Cerebral blood flow in children with persisting postconcussive symptoms and posttraumatic headache at 2 weeks
Feiven Fan1,2, Richard Beare1,3, Michael Takagi1,2
11Murdoch Children's Research Institute, Melbourne, Victoria.
Insights
Cerebral blood flow (CBF) at two weeks did not differ between children with or without persisting postconcussive symptoms. These findings suggest CBF is not an acute biomarker for pediatric concussion recovery.
Area of Science:
- Pediatric neurology
- Neuroimaging
- Concussion research
Background:
- Persisting postconcussive symptoms (pPCS) significantly impact children's recovery after concussion.
- The pathophysiology of pPCS, including headache, remains poorly understood.
- Cerebral blood flow (CBF) alterations are a potential, yet unconfirmed, contributor to pPCS.
Purpose of the Study:
- To investigate the relationship between CBF and pPCS at two weeks post-concussion in children.
- To determine if CBF variations explain the higher risk of post-traumatic headache (PTH) in female children.
- To assess the utility of CBF as an early biomarker for concussion recovery.
Main Methods:
- Prospective, longitudinal study of children (5-18 years) with concussion.
- Pseudocontinuous arterial spin labeling MRI used to quantify global gray and white matter perfusion at two weeks.
- Bayesian and frequentist analyses employed to compare groups and identify risk factors.
Main Results:
- No significant differences in global mean gray and white matter CBF were found between recovered and symptomatic children at two weeks.
- Female sex was a risk factor for PTH with migraine features (p=0.003), but CBF did not differ between females with and without PTH.
- Bayes factors indicated no substantial evidence for differences in CBF related to pPCS or female PTH.
Conclusions:
- Global CBF at two weeks is not associated with pPCS or PTH in pediatric concussion.
- Arterial spin labeling-derived CBF is not a reliable acute biomarker for predicting pediatric concussion recovery.
- Further research is needed to elucidate the pathophysiology of pPCS and identify effective biomarkers.
Objective:
Persisting postconcussive symptoms (pPCS), particularly headache, can significantly disrupt children's recovery and functioning. However, the underlying pathophysiology of these symptoms remains unclear. The goal in this study was to determine whether pPCS are related to cerebral blood flow (CBF) at 2 weeks postconcussion. The authors also investigated whether variations in CBF can explain the increased risk of acute posttraumatic headache (PTH) in female children following concussion.
Methods:
As part of a prospective, longitudinal study, the authors recruited children 5-18 years old who were admitted to the emergency department of a tertiary pediatric hospital with a concussion sustained within 48 hours of admission. Participants underwent pseudocontinuous arterial spin labeling MRI at 2 weeks postconcussion to quantify global mean gray and white matter perfusion (in ml/100 g/min). Conventional frequentist analysis and Bayesian analysis were performed.
Results:
Comparison of recovered (n = 26) and symptomatic (n = 12) groups (mean age 13.15 years, SD 2.69 years; 28 male) found no differences in mean global gray and white matter perfusion at 2 weeks postconcussion (Bayes factors > 3). Although female sex was identified as a risk factor for PTH with migraine features (p = 0.003), there was no difference in CBF between female children with and without PTH.
Conclusions:
Global CBF was not associated with pPCS and female PTH at 2 weeks after pediatric concussion. These findings provide evidence against the use of CBF measured by arterial spin labeling as an acute biomarker for pediatric concussion recovery.
