Huang, L; Obenaus, A; Hamer, M; Zhang, J
Neuroprotective effect of hyperbaric oxygen therapy in a juvenile rat model of repetitive mild traumatic brain injury Journal Article
In: Medical Gas Research, vol. 6, no. 4, pp. 187–193, 2016.
Abstract | Links | BibTeX | Tags: Adolescent, Concussion, diffusion weighted imaging, gliosis, Magnetic Resonance Imaging, rat, susceptibility weighted imaging, T2-weighted imaging
@article{Huang2016a,
title = {Neuroprotective effect of hyperbaric oxygen therapy in a juvenile rat model of repetitive mild traumatic brain injury},
author = {Huang, L and Obenaus, A and Hamer, M and Zhang, J},
doi = {10.4103/2045-9912.196900},
year = {2016},
date = {2016-01-01},
journal = {Medical Gas Research},
volume = {6},
number = {4},
pages = {187--193},
abstract = {Repetitive mild traumatic brain injury (rmTBI) is an important medical concern for adolescent athletes that can lead to long-term disabilities. Multiple mild injuries may exacerbate tissue damage resulting in cumulative brain injury and poor functional recovery. In the present study, we investigated the increased brain vulnerability to rmTBI and the effect of hyperbaric oxygen treatment using a juvenile rat model of rmTBI. Two episodes of mild cortical controlled impact (3 days apart) were induced in juvenile rats. Hyperbaric oxygen (HBO) was applied 1 hour/day × 3 days at 2 atmosphere absolute consecutively, starting at 1 day after initial mild traumatic brain injury (mTBI). Neuropathology was assessed by multi-modal magnetic resonance imaging (MRI) and tissue immunohistochemistry. After repetitive mTBI, there were increases in T2-weighted imaging-defined cortical lesions and susceptibility weighted imaging-defined cortical microhemorrhages, correlated with brain tissue gliosis at the site of impact. HBO treatment significantly decreased the MRI-identified abnormalities and tissue histopathology. Our findings suggest that HBO treatment improves the cumulative tissue damage in juvenile brain following rmTBI. Such therapy regimens could be considered in adolescent athletes at the risk of repeated concussions exposures. © 2016 Medical Gas Research | Published by Wolters Kluwer - Medknow.},
keywords = {Adolescent, Concussion, diffusion weighted imaging, gliosis, Magnetic Resonance Imaging, rat, susceptibility weighted imaging, T2-weighted imaging},
pubstate = {published},
tppubtype = {article}
}
Ellis, M J; Mutch, W A C; Ryner, L N; Graham, M R; Dufault, B; Gregson, B; Hall, T; Bunge, M; Essig, M; Fisher, J A; Duffin, J; Mikulis, D J
Brain magnetic resonance imaging CO2 stress testing in adolescent postconcussion syndrome Journal Article
In: Journal of Neurosurgery, vol. 125, no. 3, pp. 648–660, 2016.
Abstract | Links | BibTeX | Tags: Adolescent, Blood oxygen level-dependent imaging, Magnetic Resonance Imaging, postconcussion syndrome, Sports-related concussion, Trauma
@article{Ellis2016a,
title = {Brain magnetic resonance imaging CO2 stress testing in adolescent postconcussion syndrome},
author = {Ellis, M J and Mutch, W A C and Ryner, L N and Graham, M R and Dufault, B and Gregson, B and Hall, T and Bunge, M and Essig, M and Fisher, J A and Duffin, J and Mikulis, D J},
doi = {10.3171/2015.6.JNS15972},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurosurgery},
volume = {125},
number = {3},
pages = {648--660},
abstract = {OBJECTIVE: A Neuroimaging Assessment tool to visualize global and regional impairments in cerebral blood flow (CBF) and cerebrovascular responsiveness in individual patients with concussion remains elusive. Here the authors summarize the safety, feasibility, and results of brain CO2 stress testing in adolescents with postconcussion syndrome (PCS) and healthy controls. METHODS: This study was approved by the Biomedical Research Ethics Board at the University of Manitoba. Fifteen adolescents with PCS and 17 healthy control subjects underwent anatomical MRI, pseudo-continuous arterial spin labeling MRI, and brain stress testing using controlled CO2 challenge and blood oxygen level-dependent (BOLD) MRI. Post hoc processing was performed using statistical parametric mapping to determine voxel-by-voxel regional resting CBF and cerebrovascular responsiveness of the brain to the CO2 stimulus (increase in BOLD signal) or the inverse (decrease in BOLD signal). Receiver operating characteristic (ROC) curves were generated to compare voxel counts categorized by control (0) or PCS (1). RESULTS: Studies were well tolerated without any serious adverse events. Anatomical MRI was normal in all study participants. No differences in CO2 stimuli were seen between the 2 participant groups. No group differences in global mean CBF were detected between PCS patients and healthy controls. Patient-specific differences in mean regional CBF and CO2 BOLD responsiveness were observed in all PCS patients. The ROC curve analysis for brain regions manifesting a voxel response greater than and less than the control atlas (that is, abnormal voxel counts) produced an area under the curve of 0.87 (p \< 0.0001) and 0.80 (p = 0.0003), respectively, consistent with a clinically useful predictive model. CONCLUSIONS: Adolescent PCS is associated with patient-specific abnormalities in regional mean CBF and BOLD cerebrovascular responsiveness that occur in the setting of normal global resting CBF. Future prospective studies are warranted to examine the utility of brain MRI CO2 stress testing in the longitudinal assessment of acute sports-related concussion and PCS. © AANS, 2016.},
keywords = {Adolescent, Blood oxygen level-dependent imaging, Magnetic Resonance Imaging, postconcussion syndrome, Sports-related concussion, Trauma},
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}
}
Stewart, W; McNamara, P H; Lawlor, B; Hutchinson, S; Farrell, M
Chronic traumatic encephalopathy: a potential late and under recognized consequence of rugby union? Journal Article
In: Qjm, vol. 109, no. 1, pp. 11–15, 2016.
Abstract | BibTeX | Tags: *Brain Concussion/co [Complications], *Brain Injury, *Brain/pp [Physiopathology], *Football/in [Injuries], *Neurodegenerative Diseases/pp [Physiopathology], Chronic/pa [Pathology], Humans, Magnetic Resonance Imaging, Male, middle aged, neurologic examination
@article{Stewart2016,
title = {Chronic traumatic encephalopathy: a potential late and under recognized consequence of rugby union?},
author = {Stewart, W and McNamara, P H and Lawlor, B and Hutchinson, S and Farrell, M},
year = {2016},
date = {2016-01-01},
journal = {Qjm},
volume = {109},
number = {1},
pages = {11--15},
abstract = {The association between exposure to head injury and increased risk of neurodegenerative disease, specifically chronic traumatic encephalopathy (CTE), is widely recognized. Historically, this was largely considered a phenomenon restricted to boxers, with more recent case series identifying further 'high risk' individuals, such as former American footballers, or military personnel. However, in all cases thus far reported, it is clear that it is the exposure to head injury which is associated with increased dementia risk, and not the circumstances or environment of exposure. As such, there is considerable potential for under-recognition of CTE in patients presenting with neurodegenerative disease, particularly where head injury exposure might have been historical and through sport. This article reviews current understanding of CTE and, via an illustrative case in rugby union, highlights the value of a detailed history on head injury and also draws attention to imaging studies in assessing patients with neurodegenerative disease. Copyright © The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.},
keywords = {*Brain Concussion/co [Complications], *Brain Injury, *Brain/pp [Physiopathology], *Football/in [Injuries], *Neurodegenerative Diseases/pp [Physiopathology], Chronic/pa [Pathology], Humans, Magnetic Resonance Imaging, Male, middle aged, neurologic examination},
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}
}
Ellis, M J; Leiter, J; Hall, T; McDonald, P J; Sawyer, S; Silver, N; Bunge, M; Essig, M
Neuroimaging findings in pediatric sports-related concussion Journal Article
In: Journal of Neurosurgery. Pediatrics., vol. 16, no. 3, pp. 241–247, 2015.
