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Imaging Concussion

Steve H Monk, Andrew D Legarreta, Paul Kirby, Benjamin L Brett, Aaron M Yengo-Kahn, Aashim Bhatia, Gary S Solomon, Scott L Zuckerman
Sport-related concussion (SRC) has emerged as a major public health problem. The results of brain imaging studies following SRC have raised questions about long-term neurologic health, but the clinical implications of these findings remain unknown. A systematic review of brain imaging findings after SRC was performed utilizing the following inclusion criteria: football players, brain imaging within 6 months of SRC, and sample size >5. Studies were assessed for: 1) methodology, 2) imaging outcomes, and 3) number of positive statistical comparisons...
November 26, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Kenneth A Rostowsky, Alexander S Maher, Andrei Irimia
With the advent of susceptibility-weighted imaging (SWI), the ability to identify cerebral microbleeds (CMBs) associated with mild traumatic brain injury (mTBI) has become increasingly commonplace. Nevertheless, the clinical significance of post-traumatic CMBs remains controversial partly because it is unclear whether mTBI-related CMBs entail brain circuitry disruptions which, although structurally subtle, are functionally significant. This study combines magnetic resonance and diffusion tensor imaging (MRI and DTI) to map white matter (WM) circuitry differences across 6 months in 26 healthy control volunteers and in 26 older mTBI victims with acute CMBs of traumatic etiology...
2018: Frontiers in Neurology
Alexander Lin, Molly Charney, Martha E Shenton, Inga Katharina Koerte
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder associated with repetitive head impact exposure, such as that resulting from sports-related concussive and subconcussive brain trauma. Currently, the only way to diagnose CTE is by using neuropathologic markers obtained postmortem. To diagnose CTE earlier, so that possible treatment interventions may be employed, there is a need to develop noninvasive in vivo biomarkers of CTE. Neuroimaging provides promising biomarkers for the diagnosis of CTE and may also help elucidate pathophysiologic changes that occur with chronic sports-related brain injury...
2018: Handbook of Clinical Neurology
Asif K Suri, Michael L Lipton
Computed tomography (CT) and magnetic resonance imaging (MRI) have revolutionized the assessment of traumatic brain injury (TBI) by permitting rapid detection and localization of acute intracranial injuries. In concussion, the most common presentation of sports-related head trauma, CT and MRI are unrevealing. This normal appearance of the brain on standard neuroimaging, however, belies the structural and functional pathology that underpins concussion-related symptoms and dysfunction. Advances in neuroimaging have expanded our ability to gain insight into this microstructural and functional brain pathology...
2018: Handbook of Clinical Neurology
Henrik Zetterberg, Bengt Winblad, Charles Bernick, Kristine Yaffe, Marek Majdan, Gunilla Johansson, Virginia Newcombe, Lars Nyberg, David Sharp, Olli Tenovuo, Kaj Blennow
Traumatic brain injury (TBI) is clinically divided into a spectrum of severities, with mild TBI being the least severe form and a frequent occurrence in contact sports, such as ice hockey, American football, rugby, horse riding and boxing. Mild TBI is caused by blunt non-penetrating head trauma that causes movement of the brain and stretching and tearing of axons, with diffuse axonal injury being a central pathogenic mechanism. Mild TBI is in principle synonymous with concussion; both have similar criteria in which the most important elements are acute alteration or loss of consciousness and/or post-traumatic amnesia following head trauma and no apparent brain changes on standard neuroimaging...
November 27, 2018: Journal of Internal Medicine
Jeong Bin Lee, Bethann M Affeldt, Yaritxa Gamboa, Mary Hamer, Jeff F Dunn, Andrea C Pardo, Andre Obenaus
Concussion or mild traumatic brain injury (mTBI) is often accompanied by long-term behavioral and neuropsychological deficits. Emerging data suggest that these deficits can be exacerbated following repeated injuries. However, despite the overwhelming prevalence of mTBI in children due to falls and sports-related activities, the effects of mTBI on white matter (WM) structure and its development in children have not been extensively examined. Moreover, the effect of repeated mTBI (rmTBI) on developing WM has not yet been studied, despite the possibility of exacerbated outcomes with repeat injuries...
