51
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Churchill NW, Caverzasi E, Graham SJ, Hutchison MG, Schweizer TA. White matter microstructure in athletes with a history of concussion: Comparing diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI). Hum Brain Mapp 2017; 38:4201-4211. [PMID: 28556431 DOI: 10.1002/hbm.23658] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 05/08/2017] [Accepted: 05/12/2017] [Indexed: 12/22/2022] Open
Abstract
Sport concussion is associated with disturbances in brain function in the absence of gross anatomical lesions, and may have long-term health consequences. Diffusion-weighted magnetic resonance imaging (MRI) methods provide a powerful tool for investigating alterations in white matter microstructure reflecting the long-term effects of concussion. In a previous study, diffusion tensor imaging (DTI) showed that athletes with a history of concussion had elevated fractional anisotropy (FA) and reduced mean diffusivity (MD) parameters. To better understand these effects, this study compared DTI results to neurite orientation dispersion and density imaging (NODDI), which was used to estimate the intracellular volume fraction (VIC ) and orientation dispersion index (ODI). Sixty-eight (68) varsity athletes were recruited, including 37 without a history of concussion and 31 with concussion >6 months prior to imaging. Univariate analyses showed elevated FA and decreased MD for concussed athletes, along with increased VIC and reduced ODI, indicating greater neurite density and coherence of neurite orientation within white matter. Multivariate analyses also showed that for athletes with a history of concussion, white matter regions with increased FA had increased VIC and decreased ODI, with greater effects among athletes who were imaged a longer time since their last concussion. These findings enhance our understanding of the relationship between the biophysics of water diffusion and concussion neurobiology for young, healthy adults. Hum Brain Mapp 38:4201-4211, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Nathan W Churchill
- Neuroscience Research Program, St. Michael's Hospital, Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science of St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Eduardo Caverzasi
- Department of Neurology, University of California, San Francisco, California.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Simon J Graham
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Michael G Hutchison
- Neuroscience Research Program, St. Michael's Hospital, Toronto, Ontario, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Tom A Schweizer
- Neuroscience Research Program, St. Michael's Hospital, Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science of St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
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52
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McCrea M, Meier T, Huber D, Ptito A, Bigler E, Debert CT, Manley G, Menon D, Chen JK, Wall R, Schneider KJ, McAllister T. Role of advanced neuroimaging, fluid biomarkers and genetic testing in the assessment of sport-related concussion: a systematic review. Br J Sports Med 2017; 51:919-929. [DOI: 10.1136/bjsports-2016-097447] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2017] [Indexed: 01/17/2023]
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53
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Shinoda J, Asano Y. Disorder of Executive Function of the Brain after Head Injury and Mild Traumatic Brain Injury - Neuroimaging and Diagnostic Criteria for Implementation of Administrative Support in Japan. Neurol Med Chir (Tokyo) 2017; 57:199-209. [PMID: 28381654 PMCID: PMC5447811 DOI: 10.2176/nmc.ra.2016-0293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The diagnotic criteria for disorder of the executive function of the brain (DEFB) as a syndrome of sequela were administratively established (ad-DEFB) in Japan in 2006 to support disabled patients whose impairment, limited to cognition (memory, attention, execution, and behavior), emerges after organic brain injuries regardless of physical deficits. However, some patients suffering from traumatic brain injury (TBI) have been excluded from receiving medico-social services. In particular, this tendency is more prominent in patients with mild TBI because no lesions are apparent on conventional computed tomography (CT) or magnetic resonance imaging (MRI) in the chronic phase. Recent development of new MRI neuroimaging modalities and positron emission tomography (PET) imaging makes it possible to detect regions of minute organic lesions and metabolic dysfunction in the brain where organic lesions may be absent or cannot be detected on conventional CT or MRI. In this review, we discuss diagnostic criteria for mild TBI and ad-DEFB, the relationship between the two disorders, characteristic neuroimaging [(MRI and 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET)] of diffuse brain injury including cerebral concussion, which is the principal cause of mild TBI, and suggested pathological mechanisms of ad-DEFB in DBI.