Abstract | BibTeX | Tags: *Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Brain Concussion/et [Etiology], *Neuroimaging, Adolescent, Arachnoid Cysts/di [Diagnosis], Athletic Injuries/co [Complications], Athletic Injuries/pa [Pathology], Brain Concussion/pa [Pathology], Brain Injuries/di [Diagnosis], Brain Injuries/et [Etiology], Child, Contusions/di [Diagnosis], Dizziness/et [Etiology], Female, Follow-Up Studies, Headache/et [Etiology], Humans, Intracranial Hemorrhages/di [Diagnosis], Magnetic Resonance Imaging, Male, Neuroimaging/mt [Methods], postural balance, Predictive Value of Tests, Retrospective Studies, Skull Fractures/di [Diagnosis], Tomography, Unconsciousness/et [Etiology], X-Ray Computed
@article{Ellis2015b,
title = {Neuroimaging findings in pediatric sports-related concussion},
author = {Ellis, M J and Leiter, J and Hall, T and McDonald, P J and Sawyer, S and Silver, N and Bunge, M and Essig, M},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neurosurgery. Pediatrics.},
volume = {16},
number = {3},
pages = {241--247},
abstract = {OBJECT: The goal in this review was to summarize the results of clinical neuroimaging studies performed in patients with sports-related concussion (SRC) who were referred to a multidisciplinar ypediatric concussion program. METHODS: The authors conducted a retrospective review of medical records and neuroimaging findings for all patients referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Inclusion criteria were as follows: 1) age \< 19 years; and 2) physician-diagnosed SRC. All patients underwent evaluation and follow-up by the same neurosurgeon. The 2 outcomes examined in this review were the frequency of neuroimaging studies performed in this population (including CT and MRI) and the findings of those studies. Clinical indications for neuroimaging and the impact of neuroimaging findings on clinical decision making were summarized where available. This investigation was approved by the local institutional ethics review board. RESULTS: A total of 151 patients (mean age 14 years, 59% female) were included this study. Overall, 36 patients (24%) underwent neuroimaging studies, the results of which were normal in 78% of cases. Sixteen percent of patients underwent CT imaging; results were normal in 79% of cases. Abnormal CT findings included the following: arachnoid cyst (1 patient), skull fracture (2 patients), suspected intracranial hemorrhage (1 patient), and suspected hemorrhage into an arachnoid cyst (1 patient). Eleven percent of patients underwent MRI; results were normal in 75% of cases. Abnormal MRI findings included the following: intraparenchymal hemorrhage and sylvian fissure arachnoid cyst (1 patient); nonhemorrhagic contusion (1 patient); demyelinating disease (1 patient); and posterior fossa arachnoid cyst, cerebellar volume loss, and nonspecific white matter changes (1 patient). CONCLUSIONS: Results of clinical neuroimaging studies are normal in the majority of pediatric patients with SRC. However, in selected cases neuroimaging can provide information that impacts decision making about return to play and retirement from the sport.},
keywords = {*Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Brain Concussion/et [Etiology], *Neuroimaging, Adolescent, Arachnoid Cysts/di [Diagnosis], Athletic Injuries/co [Complications], Athletic Injuries/pa [Pathology], Brain Concussion/pa [Pathology], Brain Injuries/di [Diagnosis], Brain Injuries/et [Etiology], Child, Contusions/di [Diagnosis], Dizziness/et [Etiology], Female, Follow-Up Studies, Headache/et [Etiology], Humans, Intracranial Hemorrhages/di [Diagnosis], Magnetic Resonance Imaging, Male, Neuroimaging/mt [Methods], postural balance, Predictive Value of Tests, Retrospective Studies, Skull Fractures/di [Diagnosis], Tomography, Unconsciousness/et [Etiology], X-Ray Computed},
pubstate = {published},
tppubtype = {article}
}
Walter, K D; Halstead, M E
Concussion in Teenage Athletes Journal Article
In: Adolescent Medicine, vol. 26, no. 1, pp. 39–52, 2015.
BibTeX | Tags: *Athletes, *Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], Adolescent, Athletic Injuries/ep [Epidemiology], Athletic Injuries/pc [Prevention & Control], Brain Concussion/ep [Epidemiology], Brain Concussion/pc [Prevention & Control], Humans, Magnetic Resonance Imaging, Neurocognitive Disorders/di [Diagnosis], Tomography, X-Ray Computed
@article{Walter2015,
title = {Concussion in Teenage Athletes},
author = {Walter, K D and Halstead, M E},
year = {2015},
date = {2015-01-01},
journal = {Adolescent Medicine},
volume = {26},
number = {1},
pages = {39--52},
keywords = {*Athletes, *Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], Adolescent, Athletic Injuries/ep [Epidemiology], Athletic Injuries/pc [Prevention \& Control], Brain Concussion/ep [Epidemiology], Brain Concussion/pc [Prevention \& Control], Humans, Magnetic Resonance Imaging, Neurocognitive Disorders/di [Diagnosis], Tomography, 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}
}
Mayer, A R; Ling, J M; Dodd, A B; Gasparovic, C; Klimaj, S D; Meier, T B
A Longitudinal Assessment of Structural and Chemical Alterations in Mixed Martial Arts Fighters Journal Article
In: Journal of Neurotrauma, vol. 32, no. 22, pp. 1759–1767, 2015.
Abstract | Links | BibTeX | Tags: Adolescent, adult, Article, biological marker, Biomarkers, BRAIN chemistry, brain concussion, brain cortex, brain size, Cerebral Cortex, CHOLINE, clinical article, cognition, Concussion, controlled study, cortical thickness (brain), creatine, executive function, Female, follow up, Follow-Up Studies, frontal gyrus, glutamic acid, glutamine, human, Humans, Injuries, inositol, Longitudinal, Longitudinal studies, longitudinal study, Magnetic Resonance Imaging, Male, martial art, Martial Arts, Memory, middle aged, mixed martial art, n acetylaspartic acid, neuropsychological test, Neuropsychological Tests, nuclear magnetic resonance imaging, NUCLEAR magnetic resonance spectroscopy, occipital cortex, pathology, posterior cingulate, psychology, repetitive injury, Spectroscopy, volumetrics, white matter, Young Adult
@article{Mayer2015b,
title = {A Longitudinal Assessment of Structural and Chemical Alterations in Mixed Martial Arts Fighters},
author = {Mayer, A R and Ling, J M and Dodd, A B and Gasparovic, C and Klimaj, S D and Meier, T B},
doi = {10.1089/neu.2014.3833},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neurotrauma},
volume = {32},
number = {22},
pages = {1759--1767},
abstract = {Growing evidence suggests that temporally proximal acute concussions and repetitive subconcussive head injuries may lead to long-term neurological deficits. However, the underlying mechanisms of injury and their relative time-scales are not well documented in human injury models. The current study therefore investigated whether biomarkers of brain chemistry (magnetic resonance [MR] spectroscopy: N-acetylaspartate [NAA], combined glutamate and glutamine [Glx], total creatine [Cre], choline compounds [Cho], and myo-inositol [mI]) and structure (cortical thickness, white matter [WM]/subcortical volume) differed between mixed martial artists (MMA; n = 13) and matched healthy controls (HC) without a history of contact sport participation (HC; n = 14). A subset of participants (MMA = 9; HC = 10) returned for follow-up visits, with MMA (n = 3) with clinician-documented acute concussions also scanned serially. As expected, MMA self-reported a higher incidence of previous concussions and significantly more cognitive symptoms during prior concussion recovery. Fighters also exhibited reduced memory and processing speed relative to controls on neuropsychological testing coupled with cortical thinning in the left posterior cingulate gyrus and right occipital cortex at baseline assessment. Over a 1-year follow-up period, MMA experienced a significant decrease in both WM volume and NAA concentration, as well as relative thinning in the left middle and superior frontal gyri. These longitudinal changes did not correlate with self-reported metrics of injury (i.e., fight diary). In contrast, HC did not exhibit significant longitudinal changes over a 4-month follow-up period (p \> 0.05). Collectively, current results provide preliminary evidence of progressive changes in brain chemistry and structure over a relatively short time period in individuals with high exposure to repetitive head hits. These findings require replication in independent samples. © Mary Ann Liebert, Inc. 2015.},
keywords = {Adolescent, adult, Article, biological marker, Biomarkers, BRAIN chemistry, brain concussion, brain cortex, brain size, Cerebral Cortex, CHOLINE, clinical article, cognition, Concussion, controlled study, cortical thickness (brain), creatine, executive function, Female, follow up, Follow-Up Studies, frontal gyrus, glutamic acid, glutamine, human, Humans, Injuries, inositol, Longitudinal, Longitudinal studies, longitudinal study, Magnetic Resonance Imaging, Male, martial art, Martial Arts, Memory, middle aged, mixed martial art, n acetylaspartic acid, neuropsychological test, Neuropsychological Tests, nuclear magnetic resonance imaging, NUCLEAR magnetic resonance spectroscopy, occipital cortex, pathology, posterior cingulate, psychology, repetitive injury, Spectroscopy, volumetrics, white matter, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Meehan, W P; Jordaan, M; Prabhu, S P; Carew, L; Mannix, R C; Proctor, M R
Risk of athletes with chiari malformations suffering catastrophic injuries during sports participation is low Journal Article
In: Clinical Journal of Sport Medicine, vol. 25, no. 2, pp. 133–137, 2015.
