concussed survivors with persistence in several survivors over the following months. 58,[66][67][68] Acute hypoperfusions are attributed to reversible microvasoconstriction in a rat model of mTBI, 69 and acute vasoconstriction has been reported within an hour after TBI in human survivors with subarachnoid hemorrhage. 70,71 Further, even transient hypoperfusion may produce prolonged changes in cortical thickness as evidenced by decreased cortical thickness and less fMRI activation in rats at 4 months after a single episode of hypoxia-ischemia.…”

Section: Early Cortical Thinning In Mtbi Survivors After Mvcsmentioning

confidence: 99%

Early Cortical Thickness Change after Mild Traumatic Brain Injury following Motor Vehicle Collision

Wang

Xie

Cotton

et al. 2015

Journal of Neurotrauma

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In a motor vehicle collision (MVC), survivors often receive mild traumatic brain injuries (mTBI). Although there have been some reports of early white matter changes after an mTBI, much less is known about early cortical structural changes. To investigate early cortical changes within a few days after an MVC, we compared cortical thickness of mTBI survivors with nonmTBI survivors, then reexamined cortical thickness in the same survivors 3 months later. MVC survivors were categorized as mTBI or non-mTBI based on concussive symptoms documented in emergency departments (EDs). Cortical thickness was measured from MRI images using FreeSurfer within a few days and again at 3 months after MVC. Post-traumatic stress symptoms and physical conditions were also assessed. Compared with the non-mTBI group (n = 23), the mTBI group (n = 21) had thicker cortex in the left rostral middle frontal (rMFG) and right precuneus gyri, but thinner cortex in the left posterior middle temporal gyrus at 7.2 -3.1 days after MVC. After 3 months, cortical thickness had decreased in left rMFG in the mTBI group but not in the non-mTBI group. The cortical thickness of the right precuneus region in the initial scans was positively correlated with acute traumatic stress symptoms for all survivors and with the number of reduced activity days for mTBI survivors who completed the follow-up. The preliminary results suggest that alterations in cortical thickness may occur at an early stage of mTBI and that frontal cortex structure may change dynamically over the initial 3 months after mTBI.

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Section: Early Cortical Thinning In Mtbi Survivors After Mvcsmentioning

confidence: 99%

Early Cortical Thickness Change after Mild Traumatic Brain Injury following Motor Vehicle Collision

Wang

Xie

Cotton

et al. 2015

Journal of Neurotrauma

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“…80 Methods that correlate functional findings with the presence of subtle neurocognitive deficits in otherwise asymptomatic athletes can suggest the existence of a previously unknown, but suspected, 87 subtype of CTE. These athletes, who exhibit extremely subtle neurocognitive defects that persist over time, continue to participate in contact sports, potentially placing themselves at higher risk for long-term injury.…”

