An Investigation of Dynamic Cerebral Autoregulation in Adolescent Concussion.

PURPOSE: Although cerebrovascular impairments are believed to contribute to concussion symptoms, little information exists regarding brain vasomotor control in adolescent concussion, particularly autoregulatory control that forms a fundamental response mechanism during changes in blood pressure. This research tested the hypothesis that adolescent concussion is marked by impaired dynamic cerebral autoregulation.

METHODS: Nineteen concussed adolescents (15 ± 2 years, 13 females) and eighteen healthy controls (15 ± 2 years, 9 females) completed two sit-to-stand trials. Brachial artery blood pressure and cerebral blood flow velocity in the right middle cerebral artery were measured continuously. Dynamic rate of regulation was calculated as the rate of change in cerebrovascular resistance relative to the change in arterial blood pressure. The concussed adolescents were followed through their rehabilitation for up to twelve weeks.

RESULTS: At the first visit, the concussed adolescents demonstrated reduced rate of regulation compared with the healthy controls (0.12 ± 0.04 vs. 0.19 ± 0.06 s; P ≤ 0.001). At the concussed adolescents final visit, following symptom resolution, rate of regulation improved to levels that were not different from the healthy controls (n = 9; 0.15 ± 0.08 vs. 0.19 ± 0.06 s; P = 0.06). Two distinct groups were observed at the final visit with some individuals experiencing recovery of dynamic cerebral autoregulation and others showing no marked change from the initial visit.

CONCLUSION: Adolescents demonstrate an impairment in dynamic cerebral autoregulation following concussion that improves along with clinical symptoms in some individuals and remains impaired in others despite symptom resolution.