Abstract | Links | BibTeX | Tags: Adolescent, adult, Arnold Chiari malformation, Arnold-Chiari Malformation, Article, athlete, Athletes, Athletic Injuries, BASKETBALL, Brain Injuries, cerebrospinal fluid, cerebrospinal fluid flow, Child, cohort analysis, Cohort Studies, coma, Concussion, Death, descriptive research, digestive tract parameters, Female, football, foramen magnum, human, Humans, ice hockey, Magnetic Resonance Imaging, major clinical study, Male, MORTALITY, nuclear magnetic resonance imaging, paralysis, paresthesia, pathology, patient participation, priority journal, questionnaire, Retrospective Studies, retrospective study, RISK assessment, risk factor, Soccer, sport injury, Surveys and Questionnaires, terminal disease, Young Adult
@article{Meehan2015,
title = {Risk of athletes with chiari malformations suffering catastrophic injuries during sports participation is low},
author = {Meehan, W P and Jordaan, M and Prabhu, S P and Carew, L and Mannix, R C and Proctor, M R},
doi = {10.1097/JSM.0000000000000107},
year = {2015},
date = {2015-01-01},
journal = {Clinical Journal of Sport Medicine},
volume = {25},
number = {2},
pages = {133--137},
abstract = {Objective: To estimate the risk of athletes with Chiari malformations sustaining a catastrophic injury. Design: Retrospective, descriptive cohort study. Participants: All patients diagnosed with Chiari malformation at our institution between June 2008 and November 2011. Assessment of Risk Factors: Participants were mailed a questionnaire regarding the number of seasons they participated in organized athletics. Magnetic resonance images were reviewed to describe the characteristics of respondent's Chiari malformations. Main Outcome Measures: Whether or not the patient had sustained an injury resulting in death, coma, or paralysis. Results: We had a 53% (N = 147) response rate. Respondents were of a mean age of 15 years (SD, 2 years) at the time of diagnosis. The mean length of protrusion of the cerebellar tonsils below the foramen magnum was 11.2 mm (SD, 5.7 mm). Most of the respondents had pointed cerebellar tonsils and some degree of crowding within the foramen magnum. During a total of 1627 athletic seasons played by patients with Chiari malformation, 0 respondents [95% confidence interval (CI), 0.0000-0.0023] sustained an injury resulting in death, coma, or paralysis. Likewise, during 191 collision sport athletic seasons, 0 (95% CI, 0.0000-0.0191) respondents sustained an injury resulting in death, coma, or paralysis. Conclusions: The risk of athletes with Chiari malformations suffering catastrophic injuries during sports participation is low. This estimate of risk should be considered when making return-toplay decisions. Given the variability of anatomical consideration for patients with Chiari malformations, however, each return-to-play decision must continue to be made on a case-by-case basis, considering all of the available information. Clinical Relevance: The low risk of athletes with Chiari malformations suffering catastrophic injuries in sports should be considered when making return-to-play decisions. © 2014 Wolters Kluwer Health, Inc. All rights reserved.},
keywords = {Adolescent, adult, Arnold Chiari malformation, Arnold-Chiari Malformation, Article, athlete, Athletes, Athletic Injuries, BASKETBALL, Brain Injuries, cerebrospinal fluid, cerebrospinal fluid flow, Child, cohort analysis, Cohort Studies, coma, Concussion, Death, descriptive research, digestive tract parameters, Female, football, foramen magnum, human, Humans, ice hockey, Magnetic Resonance Imaging, major clinical study, Male, MORTALITY, nuclear magnetic resonance imaging, paralysis, paresthesia, pathology, patient participation, priority journal, questionnaire, Retrospective Studies, retrospective study, RISK assessment, risk factor, Soccer, sport injury, Surveys and Questionnaires, terminal disease, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Czerniak, S M; Sikoglu, E M; Liso Navarro, A A; McCafferty, J; Eisenstock, J; Stevenson, J H; King, J A; Moore, C M
A resting state functional magnetic resonance imaging study of concussion in collegiate athletes.[Erratum appears in Brain Imaging Behav. 2015 Sep;9(3):650; PMID: 25326270] Journal Article
In: Brain Imaging & Behavior, vol. 9, no. 2, pp. 323–332, 2015.
Abstract | BibTeX | Tags: *Athletic Injuries/pp [Physiopathology], *Brain Concussion/pp [Physiopathology], *Brain/pp [Physiopathology], Adolescent, Athletes, BRAIN mapping, Female, Humans, interview, Magnetic Resonance Imaging, Male, Neuropsychological Tests, Psychological, rest, Young Adult
@article{Czerniak2015b,
title = {A resting state functional magnetic resonance imaging study of concussion in collegiate athletes.[Erratum appears in Brain Imaging Behav. 2015 Sep;9(3):650; PMID: 25326270]},
author = {Czerniak, S M and Sikoglu, E M and {Liso Navarro}, A A and McCafferty, J and Eisenstock, J and Stevenson, J H and King, J A and Moore, C M},
year = {2015},
date = {2015-01-01},
journal = {Brain Imaging \& Behavior},
volume = {9},
number = {2},
pages = {323--332},
abstract = {Sports-related concussions are currently diagnosed through multi-domain assessment by a medical professional and may utilize neurocognitive testing as an aid. However, these tests have only been able to detect differences in the days to week post-concussion. Here, we investigate a measure of brain function, namely resting state functional connectivity, which may detect residual brain differences in the weeks to months after concussion. Twenty-one student athletes (9 concussed within 6 months of enrollment; 12 non-concussed; between ages 18 and 22 years) were recruited for this study. All participants completed the Wisconsin Card Sorting Task and the Color-Word Interference Test. Neuroimaging data, specifically resting state functional Magnetic Resonance Imaging data, were acquired to examine resting state functional connectivity. Two sample t-tests were used to compare the neurocognitive scores and resting state functional connectivity patterns among concussed and non-concussed participants. Correlations between neurocognitive scores and resting state functional connectivity measures were also determined across all subjects. There were no significant differences in neurocognitive performance between concussed and non-concussed groups. Concussed subjects had significantly increased connections between areas of the brain that underlie executive function. Across all subjects, better neurocognitive performance corresponded to stronger brain connectivity. Even at rest, brains of concussed athletes may have to 'work harder' than their healthy peers to achieve similar neurocognitive results. Resting state brain connectivity may be able to detect prolonged brain differences in concussed athletes in a more quantitative manner than neurocognitive test scores.},
keywords = {*Athletic Injuries/pp [Physiopathology], *Brain Concussion/pp [Physiopathology], *Brain/pp [Physiopathology], Adolescent, Athletes, BRAIN mapping, Female, Humans, interview, Magnetic Resonance Imaging, Male, Neuropsychological Tests, Psychological, rest, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Kochanek, Patrick M; Bell, Michael J
Making an IMPACT in traumatic brain injury research Journal Article
In: The Lancet Neurology, vol. 12, no. 12, pp. 1132–1133, 2013, ISBN: 1474-4422.
Abstract | Links | BibTeX | Tags: 2013, brain, clinical outcomes, Cognitive Impairment, Magnetic Resonance Imaging, MRI, neurology, Subtypes (Disorders), system dysfunction, topological organization, traumatic brain injury
@article{Kochanek2013,
title = {Making an IMPACT in traumatic brain injury research},
author = {Kochanek, Patrick M and Bell, Michael J},
doi = {10.1016/S1474-4422(13)70245-X},
isbn = {1474-4422},
year = {2013},
date = {2013-01-01},
journal = {The Lancet Neurology},
volume = {12},
number = {12},
pages = {1132--1133},
publisher = {Elsevier Science},
address = {Netherlands},
abstract = {Comments on an article by Maas et al. (see record [rid]2013-40314-020[/rid]). Maas and colleagues review key developments related to 10 years of work by an international group of investigators, the International Mission on Prognosis and Analysis of randomized Controlled Trials in TBI (IMPACT). The investigators identify essential elements for improved clinical trials in TBI, along with a roadmap for future investigations. They suggest that the key elements that have been lacking in clinical trial design for TBI include standardization of data collection (common data elements), accurate quantification of initial prognostic risk, and study designs that appropriately deal with the substantial heterogeneity of the disease. The newly recognised importance of TBI, including the evolution into viewing even mild TBI or concussion as a serious illness rather than regarding it as a so-called badge of honor to be ignored by sports participants, along with the recent major surge in funding of TBI research across the full range of illness by both traditional and new sources, such as the US Army and the National Football League, among others, is leading to a golden age of TBI research with the potential to produce significant breakthroughs. (PsycINFO Database Record (c) 2016 APA, all rights reserved)},
keywords = {2013, brain, clinical outcomes, Cognitive Impairment, Magnetic Resonance Imaging, MRI, neurology, Subtypes (Disorders), system dysfunction, topological organization, traumatic brain injury},
pubstate = {published},
tppubtype = {article}
}
Huang, L; Obenaus, A; Hamer, M; Zhang, J
Neuroprotective effect of hyperbaric oxygen therapy in a juvenile rat model of repetitive mild traumatic brain injury Journal Article
In: Medical Gas Research, vol. 6, no. 4, pp. 187–193, 2016.