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Affiliation(s)
- Jun Shinoda
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital.,Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine
| | - Yoshitaka Asano
- Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital.,Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine
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54
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Asken BM, DeKosky ST, Clugston JR, Jaffee MS, Bauer RM. Diffusion tensor imaging (DTI) findings in adult civilian, military, and sport-related mild traumatic brain injury (mTBI): a systematic critical review. Brain Imaging Behav 2017; 12:585-612. [DOI: 10.1007/s11682-017-9708-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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55
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Slobounov SM, Walter A, Breiter HC, Zhu DC, Bai X, Bream T, Seidenberg P, Mao X, Johnson B, Talavage TM. The effect of repetitive subconcussive collisions on brain integrity in collegiate football players over a single football season: A multi-modal neuroimaging study. NEUROIMAGE-CLINICAL 2017; 14:708-718. [PMID: 28393012 PMCID: PMC5377433 DOI: 10.1016/j.nicl.2017.03.006] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/17/2017] [Accepted: 03/19/2017] [Indexed: 01/14/2023]
Abstract
The cumulative effect of repetitive subconcussive collisions on the structural and functional integrity of the brain remains largely unknown. Athletes in collision sports, like football, experience a large number of impacts across a single season of play. The majority of these impacts, however, are generally overlooked, and their long-term consequences remain poorly understood. This study sought to examine the effects of repetitive collisions across a single competitive season in NCAA Football Bowl Subdivision athletes using advanced neuroimaging approaches. Players were evaluated before and after the season using multiple MRI sequences, including T1-weighted imaging, diffusion tensor imaging (DTI), arterial spin labeling (ASL), resting-state functional MRI (rs-fMRI), and susceptibility weighted imaging (SWI). While no significant differences were found between pre- and post-season for DTI metrics or cortical volumes, seed-based analysis of rs-fMRI revealed significant (p < 0.05) changes in functional connections to right isthmus of the cingulate cortex (ICC), left ICC, and left hippocampus. ASL data revealed significant (p < 0.05) increases in global cerebral blood flow (CBF), with a specific regional increase in right postcentral gyrus. SWI data revealed that 44% of the players exhibited outlier rates (p < 0.05) of regional decreases in SWI signal. Of key interest, athletes in whom changes in rs-fMRI, CBF and SWI were observed were more likely to have experienced high G impacts on a daily basis. These findings are indicative of potential pathophysiological changes in brain integrity arising from only a single season of participation in the NCAA Football Bowl Subdivision, even in the absence of clinical symptoms or a diagnosis of concussion. Whether these changes reflect compensatory adaptation to cumulative head impacts or more lasting alteration of brain integrity remains to be further explored.
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Affiliation(s)
- Semyon M. Slobounov
- Concussion Neuroimaging Consortium, Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, United States
| | - Alexa Walter
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, United States
- Corresponding author: 25 Recreation Hall University Park, PA 16802, United States.25 Recreation Hall University ParkPA16802United States
| | - Hans C. Breiter
- Concussion Neuroimaging Consortium, Department of Psychiatry and Behavioral Sciences, Northwestern University, Evanston, IL 60208, United States
| | - David C. Zhu
- Concussion Neuroimaging Consortium, Department of Radiology and Psychology, Michigan State University, East Lansing, MI 48824, United States
| | - Xiaoxiao Bai
- Social, Life, and Engineering Sciences Imaging Center, The Pennsylvania State University, University Park, PA 16802, United States
| | - Tim Bream
- Athletic Department, The Pennsylvania State University, University Park, PA 16802, United States
| | - Peter Seidenberg
- Athletic Department, The Pennsylvania State University, University Park, PA 16802, United States
| | - Xianglun Mao
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, United States
| | - Brian Johnson
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, United States
| | - Thomas M. Talavage
- Concussion Neuroimaging Consortium, School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN 47907, United States
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56
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Ratiu I, Azuma T. Language control in bilingual adults with and without history of mild traumatic brain injury. BRAIN AND LANGUAGE 2017; 166:29-39. [PMID: 28039735 DOI: 10.1016/j.bandl.2016.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 11/10/2016] [Accepted: 12/12/2016] [Indexed: 06/06/2023]
Abstract
Adults with a history of traumatic brain injury often show deficits in executive functioning (EF), including the ability to inhibit, switch, and attend to tasks. These abilities are critical for language processing in bilinguals. This study examined the effect of mild traumatic brain injury (mTBI) on EF and language processing in bilinguals using behavioral and eye-tracking measures. Twenty-two bilinguals with a history of mTBI and twenty healthy control bilinguals were administered executive function and language processing tasks. Bilinguals with a history of mTBI showed deficits in specific EFs and had higher rates of language processing errors than healthy control bilinguals. Additionally, individuals with a history of mTBI have different patterns of eye movements during reading than healthy control bilinguals. These data suggest that language processing deficits are related to underlying EF abilities. The findings provide important information regarding specific EF and language control deficits in bilinguals with a history mTBI.
