Kuhn, A W; Zuckerman, S L; Solomon, G S; Casson, I R; Viano, D C
In: Sports Health, vol. 9, no. 1, pp. 30–40, 2017.
Abstract | Links | BibTeX | Tags: chronic impairment, Cognitive function, NATIONAL Football League, neuroimaging, Neuropsychological testing, neuroradiology, Sport-related concussion
@article{Kuhn2017,
title = {Interrelationships Among Neuroimaging Biomarkers, Neuropsychological Test Data, and Symptom Reporting in a Cohort of Retired National Football League Players},
author = {Kuhn, A W and Zuckerman, S L and Solomon, G S and Casson, I R and Viano, D C},
doi = {10.1177/1941738116674006},
year = {2017},
date = {2017-01-01},
journal = {Sports Health},
volume = {9},
number = {1},
pages = {30--40},
abstract = {Background: Structural brain changes, potentially resulting from repetitive brain trauma (RBT), have been correlated with neurocognitive decline and increased symptom reporting in retired athletes. Hypothesis: In a cohort of retired National Football League (NFL) players, the relationships between 3 neuroimaging parameters, neuropsychological testing, and symptom scores will be significantly correlated. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: Comprehensive magnetic resonance imaging was performed in 45 retired NFL players. Three neuroanatomical parameters were assessed by board-certified radiologists blinded to the purpose of the study: (1) the absence or presence of small or large cavum septum pellucidum, (2) a global mean score of fractional anisotropy (FA), and (3) the presence or absence of microhemorrhages. The subjects underwent a battery of 9 paper-and-pencil neuropsychological tests, a computerized neurocognitive test, and multiple symptom and depression scales. The associations among the neuroimaging results with these outcome measures were assessed utilizing Pearson, Spearman rank, and point-biserial correlations. Results: The 45 subjects (mean age, 46.7 ± 9.1 years) reported a mean 6.9 (±6.2) concussions and 13.0 (±7.9) “dings” in the NFL. Ten (22%) did not have a cavum septum pellucidum, while 32 (71%) had a small and 3 (7%) had a large one. Four (9%) had microhemorrhages. Global FA mean was 0.459 (±0.035). The majority (50.8%) of correlations among the neuroimaging parameters and neurocognitive/symptom scores fell below the threshold of “small” effect size (r \< 0.10). The remaining (49.2%) correlations were between “small” and “medium” effect sizes (0.1 \< r \< 0.3). However, all correlations were statistically nonsignificant. Conclusion: There were minimal and statistically nonsignificant correlations among the neuroimaging, neurocognitive, and symptom scores examined in this cohort of NFL retirees. Clinical Relevance: Associating the severity of structural brain changes to neurocognitive performance and symptom burden after RBT is complex may involve other moderating variables or biomarkers, and demands further study. © 2016, © 2016 The Author(s).},
keywords = {chronic impairment, Cognitive function, NATIONAL Football League, neuroimaging, Neuropsychological testing, neuroradiology, Sport-related concussion},
pubstate = {published},
tppubtype = {article}
}
Churchill, N; Hutchison, M G; Leung, G; Graham, S; Schweizer, T A
Changes in functional connectivity of the brain associated with a history of sport concussion: A preliminary investigation Journal Article
In: Brain Injury, vol. 31, no. 1, pp. 39–48, 2017.
Abstract | Links | BibTeX | Tags: Concussion, Functional MRI, MRI scan, neuroimaging
@article{Churchill2017,
title = {Changes in functional connectivity of the brain associated with a history of sport concussion: A preliminary investigation},
author = {Churchill, N and Hutchison, M G and Leung, G and Graham, S and Schweizer, T A},
doi = {10.1080/02699052.2016.1221135},
year = {2017},
date = {2017-01-01},
journal = {Brain Injury},
volume = {31},
number = {1},
pages = {39--48},
abstract = {Objective: There is evidence of long-term clinical consequences associated with a history of sport concussion. However, there remains limited information about the underlying changes in brain function. The goal of this study was to identify brain regions where abnormal resting-state function is associated with chronic concussion, for athletes without persistent symptoms. Methods: Functional Magnetic Resonance Imaging (fMRI) was performed on a group of athletes with prior concussion (n = 22) and a group without documented injury (n = 21). Multivariate predictive modelling was used to localize reliable changes in brain connectivity that are associated with a history of concussion and with clinical factors, including number of prior concussions and recovery time from last injury. Results: No significant differences were found between athletes with and without a history of concussion, but functional connectivity was significantly associated with clinical history. The number of prior concussions was associated with most extensive connectivity changes, particularly for elements of the visual attention network and cerebellum. Conclusion: The findings of this preliminary study indicate that functional brain abnormalities associated with chronic concussion may be significantly dependent on clinical history. In addition, elements of the visual and cerebellar systems may be most sensitive to the long-term effects of sport concussion. © 2017 Taylor \& Francis Group, LLC.},
keywords = {Concussion, Functional MRI, MRI scan, neuroimaging},
pubstate = {published},
tppubtype = {article}
}
Beiske, K K; Kostov, K H; Kostov, H
Rhythmic midtemporal discharge in a youth during light sleep Journal Article
In: Neurodiagnostic Journal, vol. 56, no. 1, pp. 32–36, 2016.
Abstract | Links | BibTeX | Tags: Adolescent, Article, Automobile Driving, Benign EEG pattern, car driving, case report, case reports, complication, computer assisted tomography, Concussion, Craniocerebral Trauma, drowsiness, EEG pattern, electroencephalogram, Electroencephalography, Epilepsy, epileptic discharge, febrile convulsion, football, Functional Laterality, head injury, hemispheric dominance, human, Humans, hyperventilation, Injuries, Light sleep, Male, neuroimaging, neurologic examination, nuclear magnetic resonance imaging, Pathophysiology, Patient treatment, Rhythmic midtemporal discharge, RMTD, SLEEP, Sleep research, spike wave, temporal lobe, temporal lobe epilepsy, theta rhythm, tonic clonic seizure, unconsciousness, wakefulness
@article{Beiske2016,
title = {Rhythmic midtemporal discharge in a youth during light sleep},
author = {Beiske, K K and Kostov, K H and Kostov, H},
doi = {10.1080/21646821.2015.1119579},
year = {2016},
date = {2016-01-01},
journal = {Neurodiagnostic Journal},
volume = {56},
number = {1},
pages = {32--36},
abstract = {Rhythmic midtemporal discharge (RMTD) is a rare, benign EEG pattern that may have epileptic morphology. Recognizing variations of RMTD is important in order to avoid over- or misinterpretation of EEG findings, which may lead to inappropriate treatment and negative consequences for the patient in question. We present a case report of RTMDs during light sleep where initial erroneous description necessitated repeat EEGs and additional diagnostic exams and led to the postponement of obtaining a drivers licence for this young patient. Copyright © ASET - The Neurodiagnostic Society.},
keywords = {Adolescent, Article, Automobile Driving, Benign EEG pattern, car driving, case report, case reports, complication, computer assisted tomography, Concussion, Craniocerebral Trauma, drowsiness, EEG pattern, electroencephalogram, Electroencephalography, Epilepsy, epileptic discharge, febrile convulsion, football, Functional Laterality, head injury, hemispheric dominance, human, Humans, hyperventilation, Injuries, Light sleep, Male, neuroimaging, neurologic examination, nuclear magnetic resonance imaging, Pathophysiology, Patient treatment, Rhythmic midtemporal discharge, RMTD, SLEEP, Sleep research, spike wave, temporal lobe, temporal lobe epilepsy, theta rhythm, tonic clonic seizure, unconsciousness, wakefulness},
pubstate = {published},
tppubtype = {article}
}
Bressan, S; Babl, F E
Diagnosis and management of paediatric concussion Journal Article
In: Journal of Paediatrics & Child Health, vol. 52, no. 2, pp. 151–157, 2016.
Abstract | Links | BibTeX | Tags: Article, brain concussion, brain injury assessment, Child, child care, childhood injury, chronic brain disease, clinical feature, Concussion, conservative treatment, Glasgow Coma Scale, glial fibrillary acidic protein, human, neuroimaging, neuron specific enolase, patient care, Post Concussive Symptom Scale, post-concussive syndrome, priority journal, protein S100B, Second impact syndrome, Sport Concussion Assessment Tool 3, traumatic brain injury
@article{Bressan2016,
title = {Diagnosis and management of paediatric concussion},
author = {Bressan, S and Babl, F E},
doi = {10.1111/jpc.12967},
year = {2016},
date = {2016-01-01},
journal = {Journal of Paediatrics \& Child Health},
volume = {52},
number = {2},
pages = {151--157},
abstract = {Heightened recognition of concussions and concerns about their sequelae in children has become an increasing community and public health concern. Biomarkers and clinical tests are being explored, but the diagnosis of concussion in the emergency department continues to be based on clinical signs and symptoms. While the majority of children go on to recover from post-concussive symptoms within 2 weeks, it is unclear which patients with concussion will go on to develop short- or long-term sequelae. A number of more or less evidence-based guidelines have become available which seek to guide clinicians on how to manage children post-concussion. In general, care after the emergency department is focused on reducing the risk of re-injury and rest until cerebral recovery with a graduated return to school and then play. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).},
keywords = {Article, brain concussion, brain injury assessment, Child, child care, childhood injury, chronic brain disease, clinical feature, Concussion, conservative treatment, Glasgow Coma Scale, glial fibrillary acidic protein, human, neuroimaging, neuron specific enolase, patient care, Post Concussive Symptom Scale, post-concussive syndrome, priority journal, protein S100B, Second impact syndrome, Sport Concussion Assessment Tool 3, traumatic brain injury},
pubstate = {published},
tppubtype = {article}
}
Talavage, T M; Nauman, E A; Leverenz, L J
The role of medical imaging in the recharacterization of mild traumatic brain injury using youth sports as a laboratory Journal Article
In: Frontiers in Neurology, vol. 6, no. JAN, 2016.
Abstract | Links | BibTeX | Tags: Article, cognition assessment, Concussion, DIAGNOSTIC imaging, functional magnetic resonance imaging, Functional MRI, human, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Neuroanatomy, neuroimaging, neuromonitoring, nonhuman, NUCLEAR magnetic resonance spectroscopy, Patient monitoring, population risk, prediction, protective equipment, sport injury, Subconcussive, traumatic brain injury, validation process
@article{Talavage2016,
title = {The role of medical imaging in the recharacterization of mild traumatic brain injury using youth sports as a laboratory},
author = {Talavage, T M and Nauman, E A and Leverenz, L J},
doi = {10.3389/fneur.2015.00273},
year = {2016},
date = {2016-01-01},
journal = {Frontiers in Neurology},
volume = {6},
number = {JAN},
abstract = {The short- and long-term impact of mild traumatic brain injury (TBI) is an increasingly vital concern for both military and civilian personnel. Such injuries produce significant social and financial burdens and necessitate improved diagnostic and treatment methods. Recent integration of neuroimaging and biomechanical studies in youth collision-sport athletes has revealed that significant alterations in brain structure and function occur even in the absence of traditional clinical markers of "concussion." While task performance is maintained, athletes exposed to repetitive head accelerations exhibit structural changes to the underlying white matter, altered glial cell metabolism, aberrant vascular response, and marked changes in functional network behavior. Moreover, these changes accumulate with accrued years of exposure, suggesting a cumulative trauma mechanism that may culminate in categorization as "concussion" and long-term neurological deficits. The goal of this review is to elucidate the role of medical imaging in recharacterizing TBI, as a whole, to better identify at-risk individuals and improve the development of preventative and interventional approaches. © 2016 Talavage, Nauman and Leverenz.},
keywords = {Article, cognition assessment, Concussion, DIAGNOSTIC imaging, functional magnetic resonance imaging, Functional MRI, human, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Neuroanatomy, neuroimaging, neuromonitoring, nonhuman, NUCLEAR magnetic resonance spectroscopy, Patient monitoring, population risk, prediction, protective equipment, sport injury, Subconcussive, traumatic brain injury, validation process},
pubstate = {published},
tppubtype = {article}
}
Holtkamp, M D; Grimes, J; Ling, G
Concussion in the Military: an Evidence-Base Review of mTBI in US Military Personnel Focused on Posttraumatic Headache Journal Article
In: Current Pain & Headache Reports, vol. 20, no. 6, 2016.
Abstract | Links | BibTeX | Tags: apolipoprotein E4, assessment, biological marker, botulinum toxin, brain concussion, calcitonin gene related peptide receptor antagonis, comorbidity, Concussion, depression, DIAGNOSTIC imaging, disease course, genetic polymorphism, genetic predisposition, glial fibrillary acidic protein, headache, Headache disorder, human, MANAGEMENT, migraine, Military personnel, mTBI, neuroimaging, Pathophysiology, postconcussion syndrome, posttraumatic headache, posttraumatic stress disorder, Prognosis, Review, serotonin 1 agonist, serotonin 1F agonist, soldier, traumatic brain injury, Treatment, tricyclic antidepressant agent, triptan derivative, unclassified drug, UNITED States
@article{Holtkamp2016,
title = {Concussion in the Military: an Evidence-Base Review of mTBI in US Military Personnel Focused on Posttraumatic Headache},
author = {Holtkamp, M D and Grimes, J and Ling, G},
doi = {10.1007/s11916-016-0572-x},
year = {2016},
date = {2016-01-01},
journal = {Current Pain \& Headache Reports},
volume = {20},
number = {6},
abstract = {Traumatic brain injury (TBI) is defined as an alteration in brain function caused by an external force. Mild TBI or concussion is now well recognized to be a risk of military service as well as participation in athletic sports such as football. Posttraumatic headache (PTH) is the most common symptom after mTBI in US service members. PTH most commonly presents with migraine-like headache features. The following is an overview of the epidemiology, pathophysiology, clinical course, prognosis, complications, and treatment of mTBI and associated comorbidities with a focus on PTH. There is a particular emphasis on emerging evidence-based clinical practice. One important medical consequence of the recognition that mTBI is a highly prevalent among military service members is that the Department of Defense (DoD) is dedicating significant financial and intellectual resources to better understanding and developing treatments for TBI. The identification of the importance of TBI among the US military population has had the added benefit of increasing awareness of this condition among civilian populations, particularly those engaged in both professional and youth sports. The NIH and NSF are also supporting important TBI research. President Obama’s Brain Initiative is also providing additional impetus for these efforts. Unfortunately, the understanding of the acute and chronic effects of mTBI on the brain remains limited. Gratefully, there is hope that through innovative research, there will be advances in elucidating the underlying pathophysiology, which will lead to clinical and prognostic indicators, ultimately resulting in new treatment options for this very complicated set of disorders. © 2016, Springer Science+Business Media New York (outside the USA).},
keywords = {apolipoprotein E4, assessment, biological marker, botulinum toxin, brain concussion, calcitonin gene related peptide receptor antagonis, comorbidity, Concussion, depression, DIAGNOSTIC imaging, disease course, genetic polymorphism, genetic predisposition, glial fibrillary acidic protein, headache, Headache disorder, human, MANAGEMENT, migraine, Military personnel, mTBI, neuroimaging, Pathophysiology, postconcussion syndrome, posttraumatic headache, posttraumatic stress disorder, Prognosis, Review, serotonin 1 agonist, serotonin 1F agonist, soldier, traumatic brain injury, Treatment, tricyclic antidepressant agent, triptan derivative, unclassified drug, UNITED States},
pubstate = {published},
tppubtype = {article}
}
Ellis, M J; Cordingley, D; Vis, S; Reimer, K; Leiter, J; Russell, K
Vestibulo-ocular dysfunction in pediatric sports-related concussion Journal Article
In: Journal of Neurosurgery: Pediatrics, vol. 16, no. 3, pp. 248–255, 2015.