@article{Huang2016a,
title = {Neuroprotective effect of hyperbaric oxygen therapy in a juvenile rat model of repetitive mild traumatic brain injury},
author = {Huang, L and Obenaus, A and Hamer, M and Zhang, J},
doi = {10.4103/2045-9912.196900},
year = {2016},
date = {2016-01-01},
journal = {Medical Gas Research},
volume = {6},
number = {4},
pages = {187--193},
abstract = {Repetitive mild traumatic brain injury (rmTBI) is an important medical concern for adolescent athletes that can lead to long-term disabilities. Multiple mild injuries may exacerbate tissue damage resulting in cumulative brain injury and poor functional recovery. In the present study, we investigated the increased brain vulnerability to rmTBI and the effect of hyperbaric oxygen treatment using a juvenile rat model of rmTBI. Two episodes of mild cortical controlled impact (3 days apart) were induced in juvenile rats. Hyperbaric oxygen (HBO) was applied 1 hour/day × 3 days at 2 atmosphere absolute consecutively, starting at 1 day after initial mild traumatic brain injury (mTBI). Neuropathology was assessed by multi-modal magnetic resonance imaging (MRI) and tissue immunohistochemistry. After repetitive mTBI, there were increases in T2-weighted imaging-defined cortical lesions and susceptibility weighted imaging-defined cortical microhemorrhages, correlated with brain tissue gliosis at the site of impact. HBO treatment significantly decreased the MRI-identified abnormalities and tissue histopathology. Our findings suggest that HBO treatment improves the cumulative tissue damage in juvenile brain following rmTBI. Such therapy regimens could be considered in adolescent athletes at the risk of repeated concussions exposures. © 2016 Medical Gas Research | Published by Wolters Kluwer - Medknow.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Ellis, M J; Mutch, W A C; Ryner, L N; Graham, M R; Dufault, B; Gregson, B; Hall, T; Bunge, M; Essig, M; Fisher, J A; Duffin, J; Mikulis, D J
Brain magnetic resonance imaging CO2 stress testing in adolescent postconcussion syndrome Journal Article
In: Journal of Neurosurgery, vol. 125, no. 3, pp. 648–660, 2016.
@article{Ellis2016a,
title = {Brain magnetic resonance imaging CO2 stress testing in adolescent postconcussion syndrome},
author = {Ellis, M J and Mutch, W A C and Ryner, L N and Graham, M R and Dufault, B and Gregson, B and Hall, T and Bunge, M and Essig, M and Fisher, J A and Duffin, J and Mikulis, D J},
doi = {10.3171/2015.6.JNS15972},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurosurgery},
volume = {125},
number = {3},
pages = {648--660},
abstract = {OBJECTIVE: A Neuroimaging Assessment tool to visualize global and regional impairments in cerebral blood flow (CBF) and cerebrovascular responsiveness in individual patients with concussion remains elusive. Here the authors summarize the safety, feasibility, and results of brain CO2 stress testing in adolescents with postconcussion syndrome (PCS) and healthy controls. METHODS: This study was approved by the Biomedical Research Ethics Board at the University of Manitoba. Fifteen adolescents with PCS and 17 healthy control subjects underwent anatomical MRI, pseudo-continuous arterial spin labeling MRI, and brain stress testing using controlled CO2 challenge and blood oxygen level-dependent (BOLD) MRI. Post hoc processing was performed using statistical parametric mapping to determine voxel-by-voxel regional resting CBF and cerebrovascular responsiveness of the brain to the CO2 stimulus (increase in BOLD signal) or the inverse (decrease in BOLD signal). Receiver operating characteristic (ROC) curves were generated to compare voxel counts categorized by control (0) or PCS (1). RESULTS: Studies were well tolerated without any serious adverse events. Anatomical MRI was normal in all study participants. No differences in CO2 stimuli were seen between the 2 participant groups. No group differences in global mean CBF were detected between PCS patients and healthy controls. Patient-specific differences in mean regional CBF and CO2 BOLD responsiveness were observed in all PCS patients. The ROC curve analysis for brain regions manifesting a voxel response greater than and less than the control atlas (that is, abnormal voxel counts) produced an area under the curve of 0.87 (p \< 0.0001) and 0.80 (p = 0.0003), respectively, consistent with a clinically useful predictive model. CONCLUSIONS: Adolescent PCS is associated with patient-specific abnormalities in regional mean CBF and BOLD cerebrovascular responsiveness that occur in the setting of normal global resting CBF. Future prospective studies are warranted to examine the utility of brain MRI CO2 stress testing in the longitudinal assessment of acute sports-related concussion and PCS. © AANS, 2016.},
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}
}
Stewart, W; McNamara, P H; Lawlor, B; Hutchinson, S; Farrell, M
Chronic traumatic encephalopathy: a potential late and under recognized consequence of rugby union? Journal Article
In: Qjm, vol. 109, no. 1, pp. 11–15, 2016.
@article{Stewart2016,
title = {Chronic traumatic encephalopathy: a potential late and under recognized consequence of rugby union?},
author = {Stewart, W and McNamara, P H and Lawlor, B and Hutchinson, S and Farrell, M},
year = {2016},
date = {2016-01-01},
journal = {Qjm},
volume = {109},
number = {1},
pages = {11--15},
abstract = {The association between exposure to head injury and increased risk of neurodegenerative disease, specifically chronic traumatic encephalopathy (CTE), is widely recognized. Historically, this was largely considered a phenomenon restricted to boxers, with more recent case series identifying further 'high risk' individuals, such as former American footballers, or military personnel. However, in all cases thus far reported, it is clear that it is the exposure to head injury which is associated with increased dementia risk, and not the circumstances or environment of exposure. As such, there is considerable potential for under-recognition of CTE in patients presenting with neurodegenerative disease, particularly where head injury exposure might have been historical and through sport. This article reviews current understanding of CTE and, via an illustrative case in rugby union, highlights the value of a detailed history on head injury and also draws attention to imaging studies in assessing patients with neurodegenerative disease. Copyright © The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.},
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}
}
Ellis, M J; Leiter, J; Hall, T; McDonald, P J; Sawyer, S; Silver, N; Bunge, M; Essig, M
Neuroimaging findings in pediatric sports-related concussion Journal Article
In: Journal of Neurosurgery. Pediatrics., vol. 16, no. 3, pp. 241–247, 2015.
@article{Ellis2015b,
title = {Neuroimaging findings in pediatric sports-related concussion},
author = {Ellis, M J and Leiter, J and Hall, T and McDonald, P J and Sawyer, S and Silver, N and Bunge, M and Essig, M},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neurosurgery. Pediatrics.},
volume = {16},
number = {3},
pages = {241--247},
abstract = {OBJECT: The goal in this review was to summarize the results of clinical neuroimaging studies performed in patients with sports-related concussion (SRC) who were referred to a multidisciplinar ypediatric concussion program. METHODS: The authors conducted a retrospective review of medical records and neuroimaging findings for all patients referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Inclusion criteria were as follows: 1) age \< 19 years; and 2) physician-diagnosed SRC. All patients underwent evaluation and follow-up by the same neurosurgeon. The 2 outcomes examined in this review were the frequency of neuroimaging studies performed in this population (including CT and MRI) and the findings of those studies. Clinical indications for neuroimaging and the impact of neuroimaging findings on clinical decision making were summarized where available. This investigation was approved by the local institutional ethics review board. RESULTS: A total of 151 patients (mean age 14 years, 59% female) were included this study. Overall, 36 patients (24%) underwent neuroimaging studies, the results of which were normal in 78% of cases. Sixteen percent of patients underwent CT imaging; results were normal in 79% of cases. Abnormal CT findings included the following: arachnoid cyst (1 patient), skull fracture (2 patients), suspected intracranial hemorrhage (1 patient), and suspected hemorrhage into an arachnoid cyst (1 patient). Eleven percent of patients underwent MRI; results were normal in 75% of cases. Abnormal MRI findings included the following: intraparenchymal hemorrhage and sylvian fissure arachnoid cyst (1 patient); nonhemorrhagic contusion (1 patient); demyelinating disease (1 patient); and posterior fossa arachnoid cyst, cerebellar volume loss, and nonspecific white matter changes (1 patient). CONCLUSIONS: Results of clinical neuroimaging studies are normal in the majority of pediatric patients with SRC. However, in selected cases neuroimaging can provide information that impacts decision making about return to play and retirement from the sport.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Walter, K D; Halstead, M E
Concussion in Teenage Athletes Journal Article
In: Adolescent Medicine, vol. 26, no. 1, pp. 39–52, 2015.
