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Imaging Concussion

Aline M Studerus-Germann, Oliver P Gautschi, Pietro Bontempi, Jean-Philippe Thiran, Alessandro Daducci, David Romascano, Dieter von Ow, Gerhard Hildebrandt, Alexander von Hessling, Doortje C Engel
INTRODUCTION: Several imaging modalities are under investigation to unravel the pathophysiological mystery of delayed performance deficits in patients after mild traumatic brain injury (mTBI). Although both imaging and neuropsychological studies have been conducted, only few data on longitudinal correlations of diffusion tensor imaging (DTI), susceptibility weighted imaging (SWI) and extensive neuropsychological testing exist. METHODS: MRI with T1- and T2-weighted, SWI and DTI sequences at baseline and 12 months of 30 mTBI patients were compared with 20 healthy controls...
September 13, 2018: Neurologia i Neurochirurgia Polska
Hallie Zwibel, Adena Leder, Sheldon Yao, Christina Finn
Concussions have been increasingly reported over the past decade, but the reported incidence likely minimizes the actual numbers of people affected. Associated symptoms include emotional, somatic, and cognitive complaints, which may be prolonged in patients with certain risk factors. Neurologic examination is necessary to exclude upper motor neuron lesions and thus the need for brain imaging. Cervical conditions are often found concurrently with head injury and displays a similar presentation to concussions...
October 1, 2018: Journal of the American Osteopathic Association
Grant Gillett
Patients with repeated minor head injury are a challenge to our clinical skills of neurodiagnosis because the relevant evidence objectively demonstrating their impairment was collected in New Zealand (although published in the BMJ and Lancet) and, at the time, was mired in controversy. The effects of repeated closed diffuse head injury are increasingly recognized worldwide, but now suffer from the relentless advance of imaging technology as the dominant form of neurodiagnosis and the considerable financial interests that underpin the refusal to recognize that acute accelerational injury is the most subtle and insidiously damaging (especially when seen in the light of biopsychosocial medicine), and potentially one of the most financially momentous (given the large incomes impacted and needing compensation) phenomena in modern sports medicine...
October 2018: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Angela Lumba-Brown, Keith Owen Yeates, Kelly Sarmiento, Matthew J Breiding, Tamara M Haegerich, Gerard A Gioia, Michael Turner, Edward C Benzel, Stacy J Suskauer, Christopher C Giza, Madeline Joseph, Catherine Broomand, Barbara Weissman, Wayne Gordon, David W Wright, Rosemarie Scolaro Moser, Karen McAvoy, Linda Ewing-Cobbs, Ann-Christine Duhaime, Margot Putukian, Barbara Holshouser, David Paulk, Shari L Wade, Stanley A Herring, Mark Halstead, Heather T Keenan, Meeryo Choe, Cindy W Christian, Kevin Guskiewicz, P B Raksin, Andrew Gregory, Anne Mucha, H Gerry Taylor, James M Callahan, John DeWitt, Michael W Collins, Michael W Kirkwood, John Ragheb, Richard G Ellenbogen, Theodore J Spinks, Theodore G Ganiats, Linda J Sabelhaus, Katrina Altenhofen, Rosanne Hoffman, Tom Getchius, Gary Gronseth, Zoe Donnell, Robert E O'Connor, Shelly D Timmons
Importance: Mild traumatic brain injury (mTBI), or concussion, in children is a rapidly growing public health concern because epidemiologic data indicate a marked increase in the number of emergency department visits for mTBI over the past decade. However, no evidence-based clinical guidelines have been developed to date for diagnosing and managing pediatric mTBI in the United States. Objective: To provide a guideline based on a previous systematic review of the literature to obtain and assess evidence toward developing clinical recommendations for health care professionals related to the diagnosis, prognosis, and management/treatment of pediatric mTBI...
September 4, 2018: JAMA Pediatrics
Donald W Marion, Jamie B Grimes, Sidney R Hinds Ii, Jeffrey Lewis, Laura Baugh, Zsolt T Stockinger
Magnetic resonance imaging (MRI) has specific limitations in theater and has unique requirements for its safe use with patients which require additional technician training and strict adherence to MRI-specific safety protocols. Neuroimaging is recommended for the evaluation of service members with clinical red flags new onset or persistent or worsening symptoms, and individuals whose recovery is not progressing as anticipated. This article is a brief discussion of when MRI is appropriate.
September 1, 2018: Military Medicine
Elisabeth A Wilde, James M Provenzale, Brian A Taylor, Michael Boss, Anthony Zuccolotto, Rebecca Hachey, Sudhir Pathak, David F Tate, Tracy J Abildskov, Walter Schneider
OBJECTIVE: Multisite and longitudinal neuroimaging studies are important in uncovering trajectories of recovery and neurodegeneration following traumatic brain injury (TBI) and concussion through the use of diffusion tensor imaging (DTI) and other imaging modalities. This study assessed differences in anisotropic diffusion measurement across four scanners using a human and a novel phantom developed in conjunction with the Chronic Effects of Neurotrauma Consortium. METHOD: Human scans provided measurement within biological tissue, and the novel physical phantom provided measures of anisotropic intra-tubular diffusion to serve as a model for intra-axonal water diffusion...
