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Blood Test in Concussion

Aynsley M Smith, Michael J Stuart, William O Roberts, David W Dodick, Jonathan T Finnoff, Janelle K Jorgensen, David A Krause
OBJECTIVE: This review provides an update on sport-related concussion (SRC) in ice hockey and makes a case for changes in clinical concussion evaluation. Standard practice should require that concussions be objectively diagnosed and provide quantitative measures of the concussion injury that will serve as a platform for future evidence-based treatment. METHODS: The literature was surveyed to address several concussion-related topics: research in ice hockey-related head trauma, current subjective diagnosis, promising components of an objective diagnosis, and current and potential treatments...
January 10, 2017: Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine
Scott Bishop, Ryan Dech, Taylor Baker, Matthew Butz, Kaishan Aravinthan, J Patrick Neary
PRIMARY OBJECTIVE: To assess and compare the parasympathetic state of individuals in healthy vs concussion groups, by measuring cardiovascular metrics under resting and baroreflex conditions using a squat-stand manoeuvre. RESEARCH DESIGN: This was a retrospective mixed-method study, with participants who sustained a medically diagnosed sport concussion (n = 12), being tested within 72-hours post-injury. METHODS AND PROCEDURES: Participant's heart rate (Electrocardiogram, ECG) and blood pressure (finger plethysmography) data was collected during rest and during 10-second squat-stands (10SS, 0...
January 3, 2017: Brain Injury: [BI]
Kaj Blennow, David L Brody, Patrick M Kochanek, Harvey Levin, Ann McKee, Gerard M Ribbers, Kristine Yaffe, Henrik Zetterberg
Traumatic brain injuries (TBIs) are clinically grouped by severity: mild, moderate and severe. Mild TBI (the least severe form) is synonymous with concussion and is typically caused by blunt non-penetrating head trauma. The trauma causes stretching and tearing of axons, which leads to diffuse axonal injury - the best-studied pathogenetic mechanism of this disorder. However, mild TBI is defined on clinical grounds and no well-validated imaging or fluid biomarkers to determine the presence of neuronal damage in patients with mild TBI is available...
November 17, 2016: Nature Reviews. Disease Primers
Charles H Tegeler, Catherine L Tegeler, Jared F Cook, Sung W Lee, Lee Gerdes, Hossam A Shaltout, Christopher M Miles, Sean L Simpson
BACKGROUND: Effective interventions are needed for individuals with persisting post-concussion symptoms. High-resolution, relational, resonance-based, electroencephalic mirroring (HIRREM®) is an allostatic, closed-loop, acoustic stimulation neurotechnology, designed to facilitate relaxation and self-optimization of neural oscillations. METHODS: Fifteen athletes (seven females, mean age 18.1 years, SD 2.6) with persisting post-concussion symptoms received 18.7 (SD 6...
December 2016: Sports Medicine—Open
Noah D Silverberg, William Panenka, Grant L Iverson, Jeffrey R Brubacher, Jason R Shewchuk, Manraj K S Heran, Gary C S Oh, William G Honer, Rael T Lange
OBJECTIVES: To examine the effect of pre-injury alcohol use, acute alcohol intoxication, and post-injury alcohol use on outcome from mild to moderate traumatic brain injury (TBI). METHODS: Prospective inception cohort of patients who presented to the Emergency Department with mild to moderate TBI and had a blood alcohol level (BAL) taken for clinical purposes. Those who completed the 1-year outcome assessment were eligible for this study (N=91). Outcomes of interest were the count of post-concussion symptoms (British Columbia Post-Concussion Symptom Inventory), low neuropsychological test scores (Neuropsychological Assessment Battery), and abnormal regions of interest on diffusion tensor imaging (low fractional anisotropy)...
September 2016: Journal of the International Neuropsychological Society: JINS
W Alan C Mutch, Michael J Ellis, Lawrence N Ryner, Marc P Morissette, Philip J Pries, Brenden Dufault, Marco Essig, David J Mikulis, James Duffin, Joseph A Fisher
BACKGROUND: Advanced neuroimaging studies in concussion have been limited to detecting group differences between concussion patients and healthy controls. In this small pilot study, we used brain magnetic resonance imaging (MRI) CO2 stress testing to longitudinally assess cerebrovascular responsiveness (CVR) in individual sports-related concussion (SRC) patients. METHODS: Six SRC patients (three males and three females; mean age = 15.7, range = 15-17 years) underwent longitudinal brain MRI CO2 stress testing using blood oxygen level-dependent (BOLD) MRI and model-based prospective end-tidal CO2 targeting under isoxic conditions...
2016: Frontiers in Neurology
Damien Bouvier, Thomas Duret, Mathieu Abbot, Thibault Stiernon, Bruno Pereira, Aurélien Coste, Jean Chazal, Vincent Sapin
BACKGROUND: The incidence of concussion in professional direct-contact sports, particularly in rugby, has increased in recent years. To date, cognitive assessment is the most common means of determining whether a concussed player can return to the game. Serum S100B assay, an objective blood test known to be useful in brain injury management, may offer a novel additional approach to the management of concussed male rugby players. OBJECTIVE: The aim of this study was to investigate the S100B utility for the determination of concussion in a professional 15-players-a-side rugby team...