@article{Walter2015,
title = {Concussion in Teenage Athletes},
author = {Walter, K D and Halstead, M E},
year = {2015},
date = {2015-01-01},
journal = {Adolescent Medicine},
volume = {26},
number = {1},
pages = {39--52},
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}
}
Mayer, A R; Ling, J M; Dodd, A B; Gasparovic, C; Klimaj, S D; Meier, T B
A Longitudinal Assessment of Structural and Chemical Alterations in Mixed Martial Arts Fighters Journal Article
In: Journal of Neurotrauma, vol. 32, no. 22, pp. 1759–1767, 2015.
@article{Mayer2015b,
title = {A Longitudinal Assessment of Structural and Chemical Alterations in Mixed Martial Arts Fighters},
author = {Mayer, A R and Ling, J M and Dodd, A B and Gasparovic, C and Klimaj, S D and Meier, T B},
doi = {10.1089/neu.2014.3833},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neurotrauma},
volume = {32},
number = {22},
pages = {1759--1767},
abstract = {Growing evidence suggests that temporally proximal acute concussions and repetitive subconcussive head injuries may lead to long-term neurological deficits. However, the underlying mechanisms of injury and their relative time-scales are not well documented in human injury models. The current study therefore investigated whether biomarkers of brain chemistry (magnetic resonance [MR] spectroscopy: N-acetylaspartate [NAA], combined glutamate and glutamine [Glx], total creatine [Cre], choline compounds [Cho], and myo-inositol [mI]) and structure (cortical thickness, white matter [WM]/subcortical volume) differed between mixed martial artists (MMA; n = 13) and matched healthy controls (HC) without a history of contact sport participation (HC; n = 14). A subset of participants (MMA = 9; HC = 10) returned for follow-up visits, with MMA (n = 3) with clinician-documented acute concussions also scanned serially. As expected, MMA self-reported a higher incidence of previous concussions and significantly more cognitive symptoms during prior concussion recovery. Fighters also exhibited reduced memory and processing speed relative to controls on neuropsychological testing coupled with cortical thinning in the left posterior cingulate gyrus and right occipital cortex at baseline assessment. Over a 1-year follow-up period, MMA experienced a significant decrease in both WM volume and NAA concentration, as well as relative thinning in the left middle and superior frontal gyri. These longitudinal changes did not correlate with self-reported metrics of injury (i.e., fight diary). In contrast, HC did not exhibit significant longitudinal changes over a 4-month follow-up period (p \> 0.05). Collectively, current results provide preliminary evidence of progressive changes in brain chemistry and structure over a relatively short time period in individuals with high exposure to repetitive head hits. These findings require replication in independent samples. © Mary Ann Liebert, Inc. 2015.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Meehan, W P; Jordaan, M; Prabhu, S P; Carew, L; Mannix, R C; Proctor, M R
Risk of athletes with chiari malformations suffering catastrophic injuries during sports participation is low Journal Article
In: Clinical Journal of Sport Medicine, vol. 25, no. 2, pp. 133–137, 2015.
@article{Meehan2015,
title = {Risk of athletes with chiari malformations suffering catastrophic injuries during sports participation is low},
author = {Meehan, W P and Jordaan, M and Prabhu, S P and Carew, L and Mannix, R C and Proctor, M R},
doi = {10.1097/JSM.0000000000000107},
year = {2015},
date = {2015-01-01},
journal = {Clinical Journal of Sport Medicine},
volume = {25},
number = {2},
pages = {133--137},
abstract = {Objective: To estimate the risk of athletes with Chiari malformations sustaining a catastrophic injury. Design: Retrospective, descriptive cohort study. Participants: All patients diagnosed with Chiari malformation at our institution between June 2008 and November 2011. Assessment of Risk Factors: Participants were mailed a questionnaire regarding the number of seasons they participated in organized athletics. Magnetic resonance images were reviewed to describe the characteristics of respondent's Chiari malformations. Main Outcome Measures: Whether or not the patient had sustained an injury resulting in death, coma, or paralysis. Results: We had a 53% (N = 147) response rate. Respondents were of a mean age of 15 years (SD, 2 years) at the time of diagnosis. The mean length of protrusion of the cerebellar tonsils below the foramen magnum was 11.2 mm (SD, 5.7 mm). Most of the respondents had pointed cerebellar tonsils and some degree of crowding within the foramen magnum. During a total of 1627 athletic seasons played by patients with Chiari malformation, 0 respondents [95% confidence interval (CI), 0.0000-0.0023] sustained an injury resulting in death, coma, or paralysis. Likewise, during 191 collision sport athletic seasons, 0 (95% CI, 0.0000-0.0191) respondents sustained an injury resulting in death, coma, or paralysis. Conclusions: The risk of athletes with Chiari malformations suffering catastrophic injuries during sports participation is low. This estimate of risk should be considered when making return-toplay decisions. Given the variability of anatomical consideration for patients with Chiari malformations, however, each return-to-play decision must continue to be made on a case-by-case basis, considering all of the available information. Clinical Relevance: The low risk of athletes with Chiari malformations suffering catastrophic injuries in sports should be considered when making return-to-play decisions. © 2014 Wolters Kluwer Health, Inc. All rights reserved.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Czerniak, S M; Sikoglu, E M; Liso Navarro, A A; McCafferty, J; Eisenstock, J; Stevenson, J H; King, J A; Moore, C M
A resting state functional magnetic resonance imaging study of concussion in collegiate athletes.[Erratum appears in Brain Imaging Behav. 2015 Sep;9(3):650; PMID: 25326270] Journal Article
In: Brain Imaging & Behavior, vol. 9, no. 2, pp. 323–332, 2015.
@article{Czerniak2015b,
title = {A resting state functional magnetic resonance imaging study of concussion in collegiate athletes.[Erratum appears in Brain Imaging Behav. 2015 Sep;9(3):650; PMID: 25326270]},
author = {Czerniak, S M and Sikoglu, E M and {Liso Navarro}, A A and McCafferty, J and Eisenstock, J and Stevenson, J H and King, J A and Moore, C M},
year = {2015},
date = {2015-01-01},
journal = {Brain Imaging \& Behavior},
volume = {9},
number = {2},
pages = {323--332},
abstract = {Sports-related concussions are currently diagnosed through multi-domain assessment by a medical professional and may utilize neurocognitive testing as an aid. However, these tests have only been able to detect differences in the days to week post-concussion. Here, we investigate a measure of brain function, namely resting state functional connectivity, which may detect residual brain differences in the weeks to months after concussion. Twenty-one student athletes (9 concussed within 6 months of enrollment; 12 non-concussed; between ages 18 and 22 years) were recruited for this study. All participants completed the Wisconsin Card Sorting Task and the Color-Word Interference Test. Neuroimaging data, specifically resting state functional Magnetic Resonance Imaging data, were acquired to examine resting state functional connectivity. Two sample t-tests were used to compare the neurocognitive scores and resting state functional connectivity patterns among concussed and non-concussed participants. Correlations between neurocognitive scores and resting state functional connectivity measures were also determined across all subjects. There were no significant differences in neurocognitive performance between concussed and non-concussed groups. Concussed subjects had significantly increased connections between areas of the brain that underlie executive function. Across all subjects, better neurocognitive performance corresponded to stronger brain connectivity. Even at rest, brains of concussed athletes may have to 'work harder' than their healthy peers to achieve similar neurocognitive results. Resting state brain connectivity may be able to detect prolonged brain differences in concussed athletes in a more quantitative manner than neurocognitive test scores.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Kochanek, Patrick M; Bell, Michael J
Making an IMPACT in traumatic brain injury research Journal Article
In: The Lancet Neurology, vol. 12, no. 12, pp. 1132–1133, 2013, ISBN: 1474-4422.
@article{Kochanek2013,
title = {Making an IMPACT in traumatic brain injury research},
author = {Kochanek, Patrick M and Bell, Michael J},
doi = {10.1016/S1474-4422(13)70245-X},
isbn = {1474-4422},
year = {2013},
date = {2013-01-01},
journal = {The Lancet Neurology},
volume = {12},
number = {12},
pages = {1132--1133},
publisher = {Elsevier Science},
address = {Netherlands},
abstract = {Comments on an article by Maas et al. (see record [rid]2013-40314-020[/rid]). Maas and colleagues review key developments related to 10 years of work by an international group of investigators, the International Mission on Prognosis and Analysis of randomized Controlled Trials in TBI (IMPACT). The investigators identify essential elements for improved clinical trials in TBI, along with a roadmap for future investigations. They suggest that the key elements that have been lacking in clinical trial design for TBI include standardization of data collection (common data elements), accurate quantification of initial prognostic risk, and study designs that appropriately deal with the substantial heterogeneity of the disease. The newly recognised importance of TBI, including the evolution into viewing even mild TBI or concussion as a serious illness rather than regarding it as a so-called badge of honor to be ignored by sports participants, along with the recent major surge in funding of TBI research across the full range of illness by both traditional and new sources, such as the US Army and the National Football League, among others, is leading to a golden age of TBI research with the potential to produce significant breakthroughs. (PsycINFO Database Record (c) 2016 APA, all rights reserved)},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Huang, L; Obenaus, A; Hamer, M; Zhang, J
Neuroprotective effect of hyperbaric oxygen therapy in a juvenile rat model of repetitive mild traumatic brain injury Journal Article
In: Medical Gas Research, vol. 6, no. 4, pp. 187–193, 2016.