2018: Brain Injury: [BI]
Yang Wang, Andrew S Nencka, Timothy B Meier, Kevin Guskiewicz, Jason P Mihalik, M Alison Brooks, Andrew J Saykin, Kevin M Koch, Yu-Chien Wu, Lindsay D Nelson, Thomas W McAllister, Steven P Broglio, Michael A McCrea
Sport-related concussion (SRC) has become a major health problem, affecting millions of athletes each year. Despite the increasing occurrence and prevalence of SRC, its underlying mechanism and recovery course have yet to be fully elucidated. The National Collegiate Athletic Association-Department of Defense Grand Alliance: Concussion Assessment, Research and Education (CARE) Consortium is a large-scale, multisite study of the natural history of concussion across multiple sports. The Advanced Research Core (ARC) of CARE is focused on the advanced biomarker assessment of a reduced subject cohort...
August 29, 2018: Brain Imaging and Behavior
Andrew D Legarreta, Steve H Monk, Paul W Kirby, Benjamin L Brett, Aaron M Yengo-Kahn, Aashim Bhatia, Gary S Solomon, Scott L Zuckerman
BACKGROUND: Lasting neuroimaging changes after participation in American football are an increasing public health concern. The clinical relevance of imaging findings remains unknown. METHODS: A systematic review was performed with the following inclusion criteria: football players, brain imaging ≥2 years from previous concussion or retirement, and sample size ≥5. Studies were assessed for 1) methodology (control selection, type I error, and recall bias), 2) imaging outcomes, and 3) number of significant statistical comparisons...
August 23, 2018: World Neurosurgery
Donna L Murdaugh, Tricia Z King, Binjian Sun, Richard A Jones, Kim E Ono, Andrew Reisner, Thomas G Burns
OBJECTIVES: The aim of this study was to investigate alterations in functional connectivity, white matter integrity, and cognitive abilities due to sports-related concussion (SRC) in adolescents using a prospective longitudinal design. METHODS: We assessed male high school football players (ages 14-18) with (n=16) and without (n=12) SRC using complementary resting state functional MRI (rs-fMRI) and diffusion tensor imaging (DTI) along with cognitive performance using the Immediate Post-Concussive Assessment and Cognitive Testing (ImPACT)...
September 2018: Journal of the International Neuropsychological Society: JINS
Alexander M Weber, Anna Pukropski, Christian Kames, Michael Jarrett, Shiroy Dadachanji, Jack Taunton, David K B Li, Alexander Rauscher
Myelin sensitive MRI techniques, such as diffusion tensor imaging and myelin water imaging, have previously been used to reveal changes in myelin after sports-related concussions. What is not clear from these studies, however, is how myelin is affected: whether it becomes degraded and possibly removed, or whether the myelin sheath loosens and becomes "decompacted". Previously, our team revealed myelin specific changes in ice hockey players 2 weeks post-concussion using myelin water imaging. In that study, 45 subjects underwent a pre-season baseline scan, 11 of which sustained a concussion during play and received follow-up scans: eight were scanned within 3 days, 10 were scanned at 14 days, and nine were scanned at 60 days...
2018: Frontiers in Neurology
Brandon S Baksh, Namita Sinha, Afshin Salehi, Rowland H Han, Brandon A Miller, Sonika Dahiya, Karen M Gauvain, David D Limbrick
BACKGROUND: Choroid plexus carcinoma (CPC) is a rare, malignant tumor occurring more commonly in children than adults. This case report describes the clinical course of a 3-year-old boy with a rare case of metastatic CPC with a novel TP53 mutation. CASE DESCRIPTION: A 3-year-old boy presented with post-concussive symptoms after a fall. Computed tomography and magnetic resonance imaging revealed lesions in the suprasellar cistern, left lateral ventricle and cauda equina...
August 9, 2018: World Neurosurgery
Barry S Willer, Robert Zivadinov, Mohammad N Haider, Jeffrey C Miecznikowski, John J Leddy
OBJECTIVE: To provide an overview of 3 studies of the same population of retired professional contact sport athletes compared with age-matched noncontact sport athlete controls on cognition, executive function, behavior, and advanced brain imaging. SETTING: University Concussion Management Clinic. PARTICIPANTS: Twenty-two retired professional hockey and football athletes (average age 56 years) and 21 age-matched noncontact sport athlete controls...
September 2018: Journal of Head Trauma Rehabilitation
Roh-Eul Yoo, Seung Hong Choi, Byung-Mo Oh, Sang Do Shin, Eun Jung Lee, Dong Jae Shin, Sang Won Jo, Koung Mi Kang, Tae Jin Yun, Ji-Hoon Kim, Chul-Ho Sohn
OBJECTIVES: To explore the utility of dynamic contrast-enhanced (DCE) MR imaging for quantitative analysis of blood-brain barrier disruption in mild traumatic brain injury (mTBI) patients with post-concussion syndrome (PCS). METHODS: Forty-four consecutive patients with PCS after mTBI and 32 controls were included in this retrospective study. Ktrans and ve from DCE MR imaging were analyzed at contrast-enhancing lesions, T2 hyperintense white matter (WM) lesions, normal-appearing white matter (NAWM), and predilection sites for diffuse axonal injury (LocationDAI )...