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Affiliation(s)
- Ileana Ratiu
- Arizona State University, United States; Midwestern University, United States.
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57
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Churchill NW, Hutchison MG, Richards D, Leung G, Graham SJ, Schweizer TA. The first week after concussion: Blood flow, brain function and white matter microstructure. NEUROIMAGE-CLINICAL 2017; 14:480-489. [PMID: 28280686 PMCID: PMC5334547 DOI: 10.1016/j.nicl.2017.02.015] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/25/2017] [Accepted: 02/18/2017] [Indexed: 01/22/2023]
Abstract
Concussion is a major health concern, associated with short-term deficits in physical function, emotion and cognition, along with negative long-term health outcomes. However, we remain in the early stages of characterizing MRI markers of concussion, particularly during the first week post-injury when symptoms are most severe. In this study, 52 varsity athletes were scanned using Magnetic Resonance Imaging (MRI), including 26 athletes with acute concussion (scanned 1–7 days post-injury) and 26 matched control athletes. A comprehensive set of functional and structural MRI measures were analyzed, including cerebral blood flow (CBF) and global functional connectivity (Gconn) of grey matter, along with fractional anisotropy (FA) and mean diffusivity (MD) of white matter. An analysis comparing acutely concussed athletes and controls showed limited evidence for reliable mean effects of acute concussion, with only MD showing spatially extensive differences between groups. We subsequently demonstrated that the number of days post-injury explained a significant proportion of inter-subject variability in MRI markers of acutely concussed athletes. Athletes scanned at early acute injury (1–3 days) had elevated CBF and Gconn and reduced FA, but those scanned at late acute injury (5–7 days) had the opposite response. In contrast, MD showed a more complex, spatially-dependent relationship with days post-injury. These novel findings highlight the variability of MRI markers during the acute phase of concussion and the critical importance of considering the acute injury time interval, which has significant implications for studies relating acute MRI data to concussion outcomes. First study of acute concussion using fMRI, DTI and ASL in a single cohort Lack of reliable mean effects of concussion, indicating variability of acute injury Number of days post-injury is a significant predictor of acute brain variability.
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Affiliation(s)
- Nathan W Churchill
- The Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON M5B 1M8, Canada
| | - Michael G Hutchison
- The Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON M5B 1M8, Canada; Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON M5S 2W6, Canada
| | - Doug Richards
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON M5S 2W6, Canada
| | - General Leung
- The Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON M5B 1M8, Canada; Department of Medical Imaging, University of Toronto, Keenan Research Centre of the Li Ka Shing Knowledge Institute at St. Michael's Hospital, 209 Victoria Street, Toronto, ON M5B 1M8, Canada
| | - Simon J Graham
- Department of Medical Biophysics, University of Toronto, Sunnybrook Hospital, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada; Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Tom A Schweizer
- The Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON M5B 1M8, Canada; Faculty of Medicine (Neurosurgery), University of Toronto, Toronto, Ontario, Canada; Institute of Biomaterals and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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58
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Churchill N, Hutchison M, Richards D, Leung G, Graham S, Schweizer TA. Brain Structure and Function Associated with a History of Sport Concussion: A Multi-Modal Magnetic Resonance Imaging Study. J Neurotrauma 2017; 34:765-771. [DOI: 10.1089/neu.2016.4531] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Nathan Churchill
- Keenan Research Centre of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michael Hutchison
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Doug Richards
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - General Leung
- Keenan Research Centre of St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Simon Graham
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Tom A. Schweizer
- Keenan Research Centre of St. Michael's Hospital, Toronto, Ontario, Canada
- Faculty of Medicine (Neurosurgery), University of Toronto, Toronto, Ontario, Canada
- Institute of Biomaterals and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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59
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Hobbs JG, Young JS, Bailes JE. Sports-related concussions: diagnosis, complications, and current management strategies. Neurosurg Focus 2017; 40:E5. [PMID: 27032922 DOI: 10.3171/2016.1.focus15617] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Sports-related concussions (SRCs) are traumatic events that affect up to 3.8 million athletes per year. The initial diagnosis and management is often instituted on the field of play by coaches, athletic trainers, and team physicians. SRCs are usually transient episodes of neurological dysfunction following a traumatic impact, with most symptoms resolving in 7-10 days; however, a small percentage of patients will suffer protracted symptoms for years after the event and may develop chronic neurodegenerative disease. Rarely, SRCs are associated with complications, such as skull fractures, epidural or subdural hematomas, and edema requiring neurosurgical evaluation. Current standards of care are based on a paradigm of rest and gradual return to play, with decisions driven by subjective and objective information gleaned from a detailed history and physical examination. Advanced imaging techniques such as functional MRI, and detailed understanding of the complex pathophysiological process underlying SRCs and how they affect the athletes acutely and long-term, may change the way physicians treat athletes who suffer a concussion. It is hoped that these advances will allow a more accurate assessment of when an athlete is truly safe to return to play, decreasing the risk of secondary impact injuries, and provide avenues for therapeutic strategies targeting the complex biochemical cascade that results from a traumatic injury to the brain.