November 22, 2018: Developmental Neuroscience
Mayank Kaushal, Lezlie Y España, Andrew S Nencka, Yang Wang, Lindsay D Nelson, Michael A McCrea, Timothy B Meier
There has been a recent call for longitudinal imaging studies to better characterize the time course of physiological recovery following sport-related concussion (SRC) and its relationship with clinical recovery. To address this, we evaluated changes to resting-state functional connectivity (rs-FC) of the whole-brain network following SRC and explored associations between rs-FC and measures of clinical outcome. High school and collegiate football athletes were enrolled during preseason. Athletes that suffered SRC (N = 62) were assessed across the acute (within 48 hr) and sub-acute (days 8, 15, and 45) phases...
November 19, 2018: Human Brain Mapping
Nathan Churchill, Michael Hutchison, Simon Graham, Tom A Schweizer
Cerebrovascular reactivity (CVR) indexes the ability of blood vessels to respond to vasoactive stimuli and may be a sensitive biomarker of concussion. However, alterations in whole-brain CVR remain poorly understood during the early symptomatic phase of injury. In this study, CVR was assessed using blood-oxygenation level dependent functional magnetic resonance imaging (BOLD fMRI) combined with a respiratory challenge paradigm; resting cerebral blood flow (CBF) was also evaluated using arterial spin labelling (ASL)...
November 18, 2018: Journal of Neurotrauma
Andrea Ana Almeida, Matthew Thomas Lorincz, Andrew Nobuhide Hashikawa
Concussions after a head injury among children continues to be a substantial public health concern. An increasing number of concussions are being managed initially by primary care physicians. The diagnosis of concussion remains a clinical diagnosis despite the availability of ancillary tests such as computerized neuropsychological testing, advanced imaging, and blood biomarkers. Clinically, overlooking other injuries and comorbidities may lead to prolonged recovery for the patient. Addressing concussions in a multidisciplinary approach may help in reducing recovery time for patients...
December 2018: Pediatric Clinics of North America
Martha E Shenton, Bruce H Price, Laura Levin, Judith G Edersheim
Important advances in neuroscience and neuroimaging have revolutionized our understanding of the human brain. Many of these advances provide new evidence regarding compensable injuries that have been used to support changes in legal policy. For example, we now know that regions of the brain involved in decision making continue to develop into the mid-20s, and this information weighs heavily in determining that execution or automatic sentence of life without the possibility of parole for someone younger than 18 years old, at the time of the crime, violates the 8th Amendment prohibition against "cruel and unusual punishment...
October 31, 2018: International Journal of Law and Psychiatry
Brian L Brooks, Trevor A Low, Vickie Plourde, Shane Virani, Zeanna Jadavji, Frank P MacMaster, Karen M Barlow, R Marc Lebel, Keith Owen Yeates
OBJECTIVES: The long-term effects of concussion in youth remain poorly understood. The objective of this study was to determine the association between history of concussion and cerebral blood flow (CBF) in youth. METHODS: A total of 53 children and adolescents with a history of concussion (n = 37) or orthopaedic injury (OI; n = 16) were considered. Measures included pseudo-continuous arterial spin labelling magnetic resonance imaging to quantify CBF, post-concussion symptoms, psychological symptoms, and cognitive testing...
October 31, 2018: Brain Injury: [BI]
Omar Akhand, John-Ross Rizzo, Janet C Rucker, Lisena Hasanaj, Steven L Galetta, Laura J Balcer
BACKGROUND: Concussion leads to neurophysiologic changes that may result in visual symptoms and changes in ocular motor function. Vision-based testing is used increasingly to improve detection and assess head injury. This review will focus on the historical aspects and emerging data for vision tests, emphasizing rapid automatized naming (RAN) tasks and objective recording techniques, including video-oculography (VOG), as applied to the evaluation of mild traumatic brain injury. METHODS: Searches on PubMed were performed using combinations of the following key words: "concussion," "mild traumatic brain injury," "rapid automatized naming," "King-Devick," "mobile universal lexicon evaluation system," "video-oculography," and "eye-tracking...
October 24, 2018: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
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...
November 1, 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...
December 2018: World Neurosurgery
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