Abstract | Links | BibTeX | Tags: Adolescent, amnesia, Article, Athletic Injuries, Baseball, BASKETBALL, blurred vision, brain concussion, CANADA, Child, childhood disease, cohort analysis, complication, Concussion, consultation, controlled study, disease duration, Dizziness, Female, follow up, football, Hockey, human, Humans, interdisciplinary communication, major clinical study, Male, Manitoba, migraine, neuroimaging, neuropsychological test, Neuropsychological Tests, ODDS ratio, Pathophysiology, Pediatric, Physical Examination, physiotherapy, Post-Concussion Syndrome, postconcussion syndrome, Prevalence, priority journal, Reflex, Retrospective Studies, retrospective study, return to sport, saccadic eye movement, skating, skiing, Soccer, sport injury, sport related concussion, Sports-related concussion, Trauma, vestibular physiotherapy, Vestibular therapy, vestibulo ocular dysfunction, Vestibulo-Ocular, Vestibulo-ocular dysfunction, vestibuloocular reflex, VOLLEYBALL, Young Adult, youth sport
@article{Ellis2015,
title = {Vestibulo-ocular dysfunction in pediatric sports-related concussion},
author = {Ellis, M J and Cordingley, D and Vis, S and Reimer, K and Leiter, J and Russell, K},
doi = {10.3171/2015.1.PEDS14524},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neurosurgery: Pediatrics},
volume = {16},
number = {3},
pages = {248--255},
abstract = {Object The objective of this study was 2-fold: 1) to examine the prevalence of vestibulo-ocular dysfunction (VOD) among children and adolescents with acute sports-related concussion (SRC) and postconcussion syndrome (PCS) who were referred to a multidisciplinary pediatric concussion program; and 2) to determine if VOD is associated with the development of PCS in this cohort. Methods The authors conducted a retrospective review of all patients with acute SRC (presenting 30 days or less postinjury) and PCS (3 or more symptoms for at least 1 month) referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Initial assessment included clinical history, physical examination, and Post-Concussion Symptom Scale assessment. Patients were also assessed for VOD, which was defined as more than one subjective vestibular and oculomotor complaint (dizziness, blurred vision, and so on) and more than one objective physical examination finding (abnormal smooth pursuits, saccades, vestibulo-ocular reflex, and so on). This study was approved by the local institutional ethics review board. Results A total of 101 patients (mean age 14.2 years, SD 2.3 years; 63 male and 38 female patients) participated, including 77 (76.2%) with acute SRC and 24 (23.8%) with PCS. Twenty-two of the 77 patients (28.6%) with acute SRC and 15 of the 24 (62.5%) with PCS met the clinical criteria for VOD. The median duration of symptoms was 40 days (interquartile range [IQR] 28.5-54 days) for patients with acute SRC who had VOD compared with 21 days (IQR 13-32 days) for those without VOD (p = 0.0001). There was a statistically significant increase in the adjusted odds of developing PCS among patients with acute SRC who had VOD compared with those without VOD (adjusted OR 4.10; 95% CI 1.04-16.16). Conclusions Evidence of VOD was detected in a significant proportion of children and adolescents with acute SRC and PCS who were referred to a multidisciplinary pediatric concussion program. This clinical feature was a significant risk factor for the subsequent development of PCS in this pediatric acute SRC cohort. © AANS, 2015.},
keywords = {Adolescent, amnesia, Article, Athletic Injuries, Baseball, BASKETBALL, blurred vision, brain concussion, CANADA, Child, childhood disease, cohort analysis, complication, Concussion, consultation, controlled study, disease duration, Dizziness, Female, follow up, football, Hockey, human, Humans, interdisciplinary communication, major clinical study, Male, Manitoba, migraine, neuroimaging, neuropsychological test, Neuropsychological Tests, ODDS ratio, Pathophysiology, Pediatric, Physical Examination, physiotherapy, Post-Concussion Syndrome, postconcussion syndrome, Prevalence, priority journal, Reflex, Retrospective Studies, retrospective study, return to sport, saccadic eye movement, skating, skiing, Soccer, sport injury, sport related concussion, Sports-related concussion, Trauma, vestibular physiotherapy, Vestibular therapy, vestibulo ocular dysfunction, Vestibulo-Ocular, Vestibulo-ocular dysfunction, vestibuloocular reflex, VOLLEYBALL, Young Adult, youth sport},
pubstate = {published},
tppubtype = {article}
}
Morgan, C D; Zuckerman, S L; King, L E; Beaird, S E; Sills, A K; Solomon, G S
Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging Journal Article
In: Child's Nervous System, vol. 31, no. 12, pp. 2305–2309, 2015.
Abstract | Links | BibTeX | Tags: Adolescent, arachnoid cyst, Article, brain, Brain Injury, Child, Computed tomography (CT) neuroimaging, computer assisted tomography, Computer-Assisted, Concussion, cost effectiveness analysis, cost utility analysis, DECISION making, diagnostic value, DSM-IV, Female, human, Humans, image processing, Magnetic Resonance Imaging, Magnetic resonance imaging (MRI), major clinical study, Male, mild traumatic brain injury, neuroimaging, neurosurgery, nuclear magnetic resonance, nuclear magnetic resonance imaging, pathology, Post-Concussion Syndrome, postconcussion syndrome, Preschool, preschool child, priority journal, Radiography, Retrospective Studies, retrospective study, Sports, STATISTICS, Tomography, traumatic brain injury, X ray, X-Ray Computed
@article{Morgan2015,
title = {Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging},
author = {Morgan, C D and Zuckerman, S L and King, L E and Beaird, S E and Sills, A K and Solomon, G S},
doi = {10.1007/s00381-015-2916-y},
year = {2015},
date = {2015-01-01},
journal = {Child's Nervous System},
volume = {31},
number = {12},
pages = {2305--2309},
abstract = {Purpose: Approximately 90% of concussions are transient, with symptoms resolving within 10\textendash14 days. However, a minority of patients remain symptomatic several months post-injury, a condition known as post-concussion syndrome (PCS). The treatment of these patients can be challenging. The goal of our study was to assess the utility and cost-effectiveness of neurologic imaging two or more weeks post-injury in a cohort of youth with PCS. Methods: We conducted a retrospective study of 52 pediatric patients with persistent post-concussion symptoms after 3 months. We collected demographics and neuroimaging results obtained greater than 2 weeks post-concussion. Neuroimaging ordered in the first 2 weeks post-concussion was excluded, except to determine the rate of re-imaging. Descriptive statistics and corresponding cost data were collected. Results: Of 52 patients with PCS, 23/52 (44 %) had neuroimaging at least 2 weeks after the initial injury, for a total of 32 diagnostic studies. In summary, 1/19 MRIs (5.3 %), 1/8 CTs (13 %), and 0/5 x-rays (0 %) yielded significant positive findings, none of which altered clinical management. Chronic phase neuroimaging estimated costs from these 52 pediatric patients totaled $129,025. We estimate the cost to identify a single positive finding was $21,000 for head CT and $104,500 for brain MRI. Conclusions: In this cohort of pediatric PCS patients, brain imaging in the chronic phase (defined as more than 2 weeks after concussion) was pursued in almost half the study sample, had low diagnostic yield, and had poor cost-effectiveness. Based on these results, outpatient management of pediatric patients with long-term post-concussive symptoms should rarely include repeat neuroimaging beyond the acute phase. © 2015, Springer-Verlag Berlin Heidelberg.},
keywords = {Adolescent, arachnoid cyst, Article, brain, Brain Injury, Child, Computed tomography (CT) neuroimaging, computer assisted tomography, Computer-Assisted, Concussion, cost effectiveness analysis, cost utility analysis, DECISION making, diagnostic value, DSM-IV, Female, human, Humans, image processing, Magnetic Resonance Imaging, Magnetic resonance imaging (MRI), major clinical study, Male, mild traumatic brain injury, neuroimaging, neurosurgery, nuclear magnetic resonance, nuclear magnetic resonance imaging, pathology, Post-Concussion Syndrome, postconcussion syndrome, Preschool, preschool child, priority journal, Radiography, Retrospective Studies, retrospective study, Sports, STATISTICS, Tomography, traumatic brain injury, X ray, X-Ray Computed},
pubstate = {published},
tppubtype = {article}
}
Andre, J B
Arterial spin labeling magnetic resonance perfusion for traumatic brain injury: Technical challenges and potentials Journal Article
In: Topics in Magnetic Resonance Imaging, vol. 24, no. 5, pp. 275–287, 2015.
Abstract | BibTeX | Tags: Arterial spin labeling, artery blood flow, artifact, brain, brain blood flow, brain circulation, Brain Injuries, Brain Injury, brain perfusion, Cerebrovascular Circulation, clinical classification, Concussion, echo planar imaging, gray matter, human, Humans, Magnetic Resonance Imaging, mild traumatic brain injury, neuroimaging, neuropsychological test, nuclear magnetic resonance imaging, pathology, positron emission tomography, priority journal, procedures, Review, single photon emission computer tomography, spin labeling, Spin Labels, Sport, Sports-related concussion, symptom, traumatic brain injury, white matter
@article{Andre2015,
title = {Arterial spin labeling magnetic resonance perfusion for traumatic brain injury: Technical challenges and potentials},
author = {Andre, J B},
year = {2015},
date = {2015-01-01},
journal = {Topics in Magnetic Resonance Imaging},
volume = {24},
number = {5},
pages = {275--287},
abstract = {Traumatic brain injury (TBI), including concussion, is a public health concern, as it affects over 1.7 million persons in the United States per year. Yet, the diagnosis of TBI, particularly mild TBI (mTBI), can be controversial, as neuroimaging findings can be sparse on conventional magnetic resonance and computed tomography examinations, and when present, often poorly correlate with clinical signs and symptoms. Furthermore, the discussion of TBI, concussion, and head impact exposure is immediately complicated by the many differing opinions of what constitutes each, their respective severities, and how the underlying biomechanics of the inciting head impact might alter the distribution, severity, and prognosis of the underlying brain injury. Advanced imaging methodologies hold promise in improving the sensitivity and detectability of associated imaging biomarkers that might better correlate with patient outcome and prognostication, allowing for improved triage and therapeutic guidance in the setting of TBI, particularly in mTBI. This work will examine the defining symptom complex associated with mTBI and explore changes in cerebral blood flow measured by arterial spin labeling, as a potential imaging biomarker for TBI, and briefly correlate these observations with findings identified by single photon emission computed tomography and positron emission tomography imaging.. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.},
keywords = {Arterial spin labeling, artery blood flow, artifact, brain, brain blood flow, brain circulation, Brain Injuries, Brain Injury, brain perfusion, Cerebrovascular Circulation, clinical classification, Concussion, echo planar imaging, gray matter, human, Humans, Magnetic Resonance Imaging, mild traumatic brain injury, neuroimaging, neuropsychological test, nuclear magnetic resonance imaging, pathology, positron emission tomography, priority journal, procedures, Review, single photon emission computer tomography, spin labeling, Spin Labels, Sport, Sports-related concussion, symptom, traumatic brain injury, white matter},
pubstate = {published},
tppubtype = {article}
}
Stemper, B D; Shah, A S; Pintar, F A; McCrea, M; Kurpad, S N; Glavaski-Joksimovic, A; Olsen, C; Budde, M D
Head Rotational Acceleration Characteristics Influence Behavioral and Diffusion Tensor Imaging Outcomes Following Concussion Journal Article
In: Annals of Biomedical Engineering, vol. 43, no. 5, pp. 1071–1088, 2015.