Abstract | Links | BibTeX | Tags: Adolescent, Concussion, diffusion weighted imaging, gliosis, Magnetic Resonance Imaging, rat, susceptibility weighted imaging, T2-weighted imaging
@article{Huang2016a,
title = {Neuroprotective effect of hyperbaric oxygen therapy in a juvenile rat model of repetitive mild traumatic brain injury},
author = {Huang, L and Obenaus, A and Hamer, M and Zhang, J},
doi = {10.4103/2045-9912.196900},
year = {2016},
date = {2016-01-01},
journal = {Medical Gas Research},
volume = {6},
number = {4},
pages = {187--193},
abstract = {Repetitive mild traumatic brain injury (rmTBI) is an important medical concern for adolescent athletes that can lead to long-term disabilities. Multiple mild injuries may exacerbate tissue damage resulting in cumulative brain injury and poor functional recovery. In the present study, we investigated the increased brain vulnerability to rmTBI and the effect of hyperbaric oxygen treatment using a juvenile rat model of rmTBI. Two episodes of mild cortical controlled impact (3 days apart) were induced in juvenile rats. Hyperbaric oxygen (HBO) was applied 1 hour/day × 3 days at 2 atmosphere absolute consecutively, starting at 1 day after initial mild traumatic brain injury (mTBI). Neuropathology was assessed by multi-modal magnetic resonance imaging (MRI) and tissue immunohistochemistry. After repetitive mTBI, there were increases in T2-weighted imaging-defined cortical lesions and susceptibility weighted imaging-defined cortical microhemorrhages, correlated with brain tissue gliosis at the site of impact. HBO treatment significantly decreased the MRI-identified abnormalities and tissue histopathology. Our findings suggest that HBO treatment improves the cumulative tissue damage in juvenile brain following rmTBI. Such therapy regimens could be considered in adolescent athletes at the risk of repeated concussions exposures. © 2016 Medical Gas Research | Published by Wolters Kluwer - Medknow.},
keywords = {Adolescent, Concussion, diffusion weighted imaging, gliosis, Magnetic Resonance Imaging, rat, susceptibility weighted imaging, T2-weighted imaging},
pubstate = {published},
tppubtype = {article}
}
Ellis, M J; Mutch, W A C; Ryner, L N; Graham, M R; Dufault, B; Gregson, B; Hall, T; Bunge, M; Essig, M; Fisher, J A; Duffin, J; Mikulis, D J
Brain magnetic resonance imaging CO2 stress testing in adolescent postconcussion syndrome Journal Article
In: Journal of Neurosurgery, vol. 125, no. 3, pp. 648–660, 2016.
Abstract | Links | BibTeX | Tags: Adolescent, Blood oxygen level-dependent imaging, Magnetic Resonance Imaging, postconcussion syndrome, Sports-related concussion, Trauma
@article{Ellis2016a,
title = {Brain magnetic resonance imaging CO2 stress testing in adolescent postconcussion syndrome},
author = {Ellis, M J and Mutch, W A C and Ryner, L N and Graham, M R and Dufault, B and Gregson, B and Hall, T and Bunge, M and Essig, M and Fisher, J A and Duffin, J and Mikulis, D J},
doi = {10.3171/2015.6.JNS15972},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurosurgery},
volume = {125},
number = {3},
pages = {648--660},
abstract = {OBJECTIVE: A Neuroimaging Assessment tool to visualize global and regional impairments in cerebral blood flow (CBF) and cerebrovascular responsiveness in individual patients with concussion remains elusive. Here the authors summarize the safety, feasibility, and results of brain CO2 stress testing in adolescents with postconcussion syndrome (PCS) and healthy controls. METHODS: This study was approved by the Biomedical Research Ethics Board at the University of Manitoba. Fifteen adolescents with PCS and 17 healthy control subjects underwent anatomical MRI, pseudo-continuous arterial spin labeling MRI, and brain stress testing using controlled CO2 challenge and blood oxygen level-dependent (BOLD) MRI. Post hoc processing was performed using statistical parametric mapping to determine voxel-by-voxel regional resting CBF and cerebrovascular responsiveness of the brain to the CO2 stimulus (increase in BOLD signal) or the inverse (decrease in BOLD signal). Receiver operating characteristic (ROC) curves were generated to compare voxel counts categorized by control (0) or PCS (1). RESULTS: Studies were well tolerated without any serious adverse events. Anatomical MRI was normal in all study participants. No differences in CO2 stimuli were seen between the 2 participant groups. No group differences in global mean CBF were detected between PCS patients and healthy controls. Patient-specific differences in mean regional CBF and CO2 BOLD responsiveness were observed in all PCS patients. The ROC curve analysis for brain regions manifesting a voxel response greater than and less than the control atlas (that is, abnormal voxel counts) produced an area under the curve of 0.87 (p \< 0.0001) and 0.80 (p = 0.0003), respectively, consistent with a clinically useful predictive model. CONCLUSIONS: Adolescent PCS is associated with patient-specific abnormalities in regional mean CBF and BOLD cerebrovascular responsiveness that occur in the setting of normal global resting CBF. Future prospective studies are warranted to examine the utility of brain MRI CO2 stress testing in the longitudinal assessment of acute sports-related concussion and PCS. © AANS, 2016.},
keywords = {Adolescent, Blood oxygen level-dependent imaging, Magnetic Resonance Imaging, postconcussion syndrome, Sports-related concussion, Trauma},
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}
}
Stewart, W; McNamara, P H; Lawlor, B; Hutchinson, S; Farrell, M
Chronic traumatic encephalopathy: a potential late and under recognized consequence of rugby union? Journal Article
In: Qjm, vol. 109, no. 1, pp. 11–15, 2016.
Abstract | BibTeX | Tags: *Brain Concussion/co [Complications], *Brain Injury, *Brain/pp [Physiopathology], *Football/in [Injuries], *Neurodegenerative Diseases/pp [Physiopathology], Chronic/pa [Pathology], Humans, Magnetic Resonance Imaging, Male, middle aged, neurologic examination
@article{Stewart2016,
title = {Chronic traumatic encephalopathy: a potential late and under recognized consequence of rugby union?},
author = {Stewart, W and McNamara, P H and Lawlor, B and Hutchinson, S and Farrell, M},
year = {2016},
date = {2016-01-01},
journal = {Qjm},
volume = {109},
number = {1},
pages = {11--15},
abstract = {The association between exposure to head injury and increased risk of neurodegenerative disease, specifically chronic traumatic encephalopathy (CTE), is widely recognized. Historically, this was largely considered a phenomenon restricted to boxers, with more recent case series identifying further 'high risk' individuals, such as former American footballers, or military personnel. However, in all cases thus far reported, it is clear that it is the exposure to head injury which is associated with increased dementia risk, and not the circumstances or environment of exposure. As such, there is considerable potential for under-recognition of CTE in patients presenting with neurodegenerative disease, particularly where head injury exposure might have been historical and through sport. This article reviews current understanding of CTE and, via an illustrative case in rugby union, highlights the value of a detailed history on head injury and also draws attention to imaging studies in assessing patients with neurodegenerative disease. Copyright © The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.},
keywords = {*Brain Concussion/co [Complications], *Brain Injury, *Brain/pp [Physiopathology], *Football/in [Injuries], *Neurodegenerative Diseases/pp [Physiopathology], Chronic/pa [Pathology], Humans, Magnetic Resonance Imaging, Male, middle aged, neurologic examination},
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}
}
Ellis, M J; Leiter, J; Hall, T; McDonald, P J; Sawyer, S; Silver, N; Bunge, M; Essig, M
Neuroimaging findings in pediatric sports-related concussion Journal Article
In: Journal of Neurosurgery. Pediatrics., vol. 16, no. 3, pp. 241–247, 2015.