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Affiliation(s)
- Jonathan G Hobbs
- Department of Surgery, Section of Neurosurgery, The University of Chicago Pritzker School of Medicine, Chicago; and
| | - Jacob S Young
- Department of Surgery, Section of Neurosurgery, The University of Chicago Pritzker School of Medicine, Chicago; and
| | - Julian E Bailes
- Department of Neurosurgery, NorthShore University HealthSystem, The University of Chicago Pritzker School of Medicine, Evanston, Illinois
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60
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Autobiographical and episodic memory deficits in mild traumatic brain injury. Brain Cogn 2017; 111:112-126. [DOI: 10.1016/j.bandc.2016.11.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 11/11/2016] [Accepted: 11/14/2016] [Indexed: 11/23/2022]
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61
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White matter alterations in college football players: a longitudinal diffusion tensor imaging study. Brain Imaging Behav 2017; 12:44-53. [DOI: 10.1007/s11682-017-9672-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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62
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Abstract
OBJECTIVES Concussion is defined as a complex pathophysiological process affecting the brain. Although the cumulative and long-term effects of multiple concussions are now well documented on cognitive and motor function, little is known about their effects on emotion recognition. Recent studies have suggested that concussion can result in emotional sequelae, particularly in females and multi-concussed athletes. The objective of this study was to investigate sex-related differences in emotion recognition in asymptomatic male and female multi-concussed athletes. METHODS We tested 28 control athletes (15 males) and 22 multi-concussed athletes (10 males) more than a year since the last concussion. Participants completed the Post-Concussion Symptom Scale, the Beck Depression Inventory-II, the Beck Anxiety Inventory, a neuropsychological test battery and a morphed emotion recognition task. Pictures of a male face expressing basic emotions (anger, disgust, fear, happiness, sadness, surprise) morphed with another emotion were randomly presented. After each face presentation, participants were asked to indicate the emotion expressed by the face. RESULTS Results revealed significant sex by group interactions in accuracy and intensity threshold for negative emotions, together with significant main effects of emotion and group. CONCLUSIONS Male concussed athletes were significantly impaired in recognizing negative emotions and needed more emotional intensity to correctly identify these emotions, compared to same-sex controls. In contrast, female concussed athletes performed similarly to same-sex controls. These findings suggest that sex significantly modulates concussion effects on emotional facial expression recognition. (JINS, 2017, 23, 65-77).
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63
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Hurtubise J, Gorbet D, Hamandi Y, Macpherson A, Sergio L. The effect of concussion history on cognitive-motor integration in elite hockey players. Concussion 2016; 1:CNC17. [PMID: 30202559 PMCID: PMC6093836 DOI: 10.2217/cnc-2016-0006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/03/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To observe the effects of concussion history on cognitive-motor integration in elite-level athletes. METHODS The study included 102 National Hockey League draft prospects (n = 51 concussion history [CH]; n = 51 no history [NC]). Participants completed two computer-based visuomotor tasks, one involved 'standard' visuomotor mapping and one involved 'nonstandard' mapping in which vision and action were decoupled. RESULTS We observed a significant effect of group on reaction time (CH slower) and accuracy (CH worse), but a group by condition interaction only for reaction time (p < 0.05). There were no other deficits found. We discussed these findings in comparison to our previous work with non-elite athletes. CONCLUSION Previously concussed elite-level athletes may have lingering neurological deficits that are not detected using standard clinical assessments.