Abstract | Links | BibTeX | Tags: Acceleration, Accidents, BEHAVIORAL assessment, Behavioral assessments, Behavioral outcomes, Biomechanics, brain, Cognitive deficits, Diffusion, Diffusion Tensor Imaging, Diffusion tensor imaging (DTI), fractional anisotropy, Full factorial design, Magnetic Resonance Imaging, Microstructure, Motor vehicle crashes, neuroimaging, Rats, Rotational acceleration, Tensors, Traumatic Brain Injuries, Traumatic brain injury (mTBI)
@article{Stemper2015,
title = {Head Rotational Acceleration Characteristics Influence Behavioral and Diffusion Tensor Imaging Outcomes Following Concussion},
author = {Stemper, B D and Shah, A S and Pintar, F A and McCrea, M and Kurpad, S N and Glavaski-Joksimovic, A and Olsen, C and Budde, M D},
doi = {10.1007/s10439-014-1171-9},
year = {2015},
date = {2015-01-01},
journal = {Annals of Biomedical Engineering},
volume = {43},
number = {5},
pages = {1071--1088},
abstract = {A majority of traumatic brain injuries (TBI) in motor vehicle crashes and sporting environments are mild and caused by high-rate acceleration of the head. For injuries caused by rotational acceleration, both magnitude and duration of the acceleration pulse were shown to influence injury outcomes. This study incorporated a unique rodent model of rotational acceleration-induced mild TBI (mTBI) to quantify independent effects of magnitude and duration on behavioral and neuroimaging outcomes. Ninety-two Sprague\textendashDawley rats were exposed to head rotational acceleration at peak magnitudes of 214 or 350 krad/s2 and acceleration pulse durations of 1.6 or 3.4 ms in a full factorial design. Rats underwent a series of behavioral tests including the Composite Neuroscore (CN), Elevated Plus Maze (EPM), and Morris Water Maze (MWM). Ex vivo diffusion tensor imaging (DTI) of the fixed brains was conducted to assess the effects of rotational injury on brain microstructure as revealed by the parameter fractional anisotropy (FA). While the injury did not cause significant locomotor or cognitive deficits measured with the CN and MWM, respectively, a main effect of duration was consistently observed for the EPM. Increased duration caused significantly greater activity and exploratory behaviors measured as open arm time and number of arm changes. DTI demonstrated significant effects of both magnitude and duration, with the FA of the amygdala related to both the magnitude and duration. Increased duration also caused FA changes at the interface of gray and white matter. Collectively, the findings demonstrate that the consequences of rotational acceleration mTBI were more closely associated with duration of the rotational acceleration impulse, which is often neglected as an independent factor, and highlight the need for animal models of TBI with strong biomechanical foundations to associate behavioral outcomes with brain microstructure. © 2014, Biomedical Engineering Society (Outside the U.S.).},
keywords = {Acceleration, Accidents, BEHAVIORAL assessment, Behavioral assessments, Behavioral outcomes, Biomechanics, brain, Cognitive deficits, Diffusion, Diffusion Tensor Imaging, Diffusion tensor imaging (DTI), fractional anisotropy, Full factorial design, Magnetic Resonance Imaging, Microstructure, Motor vehicle crashes, neuroimaging, Rats, Rotational acceleration, Tensors, Traumatic Brain Injuries, Traumatic brain injury (mTBI)},
pubstate = {published},
tppubtype = {article}
}
Sikoglu, E M; Liso Navarro, A A; Czerniak, S M; McCafferty, J; Eisenstock, J; Stevenson, J H; King, J A; Moore, C M
Effects of Recent Concussion on Brain Bioenergetics: A Phosphorus-31 Magnetic Resonance Spectroscopy Study Journal Article
In: Cognitive and Behavioral Neurology, vol. 28, no. 4, pp. 181–187, 2015.
Abstract | Links | BibTeX | Tags: Adolescent, adult, Article, athlete, Athletic Injuries, biochemical analysis, bioenergy, brain concussion, clinical article, cognition, college, Concussion, energy consumption, Energy Metabolism, Female, high energy phosphate, human, Humans, Longitudinal studies, longitudinal study, Magnetic Resonance Spectroscopy, Male, metabolism, MR spectroscopy (phosphorus-31), neuroimaging, NTP, NUCLEAR magnetic resonance spectroscopy, nucleoside, nucleoside triphosphate, Nucleosides, Pathophysiology, phosphate, Phosphates, phosphorus, Phosphorus Isotopes, phosphorus nuclear magnetic resonance, PHYSIOLOGY, Prefrontal Cortex, priority journal, procedures, sport injury, Universities, university, Young Adult
@article{Sikoglu2015,
title = {Effects of Recent Concussion on Brain Bioenergetics: A Phosphorus-31 Magnetic Resonance Spectroscopy Study},
author = {Sikoglu, E M and {Liso Navarro}, A A and Czerniak, S M and McCafferty, J and Eisenstock, J and Stevenson, J H and King, J A and Moore, C M},
doi = {10.1097/WNN.0000000000000076},
year = {2015},
date = {2015-01-01},
journal = {Cognitive and Behavioral Neurology},
volume = {28},
number = {4},
pages = {181--187},
abstract = {Background: Although clinical evaluations and neurocognitive assessments are commonly used to evaluate the extent of and recovery from concussion, brain bioenergetics could provide a more quantitative marker. The neurometabolic response to a concussion is thought to increase neuronal energy consumption and thus the demand for nucleoside triphosphate (NTP). Objective: We investigated the possible disruption in high-energy metabolism within the prefrontal cortex of college athletes who had either had a concussion within the past 6 months (n=14) or had never had a concussion (n=13). We hypothesized that concussed athletes would have imbalanced brain bioenergetics resulting from increased NTP consumption, and these biochemical changes would correspond to impaired cognitive abilities. Methods: We used phosphorus-31 magnetic resonance spectroscopy to quantify high-energy phosphates. We performed the neuroimaging in conjunction with neurocognitive assessments targeting prefrontal cortex-mediated tasks. Results: Our results revealed significantly lower $gamma$-NTP levels in the athletes after concussion. Although the concussed and non-concussed participants performed similarly in neurocognitive assessments, lower levels of $gamma$-NTP were associated with worse scores on neurocognitive tasks. Conclusions: Our results support the concept of increased energy demand in the prefrontal cortex of a concussed brain, and we found that while neurocognitive assessments appear normal, brain energetics may be abnormal. A longitudinal study could help establish brain NTP levels as a biomarker to aid in diagnosis and to assess recovery in concussed patients. © 2015 Wolters Kluwer Health, Inc.},
keywords = {Adolescent, adult, Article, athlete, Athletic Injuries, biochemical analysis, bioenergy, brain concussion, clinical article, cognition, college, Concussion, energy consumption, Energy Metabolism, Female, high energy phosphate, human, Humans, Longitudinal studies, longitudinal study, Magnetic Resonance Spectroscopy, Male, metabolism, MR spectroscopy (phosphorus-31), neuroimaging, NTP, NUCLEAR magnetic resonance spectroscopy, nucleoside, nucleoside triphosphate, Nucleosides, Pathophysiology, phosphate, Phosphates, phosphorus, Phosphorus Isotopes, phosphorus nuclear magnetic resonance, PHYSIOLOGY, Prefrontal Cortex, priority journal, procedures, sport injury, Universities, university, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Liu, C Y; Law, M; Romano, R
Rational approach to understanding and preventing sports-related traumatic brain injuries Journal Article
In: World Neurosurgery, vol. 84, no. 6, pp. 1556–1557, 2015.
Links | BibTeX | Tags: accelerometer, ACCELEROMETRY, biological marker, brain, brain concussion, brain hemorrhage, cognitive defect, Diffusion Tensor Imaging, Electroencephalography, emergency health service, Female, Head Protective Devices, Helmet, high risk patient, human, Humans, Injuries, Male, neuroimaging, neuromodulation, neuroprotective agent, nuclear magnetic resonance imaging, Occupational Exposure, protective equipment, Review, risk factor, risk reduction, SAFETY, skiing, Snowboarding, sport injury, Traumatic, traumatic brain injury, viscoelastic substance
@article{Liu2015,
title = {Rational approach to understanding and preventing sports-related traumatic brain injuries},
author = {Liu, C Y and Law, M and Romano, R},
doi = {10.1016/j.wneu.2015.07.076},
year = {2015},
date = {2015-01-01},
journal = {World Neurosurgery},
volume = {84},
number = {6},
pages = {1556--1557},
keywords = {accelerometer, ACCELEROMETRY, biological marker, brain, brain concussion, brain hemorrhage, cognitive defect, Diffusion Tensor Imaging, Electroencephalography, emergency health service, Female, Head Protective Devices, Helmet, high risk patient, human, Humans, Injuries, Male, neuroimaging, neuromodulation, neuroprotective agent, nuclear magnetic resonance imaging, Occupational Exposure, protective equipment, Review, risk factor, risk reduction, SAFETY, skiing, Snowboarding, sport injury, Traumatic, traumatic brain injury, viscoelastic substance},
pubstate = {published},
tppubtype = {article}
}
Rapp, P E; Keyser, D O; Albano, A; Hernandez, R; Gibson, D B; Zambon, R A; David Hairston, W; Hughes, J D; Krystal, A; Nichols, A S
Traumatic brain injury detection using electrophysiological methods Journal Article
In: Frontiers in Human Neuroscience, vol. 9, no. FEB, 2015.
Abstract | Links | BibTeX | Tags: Article, brain electrophysiology, computer assisted tomography, Concussion, connectome, diagnostic accuracy, EEG, electroencephalogram, Electroencephalography, event related potential, Event-Related Potentials, evidence based medicine, executive function, human, intermethod comparison, latent period, neuroimaging, neuropathology, Non-linear dynamical analysis, nuclear magnetic resonance imaging, QEEG, Signal Processing, traumatic brain injury
@article{Rapp2015,
title = {Traumatic brain injury detection using electrophysiological methods},
author = {Rapp, P E and Keyser, D O and Albano, A and Hernandez, R and Gibson, D B and Zambon, R A and {David Hairston}, W and Hughes, J D and Krystal, A and Nichols, A S},
doi = {10.3389/fnhum.2015.00011},
year = {2015},
date = {2015-01-01},
journal = {Frontiers in Human Neuroscience},
volume = {9},
number = {FEB},
abstract = {Measuring neuronal activity with electrophysiological methods may be useful in detecting neurological dysfunctions, such as mild traumatic brain injury (mTBI).This approach may be particularly valuable for rapid detection in at-risk populations including military service members and athletes. Electrophysiological methods, such as quantitative electroencephalography (qEEG) and recording event-related potentials (ERPs) may be promising; however, the field is nascent and significant controversy exists on the efficacy and accuracy of the approaches as diagnostic tools. For example, the specific measures derived from an electroencephalogram (EEG) that are most suitable as markers of dysfunction have not been clearly established. A study was conducted to summarize and evaluate the statistical rigor of evidence on the overall utility of qEEG as an mTBI detection tool. The analysis evaluated qEEG measures/parameters that may be most suitable as fieldable diagnostic tools, identified other types of EEG measures and analysis methods of promise, recommended specific measures and analysis methods for further development as mTBI detection tools, identified research gaps in the field, and recommended future research and development thrust areas. The qEEG study group formed the following conclusions: (1) Individual qEEG measures provide limited diagnostic utility for mTBI. However, many measures can be important features of qEEG discriminant functions, which do show significant promise as mTBI detection tools. (2) ERPs offer utility in mTBI detection. In fact, evidence indicates that ERPs can identify abnormalities in cases where EEGs alone are non-disclosing. (3)The standard mathematical procedures used in the characterization of mTBI EEGs should be expanded to incorporate newer methods of analysis including non-linear dynamical analysis, complexity measures, analysis of causal interactions, graph theory, and information dynamics. (4) Reports of high specificity in qEEG evaluations of TBI must be interpreted with care. High specificities have been reported in carefully constructed clinical studies in which healthy controls were compared against a carefully selected TBI population. The published literature indicates, however, that similar abnormalities in qEEG measures are observed in other neuropsychiatric disorders. While it may be possible to distinguish a clinical patient from a healthy control participant with this technology, these measures are unlikely to discriminate between, for example, major depressive disorder, bipolar disorder, or TBI. The specificities observed in these clinical studies may well be lost in real world clinical practice. (5)The absence of specificity does not preclude clinical utility. The possibility of use as a longitudinal measure of treatment response remains. However, efficacy as a longitudinal clinical measure does require acceptable test-retest reliability. To date, very few test-retest reliability studies have been published with qEEG data obtained from TBI patients or from healthy controls. This is a particular concern because high variability is a known characteristic of the injured central nervous system. © 2015 Rapp, Keyser , Albano, Hernandez, Gibson, Zambon, Hairston, Hughes, Krystal and Nichols.},
keywords = {Article, brain electrophysiology, computer assisted tomography, Concussion, connectome, diagnostic accuracy, EEG, electroencephalogram, Electroencephalography, event related potential, Event-Related Potentials, evidence based medicine, executive function, human, intermethod comparison, latent period, neuroimaging, neuropathology, Non-linear dynamical analysis, nuclear magnetic resonance imaging, QEEG, Signal Processing, traumatic brain injury},
pubstate = {published},
tppubtype = {article}
}
Jordan, B D
Chronic traumatic encephalopathy and other long-term sequelae Journal Article
In: CONTINUUM Lifelong Learning in Neurology, vol. 20, pp. 1588–1604, 2014.
Abstract | Links | BibTeX | Tags: Chronic Traumatic Encephalopathy chronic disease, cognitive defect, diagnostic procedure, human, Incidence, injury severity, laboratory test, medical history, neuroimaging, neurologic examination, neurologist, neuropsychological test, Pathophysiology, postconcussion syndrome, Review, sport injury, symptomatology, traumatic brain injury
@article{Jordan2014,
title = {Chronic traumatic encephalopathy and other long-term sequelae},
author = {Jordan, B D},
url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84927562326\&partnerID=40\&md5=da8cab7e63cee5fa58ae148fa7de9dec},
year = {2014},
date = {2014-01-01},
journal = {CONTINUUM Lifelong Learning in Neurology},
volume = {20},
pages = {1588--1604},
abstract = {Purpose of Review: Growing public health concern exists over the incidence of chronic traumatic brain injury (TBI) in athletes participating in contact sports. Chronic TBI represents a spectrum of disorders associated with long-term consequences of single or repetitive TBI and includes chronic traumatic encephalopathy (CTE), chronic postconcussion syndrome, and chronic neurocognitive impairment. Neurologists should be familiar with the different types of chronic TBI and their diagnostic criteria. Recent Findings: CTE is the most severe chronic TBI and represents the neurologic consequences of repetitive mild TBI. It is particularly noted among boxers and football players. CTE presents with behavioral, cognitive, and motor symptoms, and can only be definitively diagnosed postmortem. Chronic postconcussion syndrome is defined as postconcussion symptoms that last longer than 1 year and do not appear to resolve; it may develop after a single concussive event. Chronic neurocognitive impairment is an all-encompassing clinical term denoting long-term neurologic sequelae secondary to sports-related trauma and can present either within the postconcussion syndrome or years after a symptom-free interval. Summary: This article discusses the diagnostic evaluation of chronic TBI, including clinical history, neurologic examination, neuropsychological testing, neuroimaging, and laboratory testing, as well as the distinctions between CTE, chronic postconcussion syndrome, and chronic neurocognitive impairment. Neurologic impairment among athletes exposed to repetitive brain injury appears to be a real phenomenon. Because CTE has no established treatment, prevention is of paramount importance for athletes participating in contact sports. © 2014, American Academy of Neurology.},
keywords = {Chronic Traumatic Encephalopathy chronic disease, cognitive defect, diagnostic procedure, human, Incidence, injury severity, laboratory test, medical history, neuroimaging, neurologic examination, neurologist, neuropsychological test, Pathophysiology, postconcussion syndrome, Review, sport injury, symptomatology, traumatic brain injury},
pubstate = {published},
tppubtype = {article}
}
Rabb, C H
Comments Journal Article
In: Neurosurgery, vol. 67, no. 4, pp. 1027–1028, 2010, ISBN: 0148-396X.