July 18, 2016: Sports Medicine
Joseph F Clark, Danielle N Caudell-Stamper, Stephen W Dailey, Jon G Divine
We hypothesize that a transient exertion-related carotid (TERC) murmur flow murmur similar in nature to a "bruit" heard best at the carotid artery during exercise in healthy individuals can be used as a means for assessing post-concussion injury exertion tolerance. Typically there are no arterial sounds heard at the carotid artery in healthy individuals. Bruit, heard at rest, is an indicator of cardiovascular disease. Listening for a flow murmur or bruit-like sounds during exercise may indicate brain blood flow autoregulation and that this audible change in brain blood flow autoregulation could be used to assess exercise tolerance...
August 2016: Medical Hypotheses
Leodante da Costa, Christiaan Bas van Niftrik, David Crane, Jorn Fierstra, Allison Bethune
OBJECTIVE: Increased awareness around neurocognitive deficits after mild traumatic brain injury (mTBI) has progressed the search for objective, diagnostic, and monitoring tools, yet imaging biomarkers for mTBI and recovery are not established in clinical use. It has been suggested that mTBI impairs cerebrovascular reactivity (CVR) to CO2, which could be related to post-concussive syndrome (PCS). We investigate CVR evolution after mTBI using blood-oxygen-level dependent (BOLD) magnetic resonance imaging (MRI) and possible correlation with PCS...
2016: Frontiers in Neurology
Sujoy Ghosh Hajra, Careesa C Liu, Xiaowei Song, Shaun Fickling, Luke E Liu, Gabriela Pawlowski, Janelle K Jorgensen, Aynsley M Smith, Michal Schnaider-Beeri, Rudi Van Den Broek, Rowena Rizzotti, Kirk Fisher, Ryan C N D'Arcy
Clinical assessment of brain function relies heavily on indirect behavior-based tests. Unfortunately, behavior-based assessments are subjective and therefore susceptible to several confounding factors. Event-related brain potentials (ERPs), derived from electroencephalography (EEG), are often used to provide objective, physiological measures of brain function. Historically, ERPs have been characterized extensively within research settings, with limited but growing clinical applications. Over the past 20 years, we have developed clinical ERP applications for the evaluation of functional status following serious injury and/or disease...
2016: Frontiers in Neuroscience
John Leddy, Andrea Hinds, Dan Sirica, Barry Willer
Concussion affects the autonomic nervous system and its control of cerebral blood flow, which may be why uncontrolled activity can exacerbate symptoms after concussion. Traditionally, patients have been advised to restrict physical and cognitive activity until all symptoms resolve. However, recent research suggests that prolonged rest beyond the first couple of days after a concussion might hinder rather than aid recovery. Humans do not respond well to removal from their social and physical environments, and sustained rest adversely affects the physiology of concussion and can lead to physical deconditioning and reactive depression...
March 2016: PM & R: the Journal of Injury, Function, and Rehabilitation
Michael F La Fountaine, Michita Toda, Anthony J Testa, Vicci Hill-Lombardi
The arterial pulse wave (APW) has a distinct morphology whose contours reflect dynamics in cardiac function and peripheral vascular tone as a result of sympathetic nervous system (SNS) control. With a transition from rest to increased metabolic demand, the expected augmentation of SNS outflow will not only affect arterial blood pressure and heart rate but it will also induce changes to the contours of the APW. Following a sports concussion, a transient state cardiovascular autonomic dysfunction is present. How this state affects the APW has yet to be described...
2016: Frontiers in Neurology
Che-Ming Lin, Ying-Chi Tseng, Hui-Ling Hsu, Chi-Jen Chen, David Yen-Ting Chen, Feng-Xian Yan, Wen-Ta Chiu
BACKGROUND: This study uses a MRI technique, three-dimension pulse continuous arterial spin labeling (3D-PCASL), to measure the patient's cerebral blood flow (CBF) at the subacute stage of mild traumatic brain injury (MTBI) in order to analyze the relationship between cerebral blood flow and neurocognitive deficits. OBJECTIVE: To provide the relationship between cortical CBF and neuropsychological dysfunction for the subacute MTBI patients. METHODS: After MTBI, perfusion MR imaging technique (3D-PCASL) measures the CBF of MTBI patients (n = 23) within 1 month and that of normal controls (n = 22) to determine the quantity and location of perfusion defect...