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Affiliation(s)
- Johanna Hurtubise
- School of Kinesiology & Health Science, York University, Toronto, ON, M3J 1P3, Canada
- York University Sports Medicine Team, York University Department of Athletics and Recreation, York University, Toronto, ON, M3J 1P3, Canada
| | - Diana Gorbet
- School of Kinesiology & Health Science, York University, Toronto, ON, M3J 1P3, Canada
- Center for Vision Research, York University, Toronto, ON, M3J 1P3, Canada
| | - Yehyah Hamandi
- School of Kinesiology & Health Science, York University, Toronto, ON, M3J 1P3, Canada
| | - Alison Macpherson
- School of Kinesiology & Health Science, York University, Toronto, ON, M3J 1P3, Canada
- York University Sports Medicine Team, York University Department of Athletics and Recreation, York University, Toronto, ON, M3J 1P3, Canada
| | - Lauren Sergio
- School of Kinesiology & Health Science, York University, Toronto, ON, M3J 1P3, Canada
- York University Sports Medicine Team, York University Department of Athletics and Recreation, York University, Toronto, ON, M3J 1P3, Canada
- Center for Vision Research, York University, Toronto, ON, M3J 1P3, Canada
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64
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Urban KJ, Riggs L, Wells GD, Keightley M, Chen JK, Ptito A, Fait P, Taha T, Sinopoli KJ. Cortical Thickness Changes and Their Relationship to Dual-Task Performance following Mild Traumatic Brain Injury in Youth. J Neurotrauma 2016; 34:816-823. [PMID: 27629883 DOI: 10.1089/neu.2016.4502] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Mild traumatic brain injury (mTBI) is common in youth, especially in those who participate in sport. Recent investigations from our group have shown that asymptomatic children and adolescents with mTBI continue to exhibit alterations in neural activity and cognitive performance compared with those without a history of mTBI. This is an intriguing finding, given that current return-to-learn and return-to-play protocols rely predominately on subjective symptom reports, which may not be sensitive enough to detect subtle injury-related changes. As a result, youth may be at greater risk for re-injury and long-term consequences if they are cleared for activity while their brains continue to be compromised. It is currently unknown whether mTBI also affects brain microstructure in the developing brain, particularly cortical thickness, and whether such changes are also related to cognitive performance. The present study examined cortical thickness in 13 asymptomatic youth (10-14 years old) who had sustained an mTBI 3-8 months prior to testing compared with 14 age-matched typically developing controls. Cortical thickness was also examined in relation to working memory performance during single and dual task paradigms. The results show that youth who had sustained an mTBI had thinner cortices in the left dorsolateral prefrontal region and right anterior and posterior inferior parietal lobes. Additionally, cortical thinning was associated with slower reaction time during the dual-task condition in the injured youth only. The results also point to a possible relationship between functional and structural alterations as a result of mTBI in youth, and lend evidence for neural changes beyond symptom resolution.
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Affiliation(s)
- Karolina J Urban
- 1 Bloorview Research Institute , Toronto, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada .,2 Department of Rehabilitation Sciences, University of Toronto , Toronto, Ontario, Canada
| | - Lily Riggs
- 1 Bloorview Research Institute , Toronto, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Greg D Wells
- 3 Department of Kinesiology and Physical Education, University of Toronto , Toronto, Ontario, Canada .,4 Department of Physiology and Experimental Medicine, the Hospital for Sick Children , Toronto, Ontario, Canada
| | - Michelle Keightley
- 1 Bloorview Research Institute , Toronto, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada .,2 Department of Rehabilitation Sciences, University of Toronto , Toronto, Ontario, Canada
| | - Jen-Kai Chen
- 5 McGill University Health Centre and Montreal Neurological Institute , Montreal, Quebec, Canada
| | - Alain Ptito
- 5 McGill University Health Centre and Montreal Neurological Institute , Montreal, Quebec, Canada
| | - Philippe Fait
- 6 Department of Human Kinetic, University of Quebec at Trois-Rivieres (UQTR) , Quebec, Canada .,7 Research Group on Neuromusculoskeletal Dysfunctions (GRAN), University of Quebec at Trois-Rivieres (UQTR) , Quebec, Canada
| | - Tim Taha
- 3 Department of Kinesiology and Physical Education, University of Toronto , Toronto, Ontario, Canada
| | - Katia J Sinopoli
- 8 Department of Psychology, Division of Neurology, the Hospital for Sick Children , Toronto, Ontario, Canada
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65
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Combined DTI-fMRI Analysis for a Quantitative Assessment of Connections Between WM Bundles and Their Peripheral Cortical Fields in Verbal Fluency. Brain Topogr 2016; 29:814-823. [PMID: 27509899 DOI: 10.1007/s10548-016-0516-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 08/03/2016] [Indexed: 12/17/2022]
Abstract
Diffusion tensor imaging (DTI) tractography and functional magnetic resonance imaging (fMRI) are powerful techniques to elucidate the anatomical and functional aspects of brain connectivity. However, integrating these approaches to describe the precise link between structure and function within specific brain circuits remains challenging. In this study, a novel DTI-fMRI integration method is proposed, to provide the topographical characterization and the volumetric assessment of the functional and anatomical connections within the language circuit. In a group of 21 healthy elderly subjects (mean age 68.5 ± 5.8 years), the volume of connection between the cortical activity elicited by a verbal fluency task and the cortico-cortical fiber tracts associated with this function are mapped and quantified. An application of the method to a case study in neuro-rehabilitation context is also presented. Integrating structural and functional data within the same framework, this approach provides an overall view of white and gray matter when studying specific brain circuits.