BibTeX | Tags: brain concussion, functional magnetic resonance imaging, human, Imaging & EEG, mental task, neuroimaging, Note, priority journal, sport injury, working memory Overviews
@article{Rabb2010,
title = {Comments},
author = {Rabb, C H},
isbn = {0148-396X},
year = {2010},
date = {2010-01-01},
journal = {Neurosurgery},
volume = {67},
number = {4},
pages = {1027--1028},
keywords = {brain concussion, functional magnetic resonance imaging, human, Imaging \& EEG, mental task, neuroimaging, Note, priority journal, sport injury, working memory Overviews},
pubstate = {published},
tppubtype = {article}
}
Kuhn, A W; Zuckerman, S L; Solomon, G S; Casson, I R; Viano, D C
In: Sports Health, vol. 9, no. 1, pp. 30–40, 2017.
@article{Kuhn2017,
title = {Interrelationships Among Neuroimaging Biomarkers, Neuropsychological Test Data, and Symptom Reporting in a Cohort of Retired National Football League Players},
author = {Kuhn, A W and Zuckerman, S L and Solomon, G S and Casson, I R and Viano, D C},
doi = {10.1177/1941738116674006},
year = {2017},
date = {2017-01-01},
journal = {Sports Health},
volume = {9},
number = {1},
pages = {30--40},
abstract = {Background: Structural brain changes, potentially resulting from repetitive brain trauma (RBT), have been correlated with neurocognitive decline and increased symptom reporting in retired athletes. Hypothesis: In a cohort of retired National Football League (NFL) players, the relationships between 3 neuroimaging parameters, neuropsychological testing, and symptom scores will be significantly correlated. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: Comprehensive magnetic resonance imaging was performed in 45 retired NFL players. Three neuroanatomical parameters were assessed by board-certified radiologists blinded to the purpose of the study: (1) the absence or presence of small or large cavum septum pellucidum, (2) a global mean score of fractional anisotropy (FA), and (3) the presence or absence of microhemorrhages. The subjects underwent a battery of 9 paper-and-pencil neuropsychological tests, a computerized neurocognitive test, and multiple symptom and depression scales. The associations among the neuroimaging results with these outcome measures were assessed utilizing Pearson, Spearman rank, and point-biserial correlations. Results: The 45 subjects (mean age, 46.7 ± 9.1 years) reported a mean 6.9 (±6.2) concussions and 13.0 (±7.9) “dings” in the NFL. Ten (22%) did not have a cavum septum pellucidum, while 32 (71%) had a small and 3 (7%) had a large one. Four (9%) had microhemorrhages. Global FA mean was 0.459 (±0.035). The majority (50.8%) of correlations among the neuroimaging parameters and neurocognitive/symptom scores fell below the threshold of “small” effect size (r \< 0.10). The remaining (49.2%) correlations were between “small” and “medium” effect sizes (0.1 \< r \< 0.3). However, all correlations were statistically nonsignificant. Conclusion: There were minimal and statistically nonsignificant correlations among the neuroimaging, neurocognitive, and symptom scores examined in this cohort of NFL retirees. Clinical Relevance: Associating the severity of structural brain changes to neurocognitive performance and symptom burden after RBT is complex may involve other moderating variables or biomarkers, and demands further study. © 2016, © 2016 The Author(s).},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Churchill, N; Hutchison, M G; Leung, G; Graham, S; Schweizer, T A
Changes in functional connectivity of the brain associated with a history of sport concussion: A preliminary investigation Journal Article
In: Brain Injury, vol. 31, no. 1, pp. 39–48, 2017.
@article{Churchill2017,
title = {Changes in functional connectivity of the brain associated with a history of sport concussion: A preliminary investigation},
author = {Churchill, N and Hutchison, M G and Leung, G and Graham, S and Schweizer, T A},
doi = {10.1080/02699052.2016.1221135},
year = {2017},
date = {2017-01-01},
journal = {Brain Injury},
volume = {31},
number = {1},
pages = {39--48},
abstract = {Objective: There is evidence of long-term clinical consequences associated with a history of sport concussion. However, there remains limited information about the underlying changes in brain function. The goal of this study was to identify brain regions where abnormal resting-state function is associated with chronic concussion, for athletes without persistent symptoms. Methods: Functional Magnetic Resonance Imaging (fMRI) was performed on a group of athletes with prior concussion (n = 22) and a group without documented injury (n = 21). Multivariate predictive modelling was used to localize reliable changes in brain connectivity that are associated with a history of concussion and with clinical factors, including number of prior concussions and recovery time from last injury. Results: No significant differences were found between athletes with and without a history of concussion, but functional connectivity was significantly associated with clinical history. The number of prior concussions was associated with most extensive connectivity changes, particularly for elements of the visual attention network and cerebellum. Conclusion: The findings of this preliminary study indicate that functional brain abnormalities associated with chronic concussion may be significantly dependent on clinical history. In addition, elements of the visual and cerebellar systems may be most sensitive to the long-term effects of sport concussion. © 2017 Taylor \& Francis Group, LLC.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Beiske, K K; Kostov, K H; Kostov, H
Rhythmic midtemporal discharge in a youth during light sleep Journal Article
In: Neurodiagnostic Journal, vol. 56, no. 1, pp. 32–36, 2016.
@article{Beiske2016,
title = {Rhythmic midtemporal discharge in a youth during light sleep},
author = {Beiske, K K and Kostov, K H and Kostov, H},
doi = {10.1080/21646821.2015.1119579},
year = {2016},
date = {2016-01-01},
journal = {Neurodiagnostic Journal},
volume = {56},
number = {1},
pages = {32--36},
abstract = {Rhythmic midtemporal discharge (RMTD) is a rare, benign EEG pattern that may have epileptic morphology. Recognizing variations of RMTD is important in order to avoid over- or misinterpretation of EEG findings, which may lead to inappropriate treatment and negative consequences for the patient in question. We present a case report of RTMDs during light sleep where initial erroneous description necessitated repeat EEGs and additional diagnostic exams and led to the postponement of obtaining a drivers licence for this young patient. Copyright © ASET - The Neurodiagnostic Society.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Bressan, S; Babl, F E
Diagnosis and management of paediatric concussion Journal Article
In: Journal of Paediatrics & Child Health, vol. 52, no. 2, pp. 151–157, 2016.
@article{Bressan2016,
title = {Diagnosis and management of paediatric concussion},
author = {Bressan, S and Babl, F E},
doi = {10.1111/jpc.12967},
year = {2016},
date = {2016-01-01},
journal = {Journal of Paediatrics \& Child Health},
volume = {52},
number = {2},
pages = {151--157},
abstract = {Heightened recognition of concussions and concerns about their sequelae in children has become an increasing community and public health concern. Biomarkers and clinical tests are being explored, but the diagnosis of concussion in the emergency department continues to be based on clinical signs and symptoms. While the majority of children go on to recover from post-concussive symptoms within 2 weeks, it is unclear which patients with concussion will go on to develop short- or long-term sequelae. A number of more or less evidence-based guidelines have become available which seek to guide clinicians on how to manage children post-concussion. In general, care after the emergency department is focused on reducing the risk of re-injury and rest until cerebral recovery with a graduated return to school and then play. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Talavage, T M; Nauman, E A; Leverenz, L J
The role of medical imaging in the recharacterization of mild traumatic brain injury using youth sports as a laboratory Journal Article
In: Frontiers in Neurology, vol. 6, no. JAN, 2016.
@article{Talavage2016,
title = {The role of medical imaging in the recharacterization of mild traumatic brain injury using youth sports as a laboratory},
author = {Talavage, T M and Nauman, E A and Leverenz, L J},
doi = {10.3389/fneur.2015.00273},
year = {2016},
date = {2016-01-01},
journal = {Frontiers in Neurology},
volume = {6},
number = {JAN},
abstract = {The short- and long-term impact of mild traumatic brain injury (TBI) is an increasingly vital concern for both military and civilian personnel. Such injuries produce significant social and financial burdens and necessitate improved diagnostic and treatment methods. Recent integration of neuroimaging and biomechanical studies in youth collision-sport athletes has revealed that significant alterations in brain structure and function occur even in the absence of traditional clinical markers of "concussion." While task performance is maintained, athletes exposed to repetitive head accelerations exhibit structural changes to the underlying white matter, altered glial cell metabolism, aberrant vascular response, and marked changes in functional network behavior. Moreover, these changes accumulate with accrued years of exposure, suggesting a cumulative trauma mechanism that may culminate in categorization as "concussion" and long-term neurological deficits. The goal of this review is to elucidate the role of medical imaging in recharacterizing TBI, as a whole, to better identify at-risk individuals and improve the development of preventative and interventional approaches. © 2016 Talavage, Nauman and Leverenz.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Holtkamp, M D; Grimes, J; Ling, G
Concussion in the Military: an Evidence-Base Review of mTBI in US Military Personnel Focused on Posttraumatic Headache Journal Article
In: Current Pain & Headache Reports, vol. 20, no. 6, 2016.
@article{Holtkamp2016,
title = {Concussion in the Military: an Evidence-Base Review of mTBI in US Military Personnel Focused on Posttraumatic Headache},
author = {Holtkamp, M D and Grimes, J and Ling, G},
doi = {10.1007/s11916-016-0572-x},
year = {2016},
date = {2016-01-01},
journal = {Current Pain \& Headache Reports},
volume = {20},
number = {6},
abstract = {Traumatic brain injury (TBI) is defined as an alteration in brain function caused by an external force. Mild TBI or concussion is now well recognized to be a risk of military service as well as participation in athletic sports such as football. Posttraumatic headache (PTH) is the most common symptom after mTBI in US service members. PTH most commonly presents with migraine-like headache features. The following is an overview of the epidemiology, pathophysiology, clinical course, prognosis, complications, and treatment of mTBI and associated comorbidities with a focus on PTH. There is a particular emphasis on emerging evidence-based clinical practice. One important medical consequence of the recognition that mTBI is a highly prevalent among military service members is that the Department of Defense (DoD) is dedicating significant financial and intellectual resources to better understanding and developing treatments for TBI. The identification of the importance of TBI among the US military population has had the added benefit of increasing awareness of this condition among civilian populations, particularly those engaged in both professional and youth sports. The NIH and NSF are also supporting important TBI research. President Obama’s Brain Initiative is also providing additional impetus for these efforts. Unfortunately, the understanding of the acute and chronic effects of mTBI on the brain remains limited. Gratefully, there is hope that through innovative research, there will be advances in elucidating the underlying pathophysiology, which will lead to clinical and prognostic indicators, ultimately resulting in new treatment options for this very complicated set of disorders. © 2016, Springer Science+Business Media New York (outside the USA).},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Ellis, M J; Cordingley, D; Vis, S; Reimer, K; Leiter, J; Russell, K
Vestibulo-ocular dysfunction in pediatric sports-related concussion Journal Article
In: Journal of Neurosurgery: Pediatrics, vol. 16, no. 3, pp. 248–255, 2015.
@article{Ellis2015,
title = {Vestibulo-ocular dysfunction in pediatric sports-related concussion},
author = {Ellis, M J and Cordingley, D and Vis, S and Reimer, K and Leiter, J and Russell, K},
doi = {10.3171/2015.1.PEDS14524},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neurosurgery: Pediatrics},
volume = {16},
number = {3},
pages = {248--255},
abstract = {Object The objective of this study was 2-fold: 1) to examine the prevalence of vestibulo-ocular dysfunction (VOD) among children and adolescents with acute sports-related concussion (SRC) and postconcussion syndrome (PCS) who were referred to a multidisciplinary pediatric concussion program; and 2) to determine if VOD is associated with the development of PCS in this cohort. Methods The authors conducted a retrospective review of all patients with acute SRC (presenting 30 days or less postinjury) and PCS (3 or more symptoms for at least 1 month) referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Initial assessment included clinical history, physical examination, and Post-Concussion Symptom Scale assessment. Patients were also assessed for VOD, which was defined as more than one subjective vestibular and oculomotor complaint (dizziness, blurred vision, and so on) and more than one objective physical examination finding (abnormal smooth pursuits, saccades, vestibulo-ocular reflex, and so on). This study was approved by the local institutional ethics review board. Results A total of 101 patients (mean age 14.2 years, SD 2.3 years; 63 male and 38 female patients) participated, including 77 (76.2%) with acute SRC and 24 (23.8%) with PCS. Twenty-two of the 77 patients (28.6%) with acute SRC and 15 of the 24 (62.5%) with PCS met the clinical criteria for VOD. The median duration of symptoms was 40 days (interquartile range [IQR] 28.5-54 days) for patients with acute SRC who had VOD compared with 21 days (IQR 13-32 days) for those without VOD (p = 0.0001). There was a statistically significant increase in the adjusted odds of developing PCS among patients with acute SRC who had VOD compared with those without VOD (adjusted OR 4.10; 95% CI 1.04-16.16). Conclusions Evidence of VOD was detected in a significant proportion of children and adolescents with acute SRC and PCS who were referred to a multidisciplinary pediatric concussion program. This clinical feature was a significant risk factor for the subsequent development of PCS in this pediatric acute SRC cohort. © AANS, 2015.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Morgan, C D; Zuckerman, S L; King, L E; Beaird, S E; Sills, A K; Solomon, G S
Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging Journal Article
In: Child's Nervous System, vol. 31, no. 12, pp. 2305–2309, 2015.
@article{Morgan2015,
title = {Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging},
author = {Morgan, C D and Zuckerman, S L and King, L E and Beaird, S E and Sills, A K and Solomon, G S},
doi = {10.1007/s00381-015-2916-y},
year = {2015},
date = {2015-01-01},
journal = {Child's Nervous System},
volume = {31},
number = {12},
pages = {2305--2309},
abstract = {Purpose: Approximately 90% of concussions are transient, with symptoms resolving within 10\textendash14 days. However, a minority of patients remain symptomatic several months post-injury, a condition known as post-concussion syndrome (PCS). The treatment of these patients can be challenging. The goal of our study was to assess the utility and cost-effectiveness of neurologic imaging two or more weeks post-injury in a cohort of youth with PCS. Methods: We conducted a retrospective study of 52 pediatric patients with persistent post-concussion symptoms after 3 months. We collected demographics and neuroimaging results obtained greater than 2 weeks post-concussion. Neuroimaging ordered in the first 2 weeks post-concussion was excluded, except to determine the rate of re-imaging. Descriptive statistics and corresponding cost data were collected. Results: Of 52 patients with PCS, 23/52 (44 %) had neuroimaging at least 2 weeks after the initial injury, for a total of 32 diagnostic studies. In summary, 1/19 MRIs (5.3 %), 1/8 CTs (13 %), and 0/5 x-rays (0 %) yielded significant positive findings, none of which altered clinical management. Chronic phase neuroimaging estimated costs from these 52 pediatric patients totaled $129,025. We estimate the cost to identify a single positive finding was $21,000 for head CT and $104,500 for brain MRI. Conclusions: In this cohort of pediatric PCS patients, brain imaging in the chronic phase (defined as more than 2 weeks after concussion) was pursued in almost half the study sample, had low diagnostic yield, and had poor cost-effectiveness. Based on these results, outpatient management of pediatric patients with long-term post-concussive symptoms should rarely include repeat neuroimaging beyond the acute phase. © 2015, Springer-Verlag Berlin Heidelberg.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Andre, J B
Arterial spin labeling magnetic resonance perfusion for traumatic brain injury: Technical challenges and potentials Journal Article
In: Topics in Magnetic Resonance Imaging, vol. 24, no. 5, pp. 275–287, 2015.