2016: PloS One
Vignesh Subbian, Jonathan J Ratcliff, Joseph J Korfhagen, Kimberly W Hart, Jason M Meunier, George J Shaw, Christopher J Lindsell, Fred R Beyette
OBJECTIVES: Postconcussion symptoms (PCS) are a common complication of mild traumatic brain injury (TBI). Currently, there is no validated clinically available method to reliably predict at the time of injury who will subsequently develop PCS. The purpose of this study was to determine if PCS following mild TBI can be predicted during the initial presentation to an emergency department (ED) using a novel robotic-assisted assessment of neurologic function. METHODS: All patients presenting to an urban ED with a chief complaint of head injury within the preceding 24 hours were screened for inclusion from March 2013 to April 2014...
April 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
W Alan C Mutch, Michael J Ellis, Lawrence N Ryner, M Ruth Graham, Brenden Dufault, Brian Gregson, Thomas Hall, Martin Bunge, Marco Essig, Joseph A Fisher, James Duffin, David J Mikulis
OBJECT A neuroimaging assessment tool to visualize global and regional impairments in cerebral blood flow (CBF) and cerebrovascular responsiveness in individual patients with concussion remains elusive. Here the authors summarize the safety, feasibility, and results of brain CO2 stress testing in adolescents with postconcussion syndrome (PCS) and healthy controls. METHODS This study was approved by the Biomedical Research Ethics Board at the University of Manitoba. Fifteen adolescents with PCS and 17 healthy control subjects underwent anatomical MRI, pseudo-continuous arterial spin labeling MRI, and brain stress testing using controlled CO2 challenge and blood oxygen level-dependent (BOLD) MRI...
September 2016: Journal of Neurosurgery
Lauriane Auvergne, Andrey V Bortsov, Jacob C Ulirsch, David A Peak, Jeffrey S Jones, Robert A Swor, Robert M Domeier, David C Lee, Niels K Rathlev, Phyllis L Hendry, Samuel A McLean
OBJECTIVES: To determine the influence of epidemiologic factors and the influence of genetic variants affecting FKBP5, a protein known to modulate hypothalamic-pituitary-adrenocortical axis function, on the severity of somatic symptoms commonly termed "postconcussive" 6 and 12 months after motor vehicle collision (MVC). METHODS: European Americans 18 to 65 years of age who presented to one of eight emergency departments (EDs) after MVC were enrolled. Exclusion criteria included hospital admission...
January 2016: Psychosomatic Medicine
Sigal Tal, Amir Hadanny, Nadav Berkovitz, Efrat Sasson, Eshel Ben-Jacob, Shai Efrati
PURPOSE: Recent clinical studies present convincing evidence that hyperbaric oxygen therapy (HBOT) may be the coveted neurotherapeutic method for brain repair. One of the most interesting ways in which HBOT can induce neuroplasticity is angiogenesis. The objective in this study was to assess the neurotherapeutic effect of HBOT in post TBI patients using brain perfusion imaging and clinical cognitive functions. METHODS: Retrospective analysis of patients suffering from chronic neuro-cognitive impairment from TBI treated with HBOT...
2015: Restorative Neurology and Neuroscience
Yang Wang, Lindsay D Nelson, Ashley A LaRoche, Adam Y Pfaller, Andrew S Nencka, Kevin M Koch, Michael A McCrea
Sport-related concussion (SRC) is a major health problem, affecting millions of athletes each year. While the clinical effects of SRC (e.g., symptoms and functional impairments) typically resolve within several days, increasing evidence suggests persistent neurophysiological abnormalities beyond the point of clinical recovery after injury. This study aimed to evaluate cerebral blood flow (CBF) changes in acute SRC, as measured using advanced arterial spin labeling (ASL) magnetic resonance imaging (MRI). We compared CBF maps assessed in 18 concussed football players (age, 17...
July 1, 2016: Journal of Neurotrauma
Mark H Mirabelli, Mathew J Devine, Jaskaran Singh, Michael Mendoza
The preparticipation physical evaluation is a commonly requested medical visit for amateur and professional athletes of all ages. The overarching goal is to maximize the health of athletes and their safe participation in sports. Although studies have not found that the preparticipation physical evaluation prevents morbidity and mortality associated with sports, it may detect conditions that predispose the athlete to injury or illness and can provide strategies to prevent injuries. Clearance depends on the outcome of the evaluation and the type of sport (and sometimes position or event) in which the athlete participates...
September 1, 2015: American Family Physician
H Dang, J W Stayman, A Sisniega, J Xu, W Zbijewski, X Wang, D H Foos, N Aygun, V E Koliatsos, J H Siewerdsen
Non-contrast CT reliably detects fresh blood in the brain and is the current front-line imaging modality for intracranial hemorrhage such as that occurring in acute traumatic brain injury (contrast ~40-80 HU, size  >  1 mm). We are developing flat-panel detector (FPD) cone-beam CT (CBCT) to facilitate such diagnosis in a low-cost, mobile platform suitable for point-of-care deployment. Such a system may offer benefits in the ICU, urgent care/concussion clinic, ambulance, and sports and military theatres...
August 21, 2015: Physics in Medicine and Biology
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