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66
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Myer GD, Yuan W, Barber Foss KD, Thomas S, Smith D, Leach J, Kiefer AW, Dicesare C, Adams J, Gubanich PJ, Kitchen K, Schneider DK, Braswell D, Krueger D, Altaye M. Analysis of head impact exposure and brain microstructure response in a season-long application of a jugular vein compression collar: a prospective, neuroimaging investigation in American football. Br J Sports Med 2016; 50:1276-1285. [PMID: 27307271 PMCID: PMC5099231 DOI: 10.1136/bjsports-2016-096134] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2016] [Indexed: 01/03/2023]
Abstract
Background Historical approaches to protect the brain from outside the skull (eg, helmets and mouthpieces) have been ineffective in reducing internal injury to the brain that arises from energy absorption during sports-related collisions. We aimed to evaluate the effects of a neck collar, which applies gentle bilateral jugular vein compression, resulting in cerebral venous engorgement to reduce head impact energy absorption during collision. Specifically, we investigated the effect of collar wearing during head impact exposure on brain microstructure integrity following a competitive high school American football season. Methods A prospective longitudinal controlled trial was employed to evaluate the effects of collar wearing (n=32) relative to controls (CTRL; n=30) during one competitive football season (age: 17.04±0.67 years). Impact exposure was collected using helmet sensors and white matter (WM) integrity was quantified based on diffusion tensor imaging (DTI) serving as the primary outcome. Results With similar overall g-forces and total head impact exposure experienced in the two study groups during the season (p>0.05), significant preseason to postseason changes in mean diffusivity, axial diffusivity and radial diffusivity in the WM integrity were noted in the CTRL group (corrected p<0.05) but not in the collar group (p>0.05). The CTRL group demonstrated significantly larger preseason to postseason DTI change in multiple WM regions compared with the collar group (corrected p<0.05). Discussion Reduced WM diffusivity alteration was noted in participants wearing a neck collar after a season of competitive football. Collar wearing may have provided a protective effect against brain microstructural changes after repetitive head impacts. Trial registration number NCT02696200.
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Affiliation(s)
- Gregory D Myer
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Sports Medicine, The SPORT Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA Department of Orthopaedics, University of Pennsylvania, Philadelphia, Pennsylvania, USA The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Weihong Yuan
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kim D Barber Foss
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Sports Medicine, The SPORT Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Health Sciences, Department of Athletic Training, Mount St. Joseph University, Cincinnati, Ohio, USA Rocky Mountain University of Health Professions, Provo, Utah, USA
| | - Staci Thomas
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Sports Medicine, The SPORT Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - David Smith
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - James Leach
- Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Adam W Kiefer
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Sports Medicine, The SPORT Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA Department of Psychology, Center for Cognition, Action and Perception, University of Cincinnati, Cincinnati, Ohio, USA
| | - Chris Dicesare
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Sports Medicine, The SPORT Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Janet Adams
- Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Paul J Gubanich
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
| | - Katie Kitchen
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Sports Medicine, The SPORT Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Daniel K Schneider
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Sports Medicine, The SPORT Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Daniel Braswell
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Sports Medicine, The SPORT Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Darcy Krueger
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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67
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Dalecki M, Albines D, Macpherson A, Sergio LE. Prolonged cognitive-motor impairments in children and adolescents with a history of concussion. Concussion 2016; 1:CNC14. [PMID: 30202556 PMCID: PMC6094154 DOI: 10.2217/cnc-2016-0001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 02/26/2016] [Indexed: 01/01/2023] Open
Abstract
Aim: We investigated whether children and adolescents with concussion history show cognitive–motor integration (CMI) deficits. Method: Asymptomatic children and adolescents with concussion history (n = 50; mean 12.84 years) and no history (n = 49; mean: 11.63 years) slid a cursor to targets using their finger on a dual-touch-screen laptop; target location and motor action were not aligned in the CMI task. Results: Children and adolescents with concussion history showed prolonged CMI deficits, in that their performance did not match that of no history controls until nearly 2 years postevent. Conclusion: These CMI deficits may be due to disruptions in fronto-parietal networks, contributing to an increased vulnerability to further injury. Current return-to-play assessments that do not test CMI may not fully capture functional abilities postconcussion.