@article{Andre2015,
title = {Arterial spin labeling magnetic resonance perfusion for traumatic brain injury: Technical challenges and potentials},
author = {Andre, J B},
year = {2015},
date = {2015-01-01},
journal = {Topics in Magnetic Resonance Imaging},
volume = {24},
number = {5},
pages = {275--287},
abstract = {Traumatic brain injury (TBI), including concussion, is a public health concern, as it affects over 1.7 million persons in the United States per year. Yet, the diagnosis of TBI, particularly mild TBI (mTBI), can be controversial, as neuroimaging findings can be sparse on conventional magnetic resonance and computed tomography examinations, and when present, often poorly correlate with clinical signs and symptoms. Furthermore, the discussion of TBI, concussion, and head impact exposure is immediately complicated by the many differing opinions of what constitutes each, their respective severities, and how the underlying biomechanics of the inciting head impact might alter the distribution, severity, and prognosis of the underlying brain injury. Advanced imaging methodologies hold promise in improving the sensitivity and detectability of associated imaging biomarkers that might better correlate with patient outcome and prognostication, allowing for improved triage and therapeutic guidance in the setting of TBI, particularly in mTBI. This work will examine the defining symptom complex associated with mTBI and explore changes in cerebral blood flow measured by arterial spin labeling, as a potential imaging biomarker for TBI, and briefly correlate these observations with findings identified by single photon emission computed tomography and positron emission tomography imaging.. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Stemper, B D; Shah, A S; Pintar, F A; McCrea, M; Kurpad, S N; Glavaski-Joksimovic, A; Olsen, C; Budde, M D
Head Rotational Acceleration Characteristics Influence Behavioral and Diffusion Tensor Imaging Outcomes Following Concussion Journal Article
In: Annals of Biomedical Engineering, vol. 43, no. 5, pp. 1071–1088, 2015.
@article{Stemper2015,
title = {Head Rotational Acceleration Characteristics Influence Behavioral and Diffusion Tensor Imaging Outcomes Following Concussion},
author = {Stemper, B D and Shah, A S and Pintar, F A and McCrea, M and Kurpad, S N and Glavaski-Joksimovic, A and Olsen, C and Budde, M D},
doi = {10.1007/s10439-014-1171-9},
year = {2015},
date = {2015-01-01},
journal = {Annals of Biomedical Engineering},
volume = {43},
number = {5},
pages = {1071--1088},
abstract = {A majority of traumatic brain injuries (TBI) in motor vehicle crashes and sporting environments are mild and caused by high-rate acceleration of the head. For injuries caused by rotational acceleration, both magnitude and duration of the acceleration pulse were shown to influence injury outcomes. This study incorporated a unique rodent model of rotational acceleration-induced mild TBI (mTBI) to quantify independent effects of magnitude and duration on behavioral and neuroimaging outcomes. Ninety-two Sprague\textendashDawley rats were exposed to head rotational acceleration at peak magnitudes of 214 or 350 krad/s2 and acceleration pulse durations of 1.6 or 3.4 ms in a full factorial design. Rats underwent a series of behavioral tests including the Composite Neuroscore (CN), Elevated Plus Maze (EPM), and Morris Water Maze (MWM). Ex vivo diffusion tensor imaging (DTI) of the fixed brains was conducted to assess the effects of rotational injury on brain microstructure as revealed by the parameter fractional anisotropy (FA). While the injury did not cause significant locomotor or cognitive deficits measured with the CN and MWM, respectively, a main effect of duration was consistently observed for the EPM. Increased duration caused significantly greater activity and exploratory behaviors measured as open arm time and number of arm changes. DTI demonstrated significant effects of both magnitude and duration, with the FA of the amygdala related to both the magnitude and duration. Increased duration also caused FA changes at the interface of gray and white matter. Collectively, the findings demonstrate that the consequences of rotational acceleration mTBI were more closely associated with duration of the rotational acceleration impulse, which is often neglected as an independent factor, and highlight the need for animal models of TBI with strong biomechanical foundations to associate behavioral outcomes with brain microstructure. © 2014, Biomedical Engineering Society (Outside the U.S.).},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Sikoglu, E M; Liso Navarro, A A; Czerniak, S M; McCafferty, J; Eisenstock, J; Stevenson, J H; King, J A; Moore, C M
Effects of Recent Concussion on Brain Bioenergetics: A Phosphorus-31 Magnetic Resonance Spectroscopy Study Journal Article
In: Cognitive and Behavioral Neurology, vol. 28, no. 4, pp. 181–187, 2015.
@article{Sikoglu2015,
title = {Effects of Recent Concussion on Brain Bioenergetics: A Phosphorus-31 Magnetic Resonance Spectroscopy Study},
author = {Sikoglu, E M and {Liso Navarro}, A A and Czerniak, S M and McCafferty, J and Eisenstock, J and Stevenson, J H and King, J A and Moore, C M},
doi = {10.1097/WNN.0000000000000076},
year = {2015},
date = {2015-01-01},
journal = {Cognitive and Behavioral Neurology},
volume = {28},
number = {4},
pages = {181--187},
abstract = {Background: Although clinical evaluations and neurocognitive assessments are commonly used to evaluate the extent of and recovery from concussion, brain bioenergetics could provide a more quantitative marker. The neurometabolic response to a concussion is thought to increase neuronal energy consumption and thus the demand for nucleoside triphosphate (NTP). Objective: We investigated the possible disruption in high-energy metabolism within the prefrontal cortex of college athletes who had either had a concussion within the past 6 months (n=14) or had never had a concussion (n=13). We hypothesized that concussed athletes would have imbalanced brain bioenergetics resulting from increased NTP consumption, and these biochemical changes would correspond to impaired cognitive abilities. Methods: We used phosphorus-31 magnetic resonance spectroscopy to quantify high-energy phosphates. We performed the neuroimaging in conjunction with neurocognitive assessments targeting prefrontal cortex-mediated tasks. Results: Our results revealed significantly lower $gamma$-NTP levels in the athletes after concussion. Although the concussed and non-concussed participants performed similarly in neurocognitive assessments, lower levels of $gamma$-NTP were associated with worse scores on neurocognitive tasks. Conclusions: Our results support the concept of increased energy demand in the prefrontal cortex of a concussed brain, and we found that while neurocognitive assessments appear normal, brain energetics may be abnormal. A longitudinal study could help establish brain NTP levels as a biomarker to aid in diagnosis and to assess recovery in concussed patients. © 2015 Wolters Kluwer Health, Inc.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Liu, C Y; Law, M; Romano, R
Rational approach to understanding and preventing sports-related traumatic brain injuries Journal Article
In: World Neurosurgery, vol. 84, no. 6, pp. 1556–1557, 2015.
@article{Liu2015,
title = {Rational approach to understanding and preventing sports-related traumatic brain injuries},
author = {Liu, C Y and Law, M and Romano, R},
doi = {10.1016/j.wneu.2015.07.076},
year = {2015},
date = {2015-01-01},
journal = {World Neurosurgery},
volume = {84},
number = {6},
pages = {1556--1557},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Rapp, P E; Keyser, D O; Albano, A; Hernandez, R; Gibson, D B; Zambon, R A; David Hairston, W; Hughes, J D; Krystal, A; Nichols, A S
Traumatic brain injury detection using electrophysiological methods Journal Article
In: Frontiers in Human Neuroscience, vol. 9, no. FEB, 2015.
@article{Rapp2015,
title = {Traumatic brain injury detection using electrophysiological methods},
author = {Rapp, P E and Keyser, D O and Albano, A and Hernandez, R and Gibson, D B and Zambon, R A and {David Hairston}, W and Hughes, J D and Krystal, A and Nichols, A S},
doi = {10.3389/fnhum.2015.00011},
year = {2015},
date = {2015-01-01},
journal = {Frontiers in Human Neuroscience},
volume = {9},
number = {FEB},
abstract = {Measuring neuronal activity with electrophysiological methods may be useful in detecting neurological dysfunctions, such as mild traumatic brain injury (mTBI).This approach may be particularly valuable for rapid detection in at-risk populations including military service members and athletes. Electrophysiological methods, such as quantitative electroencephalography (qEEG) and recording event-related potentials (ERPs) may be promising; however, the field is nascent and significant controversy exists on the efficacy and accuracy of the approaches as diagnostic tools. For example, the specific measures derived from an electroencephalogram (EEG) that are most suitable as markers of dysfunction have not been clearly established. A study was conducted to summarize and evaluate the statistical rigor of evidence on the overall utility of qEEG as an mTBI detection tool. The analysis evaluated qEEG measures/parameters that may be most suitable as fieldable diagnostic tools, identified other types of EEG measures and analysis methods of promise, recommended specific measures and analysis methods for further development as mTBI detection tools, identified research gaps in the field, and recommended future research and development thrust areas. The qEEG study group formed the following conclusions: (1) Individual qEEG measures provide limited diagnostic utility for mTBI. However, many measures can be important features of qEEG discriminant functions, which do show significant promise as mTBI detection tools. (2) ERPs offer utility in mTBI detection. In fact, evidence indicates that ERPs can identify abnormalities in cases where EEGs alone are non-disclosing. (3)The standard mathematical procedures used in the characterization of mTBI EEGs should be expanded to incorporate newer methods of analysis including non-linear dynamical analysis, complexity measures, analysis of causal interactions, graph theory, and information dynamics. (4) Reports of high specificity in qEEG evaluations of TBI must be interpreted with care. High specificities have been reported in carefully constructed clinical studies in which healthy controls were compared against a carefully selected TBI population. The published literature indicates, however, that similar abnormalities in qEEG measures are observed in other neuropsychiatric disorders. While it may be possible to distinguish a clinical patient from a healthy control participant with this technology, these measures are unlikely to discriminate between, for example, major depressive disorder, bipolar disorder, or TBI. The specificities observed in these clinical studies may well be lost in real world clinical practice. (5)The absence of specificity does not preclude clinical utility. The possibility of use as a longitudinal measure of treatment response remains. However, efficacy as a longitudinal clinical measure does require acceptable test-retest reliability. To date, very few test-retest reliability studies have been published with qEEG data obtained from TBI patients or from healthy controls. This is a particular concern because high variability is a known characteristic of the injured central nervous system. © 2015 Rapp, Keyser , Albano, Hernandez, Gibson, Zambon, Hairston, Hughes, Krystal and Nichols.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Jordan, B D
Chronic traumatic encephalopathy and other long-term sequelae Journal Article
In: CONTINUUM Lifelong Learning in Neurology, vol. 20, pp. 1588–1604, 2014.
@article{Jordan2014,
title = {Chronic traumatic encephalopathy and other long-term sequelae},
author = {Jordan, B D},
url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84927562326\&partnerID=40\&md5=da8cab7e63cee5fa58ae148fa7de9dec},
year = {2014},
date = {2014-01-01},
journal = {CONTINUUM Lifelong Learning in Neurology},
volume = {20},
pages = {1588--1604},
abstract = {Purpose of Review: Growing public health concern exists over the incidence of chronic traumatic brain injury (TBI) in athletes participating in contact sports. Chronic TBI represents a spectrum of disorders associated with long-term consequences of single or repetitive TBI and includes chronic traumatic encephalopathy (CTE), chronic postconcussion syndrome, and chronic neurocognitive impairment. Neurologists should be familiar with the different types of chronic TBI and their diagnostic criteria. Recent Findings: CTE is the most severe chronic TBI and represents the neurologic consequences of repetitive mild TBI. It is particularly noted among boxers and football players. CTE presents with behavioral, cognitive, and motor symptoms, and can only be definitively diagnosed postmortem. Chronic postconcussion syndrome is defined as postconcussion symptoms that last longer than 1 year and do not appear to resolve; it may develop after a single concussive event. Chronic neurocognitive impairment is an all-encompassing clinical term denoting long-term neurologic sequelae secondary to sports-related trauma and can present either within the postconcussion syndrome or years after a symptom-free interval. Summary: This article discusses the diagnostic evaluation of chronic TBI, including clinical history, neurologic examination, neuropsychological testing, neuroimaging, and laboratory testing, as well as the distinctions between CTE, chronic postconcussion syndrome, and chronic neurocognitive impairment. Neurologic impairment among athletes exposed to repetitive brain injury appears to be a real phenomenon. Because CTE has no established treatment, prevention is of paramount importance for athletes participating in contact sports. © 2014, American Academy of Neurology.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Rabb, C H
Comments Journal Article
In: Neurosurgery, vol. 67, no. 4, pp. 1027–1028, 2010, ISBN: 0148-396X.
@article{Rabb2010,
title = {Comments},
author = {Rabb, C H},
isbn = {0148-396X},
year = {2010},
date = {2010-01-01},
journal = {Neurosurgery},
volume = {67},
number = {4},
pages = {1027--1028},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Kuhn, A W; Zuckerman, S L; Solomon, G S; Casson, I R; Viano, D C
In: Sports Health, vol. 9, no. 1, pp. 30–40, 2017.