Abstract | BibTeX | Tags: *Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Brain Concussion/et [Etiology], *Neuroimaging, Adolescent, Arachnoid Cysts/di [Diagnosis], Athletic Injuries/co [Complications], Athletic Injuries/pa [Pathology], Brain Concussion/pa [Pathology], Brain Injuries/di [Diagnosis], Brain Injuries/et [Etiology], Child, Contusions/di [Diagnosis], Dizziness/et [Etiology], Female, Follow-Up Studies, Headache/et [Etiology], Humans, Intracranial Hemorrhages/di [Diagnosis], Magnetic Resonance Imaging, Male, Neuroimaging/mt [Methods], postural balance, Predictive Value of Tests, Retrospective Studies, Skull Fractures/di [Diagnosis], Tomography, Unconsciousness/et [Etiology], X-Ray Computed
@article{Ellis2015b,
title = {Neuroimaging findings in pediatric sports-related concussion},
author = {Ellis, M J and Leiter, J and Hall, T and McDonald, P J and Sawyer, S and Silver, N and Bunge, M and Essig, M},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neurosurgery. Pediatrics.},
volume = {16},
number = {3},
pages = {241--247},
abstract = {OBJECT: The goal in this review was to summarize the results of clinical neuroimaging studies performed in patients with sports-related concussion (SRC) who were referred to a multidisciplinar ypediatric concussion program. METHODS: The authors conducted a retrospective review of medical records and neuroimaging findings for all patients referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Inclusion criteria were as follows: 1) age \< 19 years; and 2) physician-diagnosed SRC. All patients underwent evaluation and follow-up by the same neurosurgeon. The 2 outcomes examined in this review were the frequency of neuroimaging studies performed in this population (including CT and MRI) and the findings of those studies. Clinical indications for neuroimaging and the impact of neuroimaging findings on clinical decision making were summarized where available. This investigation was approved by the local institutional ethics review board. RESULTS: A total of 151 patients (mean age 14 years, 59% female) were included this study. Overall, 36 patients (24%) underwent neuroimaging studies, the results of which were normal in 78% of cases. Sixteen percent of patients underwent CT imaging; results were normal in 79% of cases. Abnormal CT findings included the following: arachnoid cyst (1 patient), skull fracture (2 patients), suspected intracranial hemorrhage (1 patient), and suspected hemorrhage into an arachnoid cyst (1 patient). Eleven percent of patients underwent MRI; results were normal in 75% of cases. Abnormal MRI findings included the following: intraparenchymal hemorrhage and sylvian fissure arachnoid cyst (1 patient); nonhemorrhagic contusion (1 patient); demyelinating disease (1 patient); and posterior fossa arachnoid cyst, cerebellar volume loss, and nonspecific white matter changes (1 patient). CONCLUSIONS: Results of clinical neuroimaging studies are normal in the majority of pediatric patients with SRC. However, in selected cases neuroimaging can provide information that impacts decision making about return to play and retirement from the sport.},
keywords = {*Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Brain Concussion/et [Etiology], *Neuroimaging, Adolescent, Arachnoid Cysts/di [Diagnosis], Athletic Injuries/co [Complications], Athletic Injuries/pa [Pathology], Brain Concussion/pa [Pathology], Brain Injuries/di [Diagnosis], Brain Injuries/et [Etiology], Child, Contusions/di [Diagnosis], Dizziness/et [Etiology], Female, Follow-Up Studies, Headache/et [Etiology], Humans, Intracranial Hemorrhages/di [Diagnosis], Magnetic Resonance Imaging, Male, Neuroimaging/mt [Methods], postural balance, Predictive Value of Tests, Retrospective Studies, Skull Fractures/di [Diagnosis], Tomography, Unconsciousness/et [Etiology], X-Ray Computed},
pubstate = {published},
tppubtype = {article}
}
Walter, K D; Halstead, M E
Concussion in Teenage Athletes Journal Article
In: Adolescent Medicine, vol. 26, no. 1, pp. 39–52, 2015.
BibTeX | Tags: *Athletes, *Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], Adolescent, Athletic Injuries/ep [Epidemiology], Athletic Injuries/pc [Prevention & Control], Brain Concussion/ep [Epidemiology], Brain Concussion/pc [Prevention & Control], Humans, Magnetic Resonance Imaging, Neurocognitive Disorders/di [Diagnosis], Tomography, X-Ray Computed
@article{Walter2015,
title = {Concussion in Teenage Athletes},
author = {Walter, K D and Halstead, M E},
year = {2015},
date = {2015-01-01},
journal = {Adolescent Medicine},
volume = {26},
number = {1},
pages = {39--52},
keywords = {*Athletes, *Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], Adolescent, Athletic Injuries/ep [Epidemiology], Athletic Injuries/pc [Prevention \& Control], Brain Concussion/ep [Epidemiology], Brain Concussion/pc [Prevention \& Control], Humans, Magnetic Resonance Imaging, Neurocognitive Disorders/di [Diagnosis], Tomography, 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}
}
Mayer, A R; Ling, J M; Dodd, A B; Gasparovic, C; Klimaj, S D; Meier, T B
A Longitudinal Assessment of Structural and Chemical Alterations in Mixed Martial Arts Fighters Journal Article
In: Journal of Neurotrauma, vol. 32, no. 22, pp. 1759–1767, 2015.
Abstract | Links | BibTeX | Tags: Adolescent, adult, Article, biological marker, Biomarkers, BRAIN chemistry, brain concussion, brain cortex, brain size, Cerebral Cortex, CHOLINE, clinical article, cognition, Concussion, controlled study, cortical thickness (brain), creatine, executive function, Female, follow up, Follow-Up Studies, frontal gyrus, glutamic acid, glutamine, human, Humans, Injuries, inositol, Longitudinal, Longitudinal studies, longitudinal study, Magnetic Resonance Imaging, Male, martial art, Martial Arts, Memory, middle aged, mixed martial art, n acetylaspartic acid, neuropsychological test, Neuropsychological Tests, nuclear magnetic resonance imaging, NUCLEAR magnetic resonance spectroscopy, occipital cortex, pathology, posterior cingulate, psychology, repetitive injury, Spectroscopy, volumetrics, white matter, Young Adult
@article{Mayer2015b,
title = {A Longitudinal Assessment of Structural and Chemical Alterations in Mixed Martial Arts Fighters},
author = {Mayer, A R and Ling, J M and Dodd, A B and Gasparovic, C and Klimaj, S D and Meier, T B},
doi = {10.1089/neu.2014.3833},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neurotrauma},
volume = {32},
number = {22},
pages = {1759--1767},
abstract = {Growing evidence suggests that temporally proximal acute concussions and repetitive subconcussive head injuries may lead to long-term neurological deficits. However, the underlying mechanisms of injury and their relative time-scales are not well documented in human injury models. The current study therefore investigated whether biomarkers of brain chemistry (magnetic resonance [MR] spectroscopy: N-acetylaspartate [NAA], combined glutamate and glutamine [Glx], total creatine [Cre], choline compounds [Cho], and myo-inositol [mI]) and structure (cortical thickness, white matter [WM]/subcortical volume) differed between mixed martial artists (MMA; n = 13) and matched healthy controls (HC) without a history of contact sport participation (HC; n = 14). A subset of participants (MMA = 9; HC = 10) returned for follow-up visits, with MMA (n = 3) with clinician-documented acute concussions also scanned serially. As expected, MMA self-reported a higher incidence of previous concussions and significantly more cognitive symptoms during prior concussion recovery. Fighters also exhibited reduced memory and processing speed relative to controls on neuropsychological testing coupled with cortical thinning in the left posterior cingulate gyrus and right occipital cortex at baseline assessment. Over a 1-year follow-up period, MMA experienced a significant decrease in both WM volume and NAA concentration, as well as relative thinning in the left middle and superior frontal gyri. These longitudinal changes did not correlate with self-reported metrics of injury (i.e., fight diary). In contrast, HC did not exhibit significant longitudinal changes over a 4-month follow-up period (p \> 0.05). Collectively, current results provide preliminary evidence of progressive changes in brain chemistry and structure over a relatively short time period in individuals with high exposure to repetitive head hits. These findings require replication in independent samples. © Mary Ann Liebert, Inc. 2015.},
keywords = {Adolescent, adult, Article, biological marker, Biomarkers, BRAIN chemistry, brain concussion, brain cortex, brain size, Cerebral Cortex, CHOLINE, clinical article, cognition, Concussion, controlled study, cortical thickness (brain), creatine, executive function, Female, follow up, Follow-Up Studies, frontal gyrus, glutamic acid, glutamine, human, Humans, Injuries, inositol, Longitudinal, Longitudinal studies, longitudinal study, Magnetic Resonance Imaging, Male, martial art, Martial Arts, Memory, middle aged, mixed martial art, n acetylaspartic acid, neuropsychological test, Neuropsychological Tests, nuclear magnetic resonance imaging, NUCLEAR magnetic resonance spectroscopy, occipital cortex, pathology, posterior cingulate, psychology, repetitive injury, Spectroscopy, volumetrics, white matter, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Meehan, W P; Jordaan, M; Prabhu, S P; Carew, L; Mannix, R C; Proctor, M R
Risk of athletes with chiari malformations suffering catastrophic injuries during sports participation is low Journal Article
In: Clinical Journal of Sport Medicine, vol. 25, no. 2, pp. 133–137, 2015.