July 31, 2018: European Radiology
Todd G Rubin, Eva Catenaccio, Roman Fleysher, Liane E Hunter, Naomi Lubin, Walter F Stewart, Mimi Kim, Richard B Lipton, Michael L Lipton
Purpose To examine the role of sex in abnormal white matter microstructure after soccer heading as identified by using the diffusion-tensor imaging (DTI) metric fractional anisotropy (FA). Materials and Methods In this prospective cross-sectional study, 98 individuals who were enrolled in a larger prospective study of amateur soccer players (from 2013 to 2016) were matched 1:1 for age and history of soccer heading in the prior 12 months. Among the subjects, 49 men (mean age, 25.7 years; range, 18-50 years) and 49 women (mean age, 25...
November 2018: Radiology
Milan Toma, Paul D H Nguyen
PRIMARY OBJECTIVE: Closed brain injuries are a common danger in contact sports and motorized vehicular collisions. Mild closed brain injuries, such as concussions, are not easily visualized by computed imaging or scans. Having a comprehensive head/brain model and using fluid-structure interaction (FSI) simulations enable us to see the exact movement of the cerebrospinal fluid (CSF) under such conditions and to identify the areas of brain most affected. RESEARCH DESIGN: The presented work is based on the first FSI model capable of simulating the interaction between the CSF flow and brain...
2018: Brain Injury: [BI]
Nan-Jie Gong, Samuel Kuzminski, Michael Clark, Melissa Fraser, Mark Sundman, Kevin Guskiewicz, Jeffrey R Petrella, Chunlei Liu
OBJECTIVES: To probe microstructural changes that are associated with subconcussive head impact exposure in deep and cortical gray matter of high school football players over a single season. METHODS: Players underwent diffusion kurtosis imaging (DKI) and quantitative susceptibility mapping (QSM) scans. Head impact data was recorded. Association between parametric changes and frequency of frontal head impact was assessed. RESULTS: In deep gray matter, significant decreases in mean kurtosis (MK) and increases in mean diffusivity (MD) over the season were observed in the thalamus and putamen...
July 23, 2018: Neurobiology of Disease
Erin D Bigler, Chris Finuf, Tracy J Abildskov, Naomi J Goodrich-Hunsaker, Jo Ann Petrie, Dawn-Marie Wood, John R Hesselink, Elisabeth A Wilde, Jeffrey E Max
This investigation explored whether differences in cortical thickness could be detected in children who sustained a mild traumatic brain injury (mTBI) compared to those with orthopedic injury (OI) and whether cortical thickness related parental reporting of symptoms. To achieve this objective, FreeSurfer®-based cortical thickness measures were obtained in 330 children, 8 to 15 years of age, with either a history of mTBI or OI. Imaging was performed in all participants with the same 3 Tesla MRI scanner at six-months post-injury, where a parent-rated Post-Concussion Symptom Inventory (PCSI) was also obtained...
July 21, 2018: International Journal of Psychophysiology
Priya Santhanam, Theresa Teslovich, Steffanie H Wilson, Ping-Hong Yeh, Terrence R Oakes, Lindell Weaver
Post-traumatic stress disorder (PTSD) is commonly observed in military service members with mild traumatic brain injury (mTBI); however, the relationship between mTBI and PTSD is complex and not well-understood. The present study aims to elucidate a link between the degree of alteration in limbic system-related white matter tracts and PTSD symptoms in an mTBI population. Diffusion tensor imaging with probabilistic tractography of the fronto-limbic pathways revealed decreased white matter integrity in the uncinate fasciculus in those with comorbid mTBI and PTSD (n=34), relative to those with only mTBI (n=35)...
July 24, 2018: Journal of Neurotrauma
Thomas A Daniel, Kyle M Townsend, Yun Wang, David S Martin, Jeffrey S Katz, Gopikrishna Deshpande
While social and behavioral effects of violence in the media have been studied extensively, much less is known about how sports affect perceptions of violence. The current study examined neurofunctional differences between fans and non-fans of North American football (a contact sport) while viewing violent imagery. Participants viewed images of violence in both football and non-football settings while high-resolution functional magnetic resonance imaging (fMRI) data were acquired from their brains. Neurological activation was compared between these violence types and between groups...
2018: Frontiers in Public Health
Natalie S Dailey, Ryan Smith, Sahil Bajaj, Anna Alkozei, Melissa K Gottschlich, Adam C Raikes, Brieann C Satterfield, William D S Killgore
Mild traumatic brain injury (mTBI) remains the most commonly reported head injury in the United States, and is associated with a wide range of post-concussive symptoms including physical, cognitive and affective impairments. Elevated aggression has been documented in mTBI; however, the neural mechanisms associated with aggression at the chronic stage of recovery remain poorly understood. In the present study, we investigated the association between white matter integrity and aggression in mTBI using diffusion tensor imaging (DTI)...
2018: Frontiers in Behavioral Neuroscience
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