Abstract | Links | BibTeX | Tags: chronic impairment, Cognitive function, NATIONAL Football League, neuroimaging, Neuropsychological testing, neuroradiology, Sport-related concussion
@article{Kuhn2017,
title = {Interrelationships Among Neuroimaging Biomarkers, Neuropsychological Test Data, and Symptom Reporting in a Cohort of Retired National Football League Players},
author = {Kuhn, A W and Zuckerman, S L and Solomon, G S and Casson, I R and Viano, D C},
doi = {10.1177/1941738116674006},
year = {2017},
date = {2017-01-01},
journal = {Sports Health},
volume = {9},
number = {1},
pages = {30--40},
abstract = {Background: Structural brain changes, potentially resulting from repetitive brain trauma (RBT), have been correlated with neurocognitive decline and increased symptom reporting in retired athletes. Hypothesis: In a cohort of retired National Football League (NFL) players, the relationships between 3 neuroimaging parameters, neuropsychological testing, and symptom scores will be significantly correlated. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: Comprehensive magnetic resonance imaging was performed in 45 retired NFL players. Three neuroanatomical parameters were assessed by board-certified radiologists blinded to the purpose of the study: (1) the absence or presence of small or large cavum septum pellucidum, (2) a global mean score of fractional anisotropy (FA), and (3) the presence or absence of microhemorrhages. The subjects underwent a battery of 9 paper-and-pencil neuropsychological tests, a computerized neurocognitive test, and multiple symptom and depression scales. The associations among the neuroimaging results with these outcome measures were assessed utilizing Pearson, Spearman rank, and point-biserial correlations. Results: The 45 subjects (mean age, 46.7 ± 9.1 years) reported a mean 6.9 (±6.2) concussions and 13.0 (±7.9) “dings” in the NFL. Ten (22%) did not have a cavum septum pellucidum, while 32 (71%) had a small and 3 (7%) had a large one. Four (9%) had microhemorrhages. Global FA mean was 0.459 (±0.035). The majority (50.8%) of correlations among the neuroimaging parameters and neurocognitive/symptom scores fell below the threshold of “small” effect size (r \< 0.10). The remaining (49.2%) correlations were between “small” and “medium” effect sizes (0.1 \< r \< 0.3). However, all correlations were statistically nonsignificant. Conclusion: There were minimal and statistically nonsignificant correlations among the neuroimaging, neurocognitive, and symptom scores examined in this cohort of NFL retirees. Clinical Relevance: Associating the severity of structural brain changes to neurocognitive performance and symptom burden after RBT is complex may involve other moderating variables or biomarkers, and demands further study. © 2016, © 2016 The Author(s).},
keywords = {chronic impairment, Cognitive function, NATIONAL Football League, neuroimaging, Neuropsychological testing, neuroradiology, Sport-related concussion},
pubstate = {published},
tppubtype = {article}
}
Churchill, N; Hutchison, M G; Leung, G; Graham, S; Schweizer, T A
Changes in functional connectivity of the brain associated with a history of sport concussion: A preliminary investigation Journal Article
In: Brain Injury, vol. 31, no. 1, pp. 39–48, 2017.
Abstract | Links | BibTeX | Tags: Concussion, Functional MRI, MRI scan, neuroimaging
@article{Churchill2017,
title = {Changes in functional connectivity of the brain associated with a history of sport concussion: A preliminary investigation},
author = {Churchill, N and Hutchison, M G and Leung, G and Graham, S and Schweizer, T A},
doi = {10.1080/02699052.2016.1221135},
year = {2017},
date = {2017-01-01},
journal = {Brain Injury},
volume = {31},
number = {1},
pages = {39--48},
abstract = {Objective: There is evidence of long-term clinical consequences associated with a history of sport concussion. However, there remains limited information about the underlying changes in brain function. The goal of this study was to identify brain regions where abnormal resting-state function is associated with chronic concussion, for athletes without persistent symptoms. Methods: Functional Magnetic Resonance Imaging (fMRI) was performed on a group of athletes with prior concussion (n = 22) and a group without documented injury (n = 21). Multivariate predictive modelling was used to localize reliable changes in brain connectivity that are associated with a history of concussion and with clinical factors, including number of prior concussions and recovery time from last injury. Results: No significant differences were found between athletes with and without a history of concussion, but functional connectivity was significantly associated with clinical history. The number of prior concussions was associated with most extensive connectivity changes, particularly for elements of the visual attention network and cerebellum. Conclusion: The findings of this preliminary study indicate that functional brain abnormalities associated with chronic concussion may be significantly dependent on clinical history. In addition, elements of the visual and cerebellar systems may be most sensitive to the long-term effects of sport concussion. © 2017 Taylor \& Francis Group, LLC.},
keywords = {Concussion, Functional MRI, MRI scan, neuroimaging},
pubstate = {published},
tppubtype = {article}
}
Beiske, K K; Kostov, K H; Kostov, H
Rhythmic midtemporal discharge in a youth during light sleep Journal Article
In: Neurodiagnostic Journal, vol. 56, no. 1, pp. 32–36, 2016.
Abstract | Links | BibTeX | Tags: Adolescent, Article, Automobile Driving, Benign EEG pattern, car driving, case report, case reports, complication, computer assisted tomography, Concussion, Craniocerebral Trauma, drowsiness, EEG pattern, electroencephalogram, Electroencephalography, Epilepsy, epileptic discharge, febrile convulsion, football, Functional Laterality, head injury, hemispheric dominance, human, Humans, hyperventilation, Injuries, Light sleep, Male, neuroimaging, neurologic examination, nuclear magnetic resonance imaging, Pathophysiology, Patient treatment, Rhythmic midtemporal discharge, RMTD, SLEEP, Sleep research, spike wave, temporal lobe, temporal lobe epilepsy, theta rhythm, tonic clonic seizure, unconsciousness, wakefulness
@article{Beiske2016,
title = {Rhythmic midtemporal discharge in a youth during light sleep},
author = {Beiske, K K and Kostov, K H and Kostov, H},
doi = {10.1080/21646821.2015.1119579},
year = {2016},
date = {2016-01-01},
journal = {Neurodiagnostic Journal},
volume = {56},
number = {1},
pages = {32--36},
abstract = {Rhythmic midtemporal discharge (RMTD) is a rare, benign EEG pattern that may have epileptic morphology. Recognizing variations of RMTD is important in order to avoid over- or misinterpretation of EEG findings, which may lead to inappropriate treatment and negative consequences for the patient in question. We present a case report of RTMDs during light sleep where initial erroneous description necessitated repeat EEGs and additional diagnostic exams and led to the postponement of obtaining a drivers licence for this young patient. Copyright © ASET - The Neurodiagnostic Society.},
keywords = {Adolescent, Article, Automobile Driving, Benign EEG pattern, car driving, case report, case reports, complication, computer assisted tomography, Concussion, Craniocerebral Trauma, drowsiness, EEG pattern, electroencephalogram, Electroencephalography, Epilepsy, epileptic discharge, febrile convulsion, football, Functional Laterality, head injury, hemispheric dominance, human, Humans, hyperventilation, Injuries, Light sleep, Male, neuroimaging, neurologic examination, nuclear magnetic resonance imaging, Pathophysiology, Patient treatment, Rhythmic midtemporal discharge, RMTD, SLEEP, Sleep research, spike wave, temporal lobe, temporal lobe epilepsy, theta rhythm, tonic clonic seizure, unconsciousness, wakefulness},
pubstate = {published},
tppubtype = {article}
}
Bressan, S; Babl, F E
Diagnosis and management of paediatric concussion Journal Article
In: Journal of Paediatrics & Child Health, vol. 52, no. 2, pp. 151–157, 2016.
Abstract | Links | BibTeX | Tags: Article, brain concussion, brain injury assessment, Child, child care, childhood injury, chronic brain disease, clinical feature, Concussion, conservative treatment, Glasgow Coma Scale, glial fibrillary acidic protein, human, neuroimaging, neuron specific enolase, patient care, Post Concussive Symptom Scale, post-concussive syndrome, priority journal, protein S100B, Second impact syndrome, Sport Concussion Assessment Tool 3, traumatic brain injury
@article{Bressan2016,
title = {Diagnosis and management of paediatric concussion},
author = {Bressan, S and Babl, F E},
doi = {10.1111/jpc.12967},
year = {2016},
date = {2016-01-01},
journal = {Journal of Paediatrics \& Child Health},
volume = {52},
number = {2},
pages = {151--157},
abstract = {Heightened recognition of concussions and concerns about their sequelae in children has become an increasing community and public health concern. Biomarkers and clinical tests are being explored, but the diagnosis of concussion in the emergency department continues to be based on clinical signs and symptoms. While the majority of children go on to recover from post-concussive symptoms within 2 weeks, it is unclear which patients with concussion will go on to develop short- or long-term sequelae. A number of more or less evidence-based guidelines have become available which seek to guide clinicians on how to manage children post-concussion. In general, care after the emergency department is focused on reducing the risk of re-injury and rest until cerebral recovery with a graduated return to school and then play. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).},
keywords = {Article, brain concussion, brain injury assessment, Child, child care, childhood injury, chronic brain disease, clinical feature, Concussion, conservative treatment, Glasgow Coma Scale, glial fibrillary acidic protein, human, neuroimaging, neuron specific enolase, patient care, Post Concussive Symptom Scale, post-concussive syndrome, priority journal, protein S100B, Second impact syndrome, Sport Concussion Assessment Tool 3, traumatic brain injury},
pubstate = {published},
tppubtype = {article}
}
Talavage, T M; Nauman, E A; Leverenz, L J
The role of medical imaging in the recharacterization of mild traumatic brain injury using youth sports as a laboratory Journal Article
In: Frontiers in Neurology, vol. 6, no. JAN, 2016.
Abstract | Links | BibTeX | Tags: Article, cognition assessment, Concussion, DIAGNOSTIC imaging, functional magnetic resonance imaging, Functional MRI, human, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Neuroanatomy, neuroimaging, neuromonitoring, nonhuman, NUCLEAR magnetic resonance spectroscopy, Patient monitoring, population risk, prediction, protective equipment, sport injury, Subconcussive, traumatic brain injury, validation process
@article{Talavage2016,
title = {The role of medical imaging in the recharacterization of mild traumatic brain injury using youth sports as a laboratory},
author = {Talavage, T M and Nauman, E A and Leverenz, L J},
doi = {10.3389/fneur.2015.00273},
year = {2016},
date = {2016-01-01},
journal = {Frontiers in Neurology},
volume = {6},
number = {JAN},
abstract = {The short- and long-term impact of mild traumatic brain injury (TBI) is an increasingly vital concern for both military and civilian personnel. Such injuries produce significant social and financial burdens and necessitate improved diagnostic and treatment methods. Recent integration of neuroimaging and biomechanical studies in youth collision-sport athletes has revealed that significant alterations in brain structure and function occur even in the absence of traditional clinical markers of "concussion." While task performance is maintained, athletes exposed to repetitive head accelerations exhibit structural changes to the underlying white matter, altered glial cell metabolism, aberrant vascular response, and marked changes in functional network behavior. Moreover, these changes accumulate with accrued years of exposure, suggesting a cumulative trauma mechanism that may culminate in categorization as "concussion" and long-term neurological deficits. The goal of this review is to elucidate the role of medical imaging in recharacterizing TBI, as a whole, to better identify at-risk individuals and improve the development of preventative and interventional approaches. © 2016 Talavage, Nauman and Leverenz.},
keywords = {Article, cognition assessment, Concussion, DIAGNOSTIC imaging, functional magnetic resonance imaging, Functional MRI, human, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Neuroanatomy, neuroimaging, neuromonitoring, nonhuman, NUCLEAR magnetic resonance spectroscopy, Patient monitoring, population risk, prediction, protective equipment, sport injury, Subconcussive, traumatic brain injury, validation process},
pubstate = {published},
tppubtype = {article}
}
Holtkamp, M D; Grimes, J; Ling, G
Concussion in the Military: an Evidence-Base Review of mTBI in US Military Personnel Focused on Posttraumatic Headache Journal Article
In: Current Pain & Headache Reports, vol. 20, no. 6, 2016.
Abstract | Links | BibTeX | Tags: apolipoprotein E4, assessment, biological marker, botulinum toxin, brain concussion, calcitonin gene related peptide receptor antagonis, comorbidity, Concussion, depression, DIAGNOSTIC imaging, disease course, genetic polymorphism, genetic predisposition, glial fibrillary acidic protein, headache, Headache disorder, human, MANAGEMENT, migraine, Military personnel, mTBI, neuroimaging, Pathophysiology, postconcussion syndrome, posttraumatic headache, posttraumatic stress disorder, Prognosis, Review, serotonin 1 agonist, serotonin 1F agonist, soldier, traumatic brain injury, Treatment, tricyclic antidepressant agent, triptan derivative, unclassified drug, UNITED States
@article{Holtkamp2016,
title = {Concussion in the Military: an Evidence-Base Review of mTBI in US Military Personnel Focused on Posttraumatic Headache},
author = {Holtkamp, M D and Grimes, J and Ling, G},
doi = {10.1007/s11916-016-0572-x},
year = {2016},
date = {2016-01-01},
journal = {Current Pain \& Headache Reports},
volume = {20},
number = {6},
abstract = {Traumatic brain injury (TBI) is defined as an alteration in brain function caused by an external force. Mild TBI or concussion is now well recognized to be a risk of military service as well as participation in athletic sports such as football. Posttraumatic headache (PTH) is the most common symptom after mTBI in US service members. PTH most commonly presents with migraine-like headache features. The following is an overview of the epidemiology, pathophysiology, clinical course, prognosis, complications, and treatment of mTBI and associated comorbidities with a focus on PTH. There is a particular emphasis on emerging evidence-based clinical practice. One important medical consequence of the recognition that mTBI is a highly prevalent among military service members is that the Department of Defense (DoD) is dedicating significant financial and intellectual resources to better understanding and developing treatments for TBI. The identification of the importance of TBI among the US military population has had the added benefit of increasing awareness of this condition among civilian populations, particularly those engaged in both professional and youth sports. The NIH and NSF are also supporting important TBI research. President Obama’s Brain Initiative is also providing additional impetus for these efforts. Unfortunately, the understanding of the acute and chronic effects of mTBI on the brain remains limited. Gratefully, there is hope that through innovative research, there will be advances in elucidating the underlying pathophysiology, which will lead to clinical and prognostic indicators, ultimately resulting in new treatment options for this very complicated set of disorders. © 2016, Springer Science+Business Media New York (outside the USA).},
keywords = {apolipoprotein E4, assessment, biological marker, botulinum toxin, brain concussion, calcitonin gene related peptide receptor antagonis, comorbidity, Concussion, depression, DIAGNOSTIC imaging, disease course, genetic polymorphism, genetic predisposition, glial fibrillary acidic protein, headache, Headache disorder, human, MANAGEMENT, migraine, Military personnel, mTBI, neuroimaging, Pathophysiology, postconcussion syndrome, posttraumatic headache, posttraumatic stress disorder, Prognosis, Review, serotonin 1 agonist, serotonin 1F agonist, soldier, traumatic brain injury, Treatment, tricyclic antidepressant agent, triptan derivative, unclassified drug, UNITED States},
pubstate = {published},
tppubtype = {article}
}
Ellis, M J; Cordingley, D; Vis, S; Reimer, K; Leiter, J; Russell, K
Vestibulo-ocular dysfunction in pediatric sports-related concussion Journal Article
In: Journal of Neurosurgery: Pediatrics, vol. 16, no. 3, pp. 248–255, 2015.
