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A Neuroscientific Approach to the Examination of Concussions in Student-Athletes
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Impaired neurovascular unit function contributes to persistent symptoms after concussion: a pilot study.

Brenda L Bartnik-Olson1, Barbara Holshouser, Harrison Wang

  • 11 Department of Radiology, Loma Linda University School of Medicine , Loma Linda, California.

Journal of Neurotrauma
|April 17, 2014
PubMed
Summary

Advanced imaging reveals persistent brain changes in children with sports-related concussions (SRCs). These findings highlight impaired axonal function, metabolism, and blood flow, offering insights into long-term symptoms after mild traumatic brain injury (TBI).

Keywords:
MRIcerebral blood flowconcussionmetabolismpediatricwhite matter integrity

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Area of Science:

  • Neuroscience
  • Radiology
  • Pediatric Medicine

Background:

  • Mild traumatic brain injury (TBI), including sports-related concussions (SRCs), affects many school-aged children.
  • A significant percentage of pediatric SRC patients experience persistent post-concussive symptoms beyond three months.
  • Previous advanced imaging studies in mild TBI indicated axonal damage, reduced N-acetyl aspartate (NAA), and impaired cerebral blood flow (CBF).

Purpose of the Study:

  • To investigate the utility of advanced imaging techniques in pediatric SRC patients with persistent post-concussive symptoms.
  • To determine if perfusion-weighted imaging (PWI), spectroscopic imaging, and diffusion tensor imaging (DTI) can identify injury markers in these patients.
  • To compare imaging findings in pediatric SRC patients with persistent symptoms to those in healthy controls.

Main Methods:

  • Fifteen pediatric subjects (ages 8-17) with persistent post-concussive symptoms underwent PWI, 3D magnetic resonance spectroscopic imaging, and DTI.
  • Imaging was performed three to 12 months post-SRC.
  • Data were compared with 15 demographically matched healthy controls.

Main Results:

  • Pediatric SRC patients exhibited reduced CBF and relative cerebral blood volume (CBV) in the bilateral thalami compared to controls.
  • Reduced NAA/creatine (Cr) and NAA/choline (Cho) ratios were observed in the corpus callosum and parietal white matter of SRC subjects.
  • Diffusion tensor imaging (DTI) metrics showed significant differences, distinguishing patients with cognitive symptoms from controls and those without cognitive symptoms.

Conclusions:

  • Advanced imaging methods successfully detect a spectrum of injury in pediatric SRC patients with persistent symptoms.
  • Findings suggest impaired axonal function, neuronal metabolism, and perfusion, indicating neurovascular unit involvement.
  • These techniques provide valuable insights into the underlying pathophysiology of prolonged post-concussive symptoms in children.