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Affiliation(s)
- Marc Dalecki
- School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada.,Centre for Vision Research, York University, Toronto, Ontario, Canada.,School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada.,Centre for Vision Research, York University, Toronto, Ontario, Canada
| | - David Albines
- School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada.,School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada
| | - Alison Macpherson
- School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada.,York University Sport Medicine Team, York University, Toronto, Ontario, Canada.,School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada.,York University Sport Medicine Team, York University, Toronto, Ontario, Canada
| | - Lauren E Sergio
- School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada.,Centre for Vision Research, York University, Toronto, Ontario, Canada.,York University Sport Medicine Team, York University, Toronto, Ontario, Canada.,School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada.,Centre for Vision Research, York University, Toronto, Ontario, Canada.,York University Sport Medicine Team, York University, Toronto, Ontario, Canada
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68
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69
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Pan J, Connolly ID, Dangelmajer S, Kintzing J, Ho AL, Grant G. Sports-related brain injuries: connecting pathology to diagnosis. Neurosurg Focus 2016; 40:E14. [DOI: 10.3171/2016.1.focus15607] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Brain injuries are becoming increasingly common in athletes and represent an important diagnostic challenge. Early detection and management of brain injuries in sports are of utmost importance in preventing chronic neurological and psychiatric decline. These types of injuries incurred during sports are referred to as mild traumatic brain injuries, which represent a heterogeneous spectrum of disease. The most dramatic manifestation of chronic mild traumatic brain injuries is termed chronic traumatic encephalopathy, which is associated with profound neuropsychiatric deficits. Because chronic traumatic encephalopathy can only be diagnosed by postmortem examination, new diagnostic methodologies are needed for early detection and amelioration of disease burden. This review examines the pathology driving changes in athletes participating in high-impact sports and how this understanding can lead to innovations in neuroimaging and biomarker discovery.
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Affiliation(s)
| | | | | | - James Kintzing
- 3Bioengineering, Stanford University School of Medicine, Stanford, California
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70
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Wright AD, Jarrett M, Vavasour I, Shahinfard E, Kolind S, van Donkelaar P, Taunton J, Li D, Rauscher A. Myelin Water Fraction Is Transiently Reduced after a Single Mild Traumatic Brain Injury--A Prospective Cohort Study in Collegiate Hockey Players. PLoS One 2016; 11:e0150215. [PMID: 26913900 PMCID: PMC4767387 DOI: 10.1371/journal.pone.0150215] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/10/2016] [Indexed: 12/12/2022] Open
Abstract
Impact-related mild traumatic brain injuries (mTBI) are a major public health concern, and remain as one of the most poorly understood injuries in the field of neuroscience. Currently, the diagnosis and management of such injuries are based largely on patient-reported symptoms. An improved understanding of the underlying pathophysiology of mTBI is urgently needed in order to develop better diagnostic and management protocols. Specifically, dynamic post-injury changes to the myelin sheath in the human brain have not been examined, despite ‘compromised white matter integrity’ often being described as a consequence of mTBI. In this preliminary cohort study, myelin water imaging was used to prospectively evaluate changes in myelin water fraction, derived from the T2 decay signal, in two varsity hockey teams (45 players) over one season of athletic competition. 11 players sustained a concussion during competition, and were scanned at 72 hours, 2 weeks, and 2 months post-injury. Results demonstrated a reduction in myelin water fraction at 2 weeks post-injury in several brain areas relative to preseason scans, including the splenium of the corpus callosum, right posterior thalamic radiation, left superior corona radiata, left superior longitudinal fasciculus, and left posterior limb of the internal capsule. Myelin water fraction recovered to pre-season values by 2 months post-injury. These results may indicate transient myelin disruption following a single mTBI, with subsequent remyelination of affected neurons. Myelin disruption was not apparent in the athletes who did not experience a concussion, despite exposure to repetitive subconcussive trauma over a season of collegiate hockey. These findings may help to explain many of the metabolic and neurological deficits observed clinically following mTBI.