Abstract | Links | BibTeX | Tags: Adolescent, amnesia, Article, Athletic Injuries, Baseball, BASKETBALL, blurred vision, brain concussion, CANADA, Child, childhood disease, cohort analysis, complication, Concussion, consultation, controlled study, disease duration, Dizziness, Female, follow up, football, Hockey, human, Humans, interdisciplinary communication, major clinical study, Male, Manitoba, migraine, neuroimaging, neuropsychological test, Neuropsychological Tests, ODDS ratio, Pathophysiology, Pediatric, Physical Examination, physiotherapy, Post-Concussion Syndrome, postconcussion syndrome, Prevalence, priority journal, Reflex, Retrospective Studies, retrospective study, return to sport, saccadic eye movement, skating, skiing, Soccer, sport injury, sport related concussion, Sports-related concussion, Trauma, vestibular physiotherapy, Vestibular therapy, vestibulo ocular dysfunction, Vestibulo-Ocular, Vestibulo-ocular dysfunction, vestibuloocular reflex, VOLLEYBALL, Young Adult, youth sport
@article{Ellis2015,
title = {Vestibulo-ocular dysfunction in pediatric sports-related concussion},
author = {Ellis, M J and Cordingley, D and Vis, S and Reimer, K and Leiter, J and Russell, K},
doi = {10.3171/2015.1.PEDS14524},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neurosurgery: Pediatrics},
volume = {16},
number = {3},
pages = {248--255},
abstract = {Object The objective of this study was 2-fold: 1) to examine the prevalence of vestibulo-ocular dysfunction (VOD) among children and adolescents with acute sports-related concussion (SRC) and postconcussion syndrome (PCS) who were referred to a multidisciplinary pediatric concussion program; and 2) to determine if VOD is associated with the development of PCS in this cohort. Methods The authors conducted a retrospective review of all patients with acute SRC (presenting 30 days or less postinjury) and PCS (3 or more symptoms for at least 1 month) referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Initial assessment included clinical history, physical examination, and Post-Concussion Symptom Scale assessment. Patients were also assessed for VOD, which was defined as more than one subjective vestibular and oculomotor complaint (dizziness, blurred vision, and so on) and more than one objective physical examination finding (abnormal smooth pursuits, saccades, vestibulo-ocular reflex, and so on). This study was approved by the local institutional ethics review board. Results A total of 101 patients (mean age 14.2 years, SD 2.3 years; 63 male and 38 female patients) participated, including 77 (76.2%) with acute SRC and 24 (23.8%) with PCS. Twenty-two of the 77 patients (28.6%) with acute SRC and 15 of the 24 (62.5%) with PCS met the clinical criteria for VOD. The median duration of symptoms was 40 days (interquartile range [IQR] 28.5-54 days) for patients with acute SRC who had VOD compared with 21 days (IQR 13-32 days) for those without VOD (p = 0.0001). There was a statistically significant increase in the adjusted odds of developing PCS among patients with acute SRC who had VOD compared with those without VOD (adjusted OR 4.10; 95% CI 1.04-16.16). Conclusions Evidence of VOD was detected in a significant proportion of children and adolescents with acute SRC and PCS who were referred to a multidisciplinary pediatric concussion program. This clinical feature was a significant risk factor for the subsequent development of PCS in this pediatric acute SRC cohort. © AANS, 2015.},
keywords = {Adolescent, amnesia, Article, Athletic Injuries, Baseball, BASKETBALL, blurred vision, brain concussion, CANADA, Child, childhood disease, cohort analysis, complication, Concussion, consultation, controlled study, disease duration, Dizziness, Female, follow up, football, Hockey, human, Humans, interdisciplinary communication, major clinical study, Male, Manitoba, migraine, neuroimaging, neuropsychological test, Neuropsychological Tests, ODDS ratio, Pathophysiology, Pediatric, Physical Examination, physiotherapy, Post-Concussion Syndrome, postconcussion syndrome, Prevalence, priority journal, Reflex, Retrospective Studies, retrospective study, return to sport, saccadic eye movement, skating, skiing, Soccer, sport injury, sport related concussion, Sports-related concussion, Trauma, vestibular physiotherapy, Vestibular therapy, vestibulo ocular dysfunction, Vestibulo-Ocular, Vestibulo-ocular dysfunction, vestibuloocular reflex, VOLLEYBALL, Young Adult, youth sport},
pubstate = {published},
tppubtype = {article}
}
Morgan, C D; Zuckerman, S L; King, L E; Beaird, S E; Sills, A K; Solomon, G S
Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging Journal Article
In: Child's Nervous System, vol. 31, no. 12, pp. 2305–2309, 2015.
Abstract | Links | BibTeX | Tags: Adolescent, arachnoid cyst, Article, brain, Brain Injury, Child, Computed tomography (CT) neuroimaging, computer assisted tomography, Computer-Assisted, Concussion, cost effectiveness analysis, cost utility analysis, DECISION making, diagnostic value, DSM-IV, Female, human, Humans, image processing, Magnetic Resonance Imaging, Magnetic resonance imaging (MRI), major clinical study, Male, mild traumatic brain injury, neuroimaging, neurosurgery, nuclear magnetic resonance, nuclear magnetic resonance imaging, pathology, Post-Concussion Syndrome, postconcussion syndrome, Preschool, preschool child, priority journal, Radiography, Retrospective Studies, retrospective study, Sports, STATISTICS, Tomography, traumatic brain injury, X ray, X-Ray Computed
@article{Morgan2015,
title = {Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging},
author = {Morgan, C D and Zuckerman, S L and King, L E and Beaird, S E and Sills, A K and Solomon, G S},
doi = {10.1007/s00381-015-2916-y},
year = {2015},
date = {2015-01-01},
journal = {Child's Nervous System},
volume = {31},
number = {12},
pages = {2305--2309},
abstract = {Purpose: Approximately 90% of concussions are transient, with symptoms resolving within 10\textendash14 days. However, a minority of patients remain symptomatic several months post-injury, a condition known as post-concussion syndrome (PCS). The treatment of these patients can be challenging. The goal of our study was to assess the utility and cost-effectiveness of neurologic imaging two or more weeks post-injury in a cohort of youth with PCS. Methods: We conducted a retrospective study of 52 pediatric patients with persistent post-concussion symptoms after 3 months. We collected demographics and neuroimaging results obtained greater than 2 weeks post-concussion. Neuroimaging ordered in the first 2 weeks post-concussion was excluded, except to determine the rate of re-imaging. Descriptive statistics and corresponding cost data were collected. Results: Of 52 patients with PCS, 23/52 (44 %) had neuroimaging at least 2 weeks after the initial injury, for a total of 32 diagnostic studies. In summary, 1/19 MRIs (5.3 %), 1/8 CTs (13 %), and 0/5 x-rays (0 %) yielded significant positive findings, none of which altered clinical management. Chronic phase neuroimaging estimated costs from these 52 pediatric patients totaled $129,025. We estimate the cost to identify a single positive finding was $21,000 for head CT and $104,500 for brain MRI. Conclusions: In this cohort of pediatric PCS patients, brain imaging in the chronic phase (defined as more than 2 weeks after concussion) was pursued in almost half the study sample, had low diagnostic yield, and had poor cost-effectiveness. Based on these results, outpatient management of pediatric patients with long-term post-concussive symptoms should rarely include repeat neuroimaging beyond the acute phase. © 2015, Springer-Verlag Berlin Heidelberg.},
keywords = {Adolescent, arachnoid cyst, Article, brain, Brain Injury, Child, Computed tomography (CT) neuroimaging, computer assisted tomography, Computer-Assisted, Concussion, cost effectiveness analysis, cost utility analysis, DECISION making, diagnostic value, DSM-IV, Female, human, Humans, image processing, Magnetic Resonance Imaging, Magnetic resonance imaging (MRI), major clinical study, Male, mild traumatic brain injury, neuroimaging, neurosurgery, nuclear magnetic resonance, nuclear magnetic resonance imaging, pathology, Post-Concussion Syndrome, postconcussion syndrome, Preschool, preschool child, priority journal, Radiography, Retrospective Studies, retrospective study, Sports, STATISTICS, Tomography, traumatic brain injury, X ray, X-Ray Computed},
pubstate = {published},
tppubtype = {article}
}
Andre, J B
Arterial spin labeling magnetic resonance perfusion for traumatic brain injury: Technical challenges and potentials Journal Article
In: Topics in Magnetic Resonance Imaging, vol. 24, no. 5, pp. 275–287, 2015.
Abstract | BibTeX | Tags: Arterial spin labeling, artery blood flow, artifact, brain, brain blood flow, brain circulation, Brain Injuries, Brain Injury, brain perfusion, Cerebrovascular Circulation, clinical classification, Concussion, echo planar imaging, gray matter, human, Humans, Magnetic Resonance Imaging, mild traumatic brain injury, neuroimaging, neuropsychological test, nuclear magnetic resonance imaging, pathology, positron emission tomography, priority journal, procedures, Review, single photon emission computer tomography, spin labeling, Spin Labels, Sport, Sports-related concussion, symptom, traumatic brain injury, white matter
@article{Andre2015,
title = {Arterial spin labeling magnetic resonance perfusion for traumatic brain injury: Technical challenges and potentials},
author = {Andre, J B},
year = {2015},
date = {2015-01-01},
journal = {Topics in Magnetic Resonance Imaging},
volume = {24},
number = {5},
pages = {275--287},
abstract = {Traumatic brain injury (TBI), including concussion, is a public health concern, as it affects over 1.7 million persons in the United States per year. Yet, the diagnosis of TBI, particularly mild TBI (mTBI), can be controversial, as neuroimaging findings can be sparse on conventional magnetic resonance and computed tomography examinations, and when present, often poorly correlate with clinical signs and symptoms. Furthermore, the discussion of TBI, concussion, and head impact exposure is immediately complicated by the many differing opinions of what constitutes each, their respective severities, and how the underlying biomechanics of the inciting head impact might alter the distribution, severity, and prognosis of the underlying brain injury. Advanced imaging methodologies hold promise in improving the sensitivity and detectability of associated imaging biomarkers that might better correlate with patient outcome and prognostication, allowing for improved triage and therapeutic guidance in the setting of TBI, particularly in mTBI. This work will examine the defining symptom complex associated with mTBI and explore changes in cerebral blood flow measured by arterial spin labeling, as a potential imaging biomarker for TBI, and briefly correlate these observations with findings identified by single photon emission computed tomography and positron emission tomography imaging.. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.},
keywords = {Arterial spin labeling, artery blood flow, artifact, brain, brain blood flow, brain circulation, Brain Injuries, Brain Injury, brain perfusion, Cerebrovascular Circulation, clinical classification, Concussion, echo planar imaging, gray matter, human, Humans, Magnetic Resonance Imaging, mild traumatic brain injury, neuroimaging, neuropsychological test, nuclear magnetic resonance imaging, pathology, positron emission tomography, priority journal, procedures, Review, single photon emission computer tomography, spin labeling, Spin Labels, Sport, Sports-related concussion, symptom, traumatic brain injury, white matter},
pubstate = {published},
tppubtype = {article}
}
Stemper, B D; Shah, A S; Pintar, F A; McCrea, M; Kurpad, S N; Glavaski-Joksimovic, A; Olsen, C; Budde, M D
Head Rotational Acceleration Characteristics Influence Behavioral and Diffusion Tensor Imaging Outcomes Following Concussion Journal Article
In: Annals of Biomedical Engineering, vol. 43, no. 5, pp. 1071–1088, 2015.
Abstract | Links | BibTeX | Tags: Acceleration, Accidents, BEHAVIORAL assessment, Behavioral assessments, Behavioral outcomes, Biomechanics, brain, Cognitive deficits, Diffusion, Diffusion Tensor Imaging, Diffusion tensor imaging (DTI), fractional anisotropy, Full factorial design, Magnetic Resonance Imaging, Microstructure, Motor vehicle crashes, neuroimaging, Rats, Rotational acceleration, Tensors, Traumatic Brain Injuries, Traumatic brain injury (mTBI)
@article{Stemper2015,
title = {Head Rotational Acceleration Characteristics Influence Behavioral and Diffusion Tensor Imaging Outcomes Following Concussion},
author = {Stemper, B D and Shah, A S and Pintar, F A and McCrea, M and Kurpad, S N and Glavaski-Joksimovic, A and Olsen, C and Budde, M D},
doi = {10.1007/s10439-014-1171-9},
year = {2015},
date = {2015-01-01},
journal = {Annals of Biomedical Engineering},
volume = {43},
number = {5},
pages = {1071--1088},
abstract = {A majority of traumatic brain injuries (TBI) in motor vehicle crashes and sporting environments are mild and caused by high-rate acceleration of the head. For injuries caused by rotational acceleration, both magnitude and duration of the acceleration pulse were shown to influence injury outcomes. This study incorporated a unique rodent model of rotational acceleration-induced mild TBI (mTBI) to quantify independent effects of magnitude and duration on behavioral and neuroimaging outcomes. Ninety-two Sprague\textendashDawley rats were exposed to head rotational acceleration at peak magnitudes of 214 or 350 krad/s2 and acceleration pulse durations of 1.6 or 3.4 ms in a full factorial design. Rats underwent a series of behavioral tests including the Composite Neuroscore (CN), Elevated Plus Maze (EPM), and Morris Water Maze (MWM). Ex vivo diffusion tensor imaging (DTI) of the fixed brains was conducted to assess the effects of rotational injury on brain microstructure as revealed by the parameter fractional anisotropy (FA). While the injury did not cause significant locomotor or cognitive deficits measured with the CN and MWM, respectively, a main effect of duration was consistently observed for the EPM. Increased duration caused significantly greater activity and exploratory behaviors measured as open arm time and number of arm changes. DTI demonstrated significant effects of both magnitude and duration, with the FA of the amygdala related to both the magnitude and duration. Increased duration also caused FA changes at the interface of gray and white matter. Collectively, the findings demonstrate that the consequences of rotational acceleration mTBI were more closely associated with duration of the rotational acceleration impulse, which is often neglected as an independent factor, and highlight the need for animal models of TBI with strong biomechanical foundations to associate behavioral outcomes with brain microstructure. © 2014, Biomedical Engineering Society (Outside the U.S.).},
keywords = {Acceleration, Accidents, BEHAVIORAL assessment, Behavioral assessments, Behavioral outcomes, Biomechanics, brain, Cognitive deficits, Diffusion, Diffusion Tensor Imaging, Diffusion tensor imaging (DTI), fractional anisotropy, Full factorial design, Magnetic Resonance Imaging, Microstructure, Motor vehicle crashes, neuroimaging, Rats, Rotational acceleration, Tensors, Traumatic Brain Injuries, Traumatic brain injury (mTBI)},
pubstate = {published},
tppubtype = {article}
}
Sikoglu, E M; Liso Navarro, A A; Czerniak, S M; McCafferty, J; Eisenstock, J; Stevenson, J H; King, J A; Moore, C M
Effects of Recent Concussion on Brain Bioenergetics: A Phosphorus-31 Magnetic Resonance Spectroscopy Study Journal Article
In: Cognitive and Behavioral Neurology, vol. 28, no. 4, pp. 181–187, 2015.
