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Blood Test in Concussion

Lawrence M Lewis, Derek Schloemann, Linda Papa, Robert Fucetola, Jeffrey Bazarian, Miranda Lindburg, Robert Welch
OBJECTIVE: To compare test characteristics of a single serum concentration of glial fibrillary acidic protein (GFAP), S-100β, and ubiquitin carboxyl terminal hydrolase L1 (UCH-L1), obtained within 6 hours of head injury, to diagnose mild traumatic brain injury (mTBI) in head-injured subjects. METHODS: Adults aged 18-80 who presented to one of seven EDs with a blunt closed head injury, underwent head CT within 4 hours of injury, and had blood drawn for biomarker analysis within 6 hours of injury were eligible...
February 7, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
John L Dobson, Mary Beth Yarbrough, Jose Perez, Kelsey Evans, Thomas Buckley
Recent evidence suggests that concussions may disrupt autonomic cardiovascular control. This study investigated the initial effects of concussion on cardiovascular function using three autonomic reflex tests. Twenty three recreational athletes (12 females, 11 males) were divided into concussed (n = 12) and control (n = 11) groups. Concussed participants performed forced breathing, standing and Valsalva autonomic tests four times: 1) within 48 hours of injury, 2) 24 hours later, 3) 1 week after injury and 4) 2 weeks after injury...
February 1, 2017: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology
Biswadev Mitra, Thomas F Rau, Nanda Surendran, James H Brennan, Prasanthan Thaveenthiran, Edmond Sorich, Mark C Fitzgerald, Jeffrey V Rosenfeld, Sarjubhai A Patel
Prediction of post-concussive syndrome after apparent mild traumatic brain injury (TBI) and subsequent cognitive recovery remains challenging, with substantial limitations of current methods of cognitive testing. This pilot study aimed to determine if levels of micro ribonucleic acids (RNAs) circulating in plasma are altered following TBI, and if changes to levels of such biomarkers over time could assist in determination of prognosis after TBI. Patients were enrolled after TBI on presentation to the Emergency Department and allocated to three groups: A - TBI (physical trauma to the head), witnessed loss of consciousness, amnesia, GCS=15, a normal CT Brain and a recorded first pass after post-traumatic amnesia (PTA) scale; B TBI, witnessed LOC, amnesia, GCS=15, a normal CT brain and a PTA scale test fail and: C - TBI and initial GCS <13 on arrival to the ED...
January 20, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
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...
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...
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
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