Research Reports - Impaired neurovascular function contributes to persistent symptoms after concussion

J Neurotrauma. 2014 Jul 8

Bartnik-Olson BL(1), Holshouser B, Wang H, Grube M, Tong K, Wong V, Ashwal S

Abstract Research shows that approximately 14% of school age children with mild
traumatic brain injury (TBI) including sports-related concussions (SRCs) remain
symptomatic three months after injury. Advanced imaging studies early after
injury have shown evidence of axonal damage, reduced N-acetyl aspartate (NAA) and
impaired cerebral blood flow (CBF) in individuals with mild TBI. This study was
undertaken to determine whether these techniques can provide valuable information
in pediatric SRC patients with persistent post-concussive symptoms. Fifteen
pediatric subjects ages 8 to 17 years with persistent post-concussive symptoms
were evaluated using perfusion-weighted imaging (PWI), three-dimensional (3D)
magnetic resonance spectroscopic imaging, and diffusion tensor imaging (DTI)
three to 12 months post-SRC. Data were compared with 15 demographically similar
(age, gender, and body mass index) controls. In the bilateral thalami, SRC
patients showed reduced CBF (p=0.02 and p=0.02) and relative cerebral blood
volume (CBV; p=0.05 and p=0.03), compared with controls. NAA/creatine (Cr) and
NAA/choline (Cho) ratios were reduced in the corpus callosum (p=0.003; p=0.05)
and parietal white matter (p<0.001; p=0.006) of SRC subjects, compared with
controls. Significant differences in DTI metrics differentiated patients with
cognitive symptoms, compared with those without cognitive symptoms and controls.
Advanced imaging methods detect a spectrum of injury including impaired axonal
function, neuronal metabolism and perfusion, suggesting involvement of the
neurovascular unit in the presence of persistent symptoms in pediatric SRC
patients.

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