Abstract | Links | BibTeX | Tags: Adolescent, adult, Article, athlete, Athletic Injuries, biochemical analysis, bioenergy, brain concussion, clinical article, cognition, college, Concussion, energy consumption, Energy Metabolism, Female, high energy phosphate, human, Humans, Longitudinal studies, longitudinal study, Magnetic Resonance Spectroscopy, Male, metabolism, MR spectroscopy (phosphorus-31), neuroimaging, NTP, NUCLEAR magnetic resonance spectroscopy, nucleoside, nucleoside triphosphate, Nucleosides, Pathophysiology, phosphate, Phosphates, phosphorus, Phosphorus Isotopes, phosphorus nuclear magnetic resonance, PHYSIOLOGY, Prefrontal Cortex, priority journal, procedures, sport injury, Universities, university, Young Adult
@article{Sikoglu2015,
title = {Effects of Recent Concussion on Brain Bioenergetics: A Phosphorus-31 Magnetic Resonance Spectroscopy Study},
author = {Sikoglu, E M and {Liso Navarro}, A A and Czerniak, S M and McCafferty, J and Eisenstock, J and Stevenson, J H and King, J A and Moore, C M},
doi = {10.1097/WNN.0000000000000076},
year = {2015},
date = {2015-01-01},
journal = {Cognitive and Behavioral Neurology},
volume = {28},
number = {4},
pages = {181--187},
abstract = {Background: Although clinical evaluations and neurocognitive assessments are commonly used to evaluate the extent of and recovery from concussion, brain bioenergetics could provide a more quantitative marker. The neurometabolic response to a concussion is thought to increase neuronal energy consumption and thus the demand for nucleoside triphosphate (NTP). Objective: We investigated the possible disruption in high-energy metabolism within the prefrontal cortex of college athletes who had either had a concussion within the past 6 months (n=14) or had never had a concussion (n=13). We hypothesized that concussed athletes would have imbalanced brain bioenergetics resulting from increased NTP consumption, and these biochemical changes would correspond to impaired cognitive abilities. Methods: We used phosphorus-31 magnetic resonance spectroscopy to quantify high-energy phosphates. We performed the neuroimaging in conjunction with neurocognitive assessments targeting prefrontal cortex-mediated tasks. Results: Our results revealed significantly lower $gamma$-NTP levels in the athletes after concussion. Although the concussed and non-concussed participants performed similarly in neurocognitive assessments, lower levels of $gamma$-NTP were associated with worse scores on neurocognitive tasks. Conclusions: Our results support the concept of increased energy demand in the prefrontal cortex of a concussed brain, and we found that while neurocognitive assessments appear normal, brain energetics may be abnormal. A longitudinal study could help establish brain NTP levels as a biomarker to aid in diagnosis and to assess recovery in concussed patients. © 2015 Wolters Kluwer Health, Inc.},
keywords = {Adolescent, adult, Article, athlete, Athletic Injuries, biochemical analysis, bioenergy, brain concussion, clinical article, cognition, college, Concussion, energy consumption, Energy Metabolism, Female, high energy phosphate, human, Humans, Longitudinal studies, longitudinal study, Magnetic Resonance Spectroscopy, Male, metabolism, MR spectroscopy (phosphorus-31), neuroimaging, NTP, NUCLEAR magnetic resonance spectroscopy, nucleoside, nucleoside triphosphate, Nucleosides, Pathophysiology, phosphate, Phosphates, phosphorus, Phosphorus Isotopes, phosphorus nuclear magnetic resonance, PHYSIOLOGY, Prefrontal Cortex, priority journal, procedures, sport injury, Universities, university, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Liu, C Y; Law, M; Romano, R
Rational approach to understanding and preventing sports-related traumatic brain injuries Journal Article
In: World Neurosurgery, vol. 84, no. 6, pp. 1556–1557, 2015.
Links | BibTeX | Tags: accelerometer, ACCELEROMETRY, biological marker, brain, brain concussion, brain hemorrhage, cognitive defect, Diffusion Tensor Imaging, Electroencephalography, emergency health service, Female, Head Protective Devices, Helmet, high risk patient, human, Humans, Injuries, Male, neuroimaging, neuromodulation, neuroprotective agent, nuclear magnetic resonance imaging, Occupational Exposure, protective equipment, Review, risk factor, risk reduction, SAFETY, skiing, Snowboarding, sport injury, Traumatic, traumatic brain injury, viscoelastic substance
@article{Liu2015,
title = {Rational approach to understanding and preventing sports-related traumatic brain injuries},
author = {Liu, C Y and Law, M and Romano, R},
doi = {10.1016/j.wneu.2015.07.076},
year = {2015},
date = {2015-01-01},
journal = {World Neurosurgery},
volume = {84},
number = {6},
pages = {1556--1557},
keywords = {accelerometer, ACCELEROMETRY, biological marker, brain, brain concussion, brain hemorrhage, cognitive defect, Diffusion Tensor Imaging, Electroencephalography, emergency health service, Female, Head Protective Devices, Helmet, high risk patient, human, Humans, Injuries, Male, neuroimaging, neuromodulation, neuroprotective agent, nuclear magnetic resonance imaging, Occupational Exposure, protective equipment, Review, risk factor, risk reduction, SAFETY, skiing, Snowboarding, sport injury, Traumatic, traumatic brain injury, viscoelastic substance},
pubstate = {published},
tppubtype = {article}
}
Rapp, P E; Keyser, D O; Albano, A; Hernandez, R; Gibson, D B; Zambon, R A; David Hairston, W; Hughes, J D; Krystal, A; Nichols, A S
Traumatic brain injury detection using electrophysiological methods Journal Article
In: Frontiers in Human Neuroscience, vol. 9, no. FEB, 2015.
Abstract | Links | BibTeX | Tags: Article, brain electrophysiology, computer assisted tomography, Concussion, connectome, diagnostic accuracy, EEG, electroencephalogram, Electroencephalography, event related potential, Event-Related Potentials, evidence based medicine, executive function, human, intermethod comparison, latent period, neuroimaging, neuropathology, Non-linear dynamical analysis, nuclear magnetic resonance imaging, QEEG, Signal Processing, traumatic brain injury
@article{Rapp2015,
title = {Traumatic brain injury detection using electrophysiological methods},
author = {Rapp, P E and Keyser, D O and Albano, A and Hernandez, R and Gibson, D B and Zambon, R A and {David Hairston}, W and Hughes, J D and Krystal, A and Nichols, A S},
doi = {10.3389/fnhum.2015.00011},
year = {2015},
date = {2015-01-01},
journal = {Frontiers in Human Neuroscience},
volume = {9},
number = {FEB},
abstract = {Measuring neuronal activity with electrophysiological methods may be useful in detecting neurological dysfunctions, such as mild traumatic brain injury (mTBI).This approach may be particularly valuable for rapid detection in at-risk populations including military service members and athletes. Electrophysiological methods, such as quantitative electroencephalography (qEEG) and recording event-related potentials (ERPs) may be promising; however, the field is nascent and significant controversy exists on the efficacy and accuracy of the approaches as diagnostic tools. For example, the specific measures derived from an electroencephalogram (EEG) that are most suitable as markers of dysfunction have not been clearly established. A study was conducted to summarize and evaluate the statistical rigor of evidence on the overall utility of qEEG as an mTBI detection tool. The analysis evaluated qEEG measures/parameters that may be most suitable as fieldable diagnostic tools, identified other types of EEG measures and analysis methods of promise, recommended specific measures and analysis methods for further development as mTBI detection tools, identified research gaps in the field, and recommended future research and development thrust areas. The qEEG study group formed the following conclusions: (1) Individual qEEG measures provide limited diagnostic utility for mTBI. However, many measures can be important features of qEEG discriminant functions, which do show significant promise as mTBI detection tools. (2) ERPs offer utility in mTBI detection. In fact, evidence indicates that ERPs can identify abnormalities in cases where EEGs alone are non-disclosing. (3)The standard mathematical procedures used in the characterization of mTBI EEGs should be expanded to incorporate newer methods of analysis including non-linear dynamical analysis, complexity measures, analysis of causal interactions, graph theory, and information dynamics. (4) Reports of high specificity in qEEG evaluations of TBI must be interpreted with care. High specificities have been reported in carefully constructed clinical studies in which healthy controls were compared against a carefully selected TBI population. The published literature indicates, however, that similar abnormalities in qEEG measures are observed in other neuropsychiatric disorders. While it may be possible to distinguish a clinical patient from a healthy control participant with this technology, these measures are unlikely to discriminate between, for example, major depressive disorder, bipolar disorder, or TBI. The specificities observed in these clinical studies may well be lost in real world clinical practice. (5)The absence of specificity does not preclude clinical utility. The possibility of use as a longitudinal measure of treatment response remains. However, efficacy as a longitudinal clinical measure does require acceptable test-retest reliability. To date, very few test-retest reliability studies have been published with qEEG data obtained from TBI patients or from healthy controls. This is a particular concern because high variability is a known characteristic of the injured central nervous system. © 2015 Rapp, Keyser , Albano, Hernandez, Gibson, Zambon, Hairston, Hughes, Krystal and Nichols.},
keywords = {Article, brain electrophysiology, computer assisted tomography, Concussion, connectome, diagnostic accuracy, EEG, electroencephalogram, Electroencephalography, event related potential, Event-Related Potentials, evidence based medicine, executive function, human, intermethod comparison, latent period, neuroimaging, neuropathology, Non-linear dynamical analysis, nuclear magnetic resonance imaging, QEEG, Signal Processing, traumatic brain injury},
pubstate = {published},
tppubtype = {article}
}
Jordan, B D
Chronic traumatic encephalopathy and other long-term sequelae Journal Article
In: CONTINUUM Lifelong Learning in Neurology, vol. 20, pp. 1588–1604, 2014.
Abstract | Links | BibTeX | Tags: Chronic Traumatic Encephalopathy chronic disease, cognitive defect, diagnostic procedure, human, Incidence, injury severity, laboratory test, medical history, neuroimaging, neurologic examination, neurologist, neuropsychological test, Pathophysiology, postconcussion syndrome, Review, sport injury, symptomatology, traumatic brain injury
@article{Jordan2014,
title = {Chronic traumatic encephalopathy and other long-term sequelae},
author = {Jordan, B D},
url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84927562326\&partnerID=40\&md5=da8cab7e63cee5fa58ae148fa7de9dec},
year = {2014},
date = {2014-01-01},
journal = {CONTINUUM Lifelong Learning in Neurology},
volume = {20},
pages = {1588--1604},
abstract = {Purpose of Review: Growing public health concern exists over the incidence of chronic traumatic brain injury (TBI) in athletes participating in contact sports. Chronic TBI represents a spectrum of disorders associated with long-term consequences of single or repetitive TBI and includes chronic traumatic encephalopathy (CTE), chronic postconcussion syndrome, and chronic neurocognitive impairment. Neurologists should be familiar with the different types of chronic TBI and their diagnostic criteria. Recent Findings: CTE is the most severe chronic TBI and represents the neurologic consequences of repetitive mild TBI. It is particularly noted among boxers and football players. CTE presents with behavioral, cognitive, and motor symptoms, and can only be definitively diagnosed postmortem. Chronic postconcussion syndrome is defined as postconcussion symptoms that last longer than 1 year and do not appear to resolve; it may develop after a single concussive event. Chronic neurocognitive impairment is an all-encompassing clinical term denoting long-term neurologic sequelae secondary to sports-related trauma and can present either within the postconcussion syndrome or years after a symptom-free interval. Summary: This article discusses the diagnostic evaluation of chronic TBI, including clinical history, neurologic examination, neuropsychological testing, neuroimaging, and laboratory testing, as well as the distinctions between CTE, chronic postconcussion syndrome, and chronic neurocognitive impairment. Neurologic impairment among athletes exposed to repetitive brain injury appears to be a real phenomenon. Because CTE has no established treatment, prevention is of paramount importance for athletes participating in contact sports. © 2014, American Academy of Neurology.},
keywords = {Chronic Traumatic Encephalopathy chronic disease, cognitive defect, diagnostic procedure, human, Incidence, injury severity, laboratory test, medical history, neuroimaging, neurologic examination, neurologist, neuropsychological test, Pathophysiology, postconcussion syndrome, Review, sport injury, symptomatology, traumatic brain injury},
pubstate = {published},
tppubtype = {article}
}
Rabb, C H
Comments Journal Article
In: Neurosurgery, vol. 67, no. 4, pp. 1027–1028, 2010, ISBN: 0148-396X.
BibTeX | Tags: brain concussion, functional magnetic resonance imaging, human, Imaging & EEG, mental task, neuroimaging, Note, priority journal, sport injury, working memory Overviews
@article{Rabb2010,
title = {Comments},
author = {Rabb, C H},
isbn = {0148-396X},
year = {2010},
date = {2010-01-01},
journal = {Neurosurgery},
volume = {67},
number = {4},
pages = {1027--1028},
keywords = {brain concussion, functional magnetic resonance imaging, human, Imaging \& EEG, mental task, neuroimaging, Note, priority journal, sport injury, working memory Overviews},
pubstate = {published},
tppubtype = {article}
}