Cerebral Blood Flow Predicts Recovery in Children with Persistent Post-Concussion Symptoms after Mild Traumatic Brain
Karen M Barlow1,2,3,4, Kartik Iyer1, Tingting Yan3
1Children's Health Research Centre, University of Queensland, Brisbane, Queensland, Australia.
Insights
Cerebral blood flow (CBF) was higher in children with persistent post-concussion symptoms (PPCS) who showed poor recovery. Decreased CBF over time predicted better outcomes in pediatric mild traumatic brain injury (mTBI) patients.
Area of Science:
- Neurology
- Pediatric Medicine
- Radiology
Background:
- Persistent post-concussion symptoms (PPCS) following pediatric mild traumatic brain injury (mTBI) are linked to altered cerebral blood flow (CBF).
- Understanding CBF changes during recovery is crucial for identifying therapeutic targets in pediatric mTBI.
Purpose of the Study:
- To investigate CBF changes during recovery in children experiencing PPCS after mTBI.
- To determine if CBF changes correlate with clinical recovery and can predict outcomes.
Main Methods:
- A prospective cohort study involving 61 children and adolescents with PPCS.
- Three-dimensional (3D) pseudo-continuous arterial spin-labelled (pCASL) MRI was used to assess CBF at two time points (4-6 and 8-10 weeks post-injury).
- Participants were categorized based on clinical recovery status at the second scan.
Main Results:
- Children with poor recovery exhibited higher relative and mean absolute CBF compared to those with good recovery.
- CBF decreased over time, with a more significant decrease observed in participants who achieved good recovery.
- The rate of CBF decrease predicted recovery outcome in 77% of children with PPCS.
Conclusions:
- CBF dynamics during recovery are associated with clinical outcomes in pediatric mTBI.
- A decrease in CBF over time may serve as a predictive biomarker for recovery in children with PPCS.
- Further research is needed to validate CBF as a predictive biomarker for PPCS outcomes.
Abstract:
Persistent post-concussion symptoms (PPCS) following pediatric mild traumatic brain injury (mTBI) are associated with differential changes in cerebral blood flow (CBF). Given its potential as a therapeutic target, we examined CBF changes during recovery in children with PPCS. We hypothesized that CBF would decrease and that such decreases would mirror clinical recovery. In a prospective cohort study, 61 children and adolescents (mean age 14 [standard deviation = 2.6] years; 41% male) with PPCS were imaged with three-dimensional (3D) pseudo-continuous arterial spin-labelled (pCASL) magnetic resonance imaging (MRI) at 4-6 and 8-10 weeks post-injury. Exclusion criteria included any significant past medical history and/or previous concussion within the past 3 months. Twenty-three participants had clinically recovered at the time of the second scan. We found that relative and mean absolute CBF were higher in participants with poor recovery, 44.0 (95% confidence interval [CI]: 43.32, 44.67) than in those with good recovery, 42.19 (95% CI: 41.77, 42.60) mL/min/100 g gray tissue and decreased over time (β = -1.75; p < 0.001). The decrease was greater in those with good recovery (β = 2.29; p < 0.001) and predicted outcome in 77% of children with PPCS (odds ratio [OR] 0.54, 95% CI: 0.36, 0.80; p = 0.002). Future studies are warranted to validate the utility of CBF as a useful predictive biomarker of outcome in PPCS.