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confidence: 99%

Sports-related brain injuries: connecting pathology to diagnosis

Pan¹,

Connolly²,

Dangelmajer³

et al. 2016

FOC

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Neurosurg Focus 40 (4):E14, 2016M any sports-related brain injuries involve mild traumatic brain injuries (mTBIs), which result from physical blows to the head sustained over a period of time. Sports associated with an increased risk of head injury include American football, ice hockey, soccer, rugby, the martial arts, boxing, and bicycling. 21,90 These injuries are often unrecognized, undiagnosed, or underreported, which reflects the fact that this is a growing medical concern, often labeled a "silent epidemic." 8,66 Chronic exposure to mild brain injuries can result in long-term neurological consequences and represents a spectrum of disorders. The most remarkable outcome of mTBI is termed chronic traumatic encephalopathy (CTE), a clinical syndrome that is associated with neurodegeneration and behavioral, cognitive, and/or motor deficits. Although this disease has distinct pathological features, CTE is considered a diagnosis of exclusion because only postmortem biopsies can confirm the diagnosis. Therefore, new diagnostic methods need to be developed to: 1) inform patients of a definitive diagnosis, 2) better understand the epidemiology and risk factors of the disease, and 3) implement intervention programs to prevent any potential long-term complications. This review examines how understanding the pathology and molecular changes associated with repeated head trauma can lead to the discovery of novel imaging techniques and biomarkers. Mild Traumatic Brain Injury and CTEChronic traumatic encephalopathy has evolved from the so-called punch-drunk syndrome, which was used to describe a distinct neuropsychiatric condition that seemed to affect boxers, eventually becoming known as dementia pugilistica during the 1920s and 1930s. Symptoms such ABBrEvIATIoNs AD = Alzheimer's disease; APOE = apolipoprotein E; ASL = arterial spin labeling; BBB = blood-brain barrier; BOLD = blood oxygen level-dependent; CA = cornu ammonis; CTE = chronic traumatic encephalopathy; DTI = diffusion tensor imaging; FA = fractional anisotropy; fMRI = functional MRI; GFAP = glial fibrillary acidic protein; GRE = gradient recall echo; miRNA = microRNA; MRS = MR spectroscopy; mTBI = mild traumatic brain injury; NFL = National Football League; NFT = neurofibrillary tangle; NINDS = National Institute of Neurological Disorders and Stroke; NSE = neuron-specific enolase; p-tau = phosphorylated tau; SWI = susceptibility-weighted imaging; TDP-43 = TAR DNA-binding protein 43;18 F-FDDNP = 2-(1-{6- [(2-[fluorine-18] Brain injuries are becoming increasingly common in athletes and represent an important diagnostic challenge. Early detection and management of brain injuries in sports are of utmost importance in preventing chronic neurological and psychiatric decline. These types of injuries incurred during sports are referred to as mild traumatic brain injuries, which represent a heterogeneous spectrum of disease. The most dramatic manifestation of chronic mild traumatic brain injuries is termed chronic traumatic encephalopathy, which is associated with profo...

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“…Altered functional connectivity has also been observed relative to executive function, visual, and motor networks [57][58][59][60]. Reduced cerebral blood flow (CBF) has been reported during the acute and sub-acute phases (days to weeks) post-concussion [61][62][63], as well as at more chronic time points (approximately 5 months) [64].…”

Section: Neuroimagingmentioning

confidence: 99%

Sports Concussion: A Clinical Overview

Gardner¹

2018

Sport and Exercise Science

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Concussion is an injury risk associated with participation in collision sports. It has been identified as a research priority for many contacts and collision sports governing bodies worldwide. However, concussion remains under-researched in terms of clinical translation from both experimental models to clinical understanding, and from clinical studies to sports policy. Currently, the clinical management of concussion is largely guided by the presence or absence of symptoms with recovery indicated once all post-injury symptoms have resolved. Management of concussion includes physical and cognitive rest until acute symptoms resolve, with a graded program of exertion implemented prior to medical clearance and return-to-play. Considering the potential sequelae, the heterogeneity of symptoms, and the lack of an intervention known to prevent concussion, it is not any wonder that concussion is one of the most complex and perplexing injuries faced by medical professionals, and why making the return-to-play decision can be quite challenging. This chapter will provide an overview of the current clinical management guidelines and research literature pertaining to identification and diagnosis of injury, acute and post-acute management, and return-to-play decision-making. The traditional standard assessment process (e.g., symptom reporting, cognitive assessment, balance testing), new methods and advanced technology (e.g., ocular-motor testing, neuroimaging techniques), and biomarkers (e.g., blood plasma and serum, fluid) have led to greater insights into sports concussion and will also be briefly explored in this chapter.

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Pediatric Sports-Related Concussion Produces Cerebral Blood Flow Alterations

Abstract: Pediatric SRC is primarily a physiologic injury, affecting CBF significantly without evidence of measurable structural, metabolic neuronal or axonal injury. Further study of CBF mechanisms is needed to explain patterns of recovery.

Cited by 304 publications

References 93 publications

Early Cortical Thickness Change after Mild Traumatic Brain Injury following Motor Vehicle Collision

Early Cortical Thickness Change after Mild Traumatic Brain Injury following Motor Vehicle Collision

Sports-related brain injuries: connecting pathology to diagnosis

Sports Concussion: A Clinical Overview

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