Abstract | Links | BibTeX | Tags: Adolescent, adult, Arnold Chiari malformation, Arnold-Chiari Malformation, Article, athlete, Athletes, Athletic Injuries, BASKETBALL, Brain Injuries, cerebrospinal fluid, cerebrospinal fluid flow, Child, cohort analysis, Cohort Studies, coma, Concussion, Death, descriptive research, digestive tract parameters, Female, football, foramen magnum, human, Humans, ice hockey, Magnetic Resonance Imaging, major clinical study, Male, MORTALITY, nuclear magnetic resonance imaging, paralysis, paresthesia, pathology, patient participation, priority journal, questionnaire, Retrospective Studies, retrospective study, RISK assessment, risk factor, Soccer, sport injury, Surveys and Questionnaires, terminal disease, Young Adult
@article{Meehan2015,
title = {Risk of athletes with chiari malformations suffering catastrophic injuries during sports participation is low},
author = {Meehan, W P and Jordaan, M and Prabhu, S P and Carew, L and Mannix, R C and Proctor, M R},
doi = {10.1097/JSM.0000000000000107},
year = {2015},
date = {2015-01-01},
journal = {Clinical Journal of Sport Medicine},
volume = {25},
number = {2},
pages = {133--137},
abstract = {Objective: To estimate the risk of athletes with Chiari malformations sustaining a catastrophic injury. Design: Retrospective, descriptive cohort study. Participants: All patients diagnosed with Chiari malformation at our institution between June 2008 and November 2011. Assessment of Risk Factors: Participants were mailed a questionnaire regarding the number of seasons they participated in organized athletics. Magnetic resonance images were reviewed to describe the characteristics of respondent's Chiari malformations. Main Outcome Measures: Whether or not the patient had sustained an injury resulting in death, coma, or paralysis. Results: We had a 53% (N = 147) response rate. Respondents were of a mean age of 15 years (SD, 2 years) at the time of diagnosis. The mean length of protrusion of the cerebellar tonsils below the foramen magnum was 11.2 mm (SD, 5.7 mm). Most of the respondents had pointed cerebellar tonsils and some degree of crowding within the foramen magnum. During a total of 1627 athletic seasons played by patients with Chiari malformation, 0 respondents [95% confidence interval (CI), 0.0000-0.0023] sustained an injury resulting in death, coma, or paralysis. Likewise, during 191 collision sport athletic seasons, 0 (95% CI, 0.0000-0.0191) respondents sustained an injury resulting in death, coma, or paralysis. Conclusions: The risk of athletes with Chiari malformations suffering catastrophic injuries during sports participation is low. This estimate of risk should be considered when making return-toplay decisions. Given the variability of anatomical consideration for patients with Chiari malformations, however, each return-to-play decision must continue to be made on a case-by-case basis, considering all of the available information. Clinical Relevance: The low risk of athletes with Chiari malformations suffering catastrophic injuries in sports should be considered when making return-to-play decisions. © 2014 Wolters Kluwer Health, Inc. All rights reserved.},
keywords = {Adolescent, adult, Arnold Chiari malformation, Arnold-Chiari Malformation, Article, athlete, Athletes, Athletic Injuries, BASKETBALL, Brain Injuries, cerebrospinal fluid, cerebrospinal fluid flow, Child, cohort analysis, Cohort Studies, coma, Concussion, Death, descriptive research, digestive tract parameters, Female, football, foramen magnum, human, Humans, ice hockey, Magnetic Resonance Imaging, major clinical study, Male, MORTALITY, nuclear magnetic resonance imaging, paralysis, paresthesia, pathology, patient participation, priority journal, questionnaire, Retrospective Studies, retrospective study, RISK assessment, risk factor, Soccer, sport injury, Surveys and Questionnaires, terminal disease, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Czerniak, S M; Sikoglu, E M; Liso Navarro, A A; McCafferty, J; Eisenstock, J; Stevenson, J H; King, J A; Moore, C M
A resting state functional magnetic resonance imaging study of concussion in collegiate athletes.[Erratum appears in Brain Imaging Behav. 2015 Sep;9(3):650; PMID: 25326270] Journal Article
In: Brain Imaging & Behavior, vol. 9, no. 2, pp. 323–332, 2015.
Abstract | BibTeX | Tags: *Athletic Injuries/pp [Physiopathology], *Brain Concussion/pp [Physiopathology], *Brain/pp [Physiopathology], Adolescent, Athletes, BRAIN mapping, Female, Humans, interview, Magnetic Resonance Imaging, Male, Neuropsychological Tests, Psychological, rest, Young Adult
@article{Czerniak2015b,
title = {A resting state functional magnetic resonance imaging study of concussion in collegiate athletes.[Erratum appears in Brain Imaging Behav. 2015 Sep;9(3):650; PMID: 25326270]},
author = {Czerniak, S M and Sikoglu, E M and {Liso Navarro}, A A and McCafferty, J and Eisenstock, J and Stevenson, J H and King, J A and Moore, C M},
year = {2015},
date = {2015-01-01},
journal = {Brain Imaging \& Behavior},
volume = {9},
number = {2},
pages = {323--332},
abstract = {Sports-related concussions are currently diagnosed through multi-domain assessment by a medical professional and may utilize neurocognitive testing as an aid. However, these tests have only been able to detect differences in the days to week post-concussion. Here, we investigate a measure of brain function, namely resting state functional connectivity, which may detect residual brain differences in the weeks to months after concussion. Twenty-one student athletes (9 concussed within 6 months of enrollment; 12 non-concussed; between ages 18 and 22 years) were recruited for this study. All participants completed the Wisconsin Card Sorting Task and the Color-Word Interference Test. Neuroimaging data, specifically resting state functional Magnetic Resonance Imaging data, were acquired to examine resting state functional connectivity. Two sample t-tests were used to compare the neurocognitive scores and resting state functional connectivity patterns among concussed and non-concussed participants. Correlations between neurocognitive scores and resting state functional connectivity measures were also determined across all subjects. There were no significant differences in neurocognitive performance between concussed and non-concussed groups. Concussed subjects had significantly increased connections between areas of the brain that underlie executive function. Across all subjects, better neurocognitive performance corresponded to stronger brain connectivity. Even at rest, brains of concussed athletes may have to 'work harder' than their healthy peers to achieve similar neurocognitive results. Resting state brain connectivity may be able to detect prolonged brain differences in concussed athletes in a more quantitative manner than neurocognitive test scores.},
keywords = {*Athletic Injuries/pp [Physiopathology], *Brain Concussion/pp [Physiopathology], *Brain/pp [Physiopathology], Adolescent, Athletes, BRAIN mapping, Female, Humans, interview, Magnetic Resonance Imaging, Male, Neuropsychological Tests, Psychological, rest, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Kochanek, Patrick M; Bell, Michael J
Making an IMPACT in traumatic brain injury research Journal Article
In: The Lancet Neurology, vol. 12, no. 12, pp. 1132–1133, 2013, ISBN: 1474-4422.
Abstract | Links | BibTeX | Tags: 2013, brain, clinical outcomes, Cognitive Impairment, Magnetic Resonance Imaging, MRI, neurology, Subtypes (Disorders), system dysfunction, topological organization, traumatic brain injury
@article{Kochanek2013,
title = {Making an IMPACT in traumatic brain injury research},
author = {Kochanek, Patrick M and Bell, Michael J},
doi = {10.1016/S1474-4422(13)70245-X},
isbn = {1474-4422},
year = {2013},
date = {2013-01-01},
journal = {The Lancet Neurology},
volume = {12},
number = {12},
pages = {1132--1133},
publisher = {Elsevier Science},
address = {Netherlands},
abstract = {Comments on an article by Maas et al. (see record [rid]2013-40314-020[/rid]). Maas and colleagues review key developments related to 10 years of work by an international group of investigators, the International Mission on Prognosis and Analysis of randomized Controlled Trials in TBI (IMPACT). The investigators identify essential elements for improved clinical trials in TBI, along with a roadmap for future investigations. They suggest that the key elements that have been lacking in clinical trial design for TBI include standardization of data collection (common data elements), accurate quantification of initial prognostic risk, and study designs that appropriately deal with the substantial heterogeneity of the disease. The newly recognised importance of TBI, including the evolution into viewing even mild TBI or concussion as a serious illness rather than regarding it as a so-called badge of honor to be ignored by sports participants, along with the recent major surge in funding of TBI research across the full range of illness by both traditional and new sources, such as the US Army and the National Football League, among others, is leading to a golden age of TBI research with the potential to produce significant breakthroughs. (PsycINFO Database Record (c) 2016 APA, all rights reserved)},
keywords = {2013, brain, clinical outcomes, Cognitive Impairment, Magnetic Resonance Imaging, MRI, neurology, Subtypes (Disorders), system dysfunction, topological organization, traumatic brain injury},
pubstate = {published},
tppubtype = {article}
}