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Affiliation(s)
- Alexander D. Wright
- MD/PhD Program, University of British Columbia, Vancouver, Canada
- Southern Medical Program, University of British Columbia Okanagan, Kelowna, Canada
- Department of Experimental Medicine, University of British Columbia, Vancouver, Canada
| | - Michael Jarrett
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
| | - Irene Vavasour
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
| | - Elham Shahinfard
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
| | - Shannon Kolind
- Faculty of Medicine, Division of Neurology, University of British Columbia, Vancouver, Canada
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada
| | - Jack Taunton
- Faculty of Medicine, Division of Sports Medicine, University of British Columbia, Vancouver, Canada
| | - David Li
- Faculty of Medicine, Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Alexander Rauscher
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
- Department of Pediatrics, Division of Neurology, University of British Columbia, Vancouver, Canada
- * E-mail:
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71
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Meier TB, Bergamino M, Bellgowan PSF, Teague TK, Ling JM, Jeromin A, Mayer AR. Longitudinal assessment of white matter abnormalities following sports-related concussion. Hum Brain Mapp 2015; 37:833-45. [PMID: 26663463 DOI: 10.1002/hbm.23072] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/23/2015] [Indexed: 01/08/2023] Open
Abstract
There is great interest in developing physiological-based biomarkers such as diffusion tensor imaging to aid in the management of concussion, which is currently entirely dependent on clinical judgment. However, the time course for recovery of white matter abnormalities following sports-related concussion (SRC) is unknown. We collected diffusion tensor imaging and behavioral data in forty concussed collegiate athletes on average 1.64 days (T1; n = 33), 8.33 days (T2; n = 30), and 32.15 days post-concussion (T3; n = 26), with healthy collegiate contact-sport athletes (HA) serving as controls (n = 46). We hypothesized that fractional anisotropy (FA) would be increased acutely and partially recovered by one month post-concussion. Mood symptoms were assessed using structured interviews. FA differences were assessed using both traditional and subject-specific analyses. An exploratory analysis of tau plasma levels was conducted in a subset of participants. Results indicated that mood symptoms improved over time post-concussion, but remained elevated at T3 relative to HA. Across both group and subject-specific analyses, concussed athletes exhibited increased FA in several white matter tracts at each visit post-concussion with no longitudinal evidence of recovery. Increased FA at T1 and T3 was significantly associated with an independent, real-world outcome measure for return-to-play. Finally, we observed a nonsignificant trend for reduced tau in plasma of concussed athletes at T1 relative to HA, with tau significantly increasing by T2. These results suggest white matter abnormalities following SRC may persist beyond one month and have potential as an objective biomarker for concussion outcome. Hum Brain Mapp 37:833-845, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico.,Laureate Institute for Brain Research, Tulsa, Oklahoma
| | | | - Patrick S F Bellgowan
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, North Bethesda, Maryland
| | - T K Teague
- Departments of Surgery and Psychiatry, University of Oklahoma College of Medicine, Tulsa, Oklahoma.,Department of Pharmaceutical Sciences, University of Oklahoma College of Pharmacy, Tulsa, Oklahoma.,Department of Biochemistry and Microbiology, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - Josef M Ling
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
| | | | - Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico.,Neurology Department, University of New Mexico School of Medicine, Albuquerque, New Mexico.,Department of Psychology, University of New Mexico, Albuquerque, New Mexico
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72
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Yang W, Liu TT, Song XB, Zhang Y, Li ZH, Cui ZH, Hao Q, Liu HL, Lei CL, Liu J. Comparison of different stimulation parameters of repetitive transcranial magnetic stimulation for unilateral spatial neglect in stroke patients. J Neurol Sci 2015; 359:219-25. [DOI: 10.1016/j.jns.2015.08.1541] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 08/20/2015] [Accepted: 08/27/2015] [Indexed: 11/28/2022]
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73
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Ou Y, Gollub RL, Retzepi K, Reynolds N, Pienaar R, Pieper S, Murphy SN, Grant PE, Zöllei L. Brain extraction in pediatric ADC maps, toward characterizing neuro-development in multi-platform and multi-institution clinical images. Neuroimage 2015; 122:246-61. [PMID: 26260429 PMCID: PMC4966541 DOI: 10.1016/j.neuroimage.2015.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 07/29/2015] [Accepted: 08/03/2015] [Indexed: 01/18/2023] Open
Abstract
Apparent Diffusion Coefficient (ADC) maps can be used to characterize myelination and to detect abnormalities in the developing brain. However, given the normal variation in regional ADC with myelination, detection of abnormalities is difficult when based on visual assessment. Quantitative and automated analysis of pediatric ADC maps is thus desired but requires accurate brain extraction as the first step. Currently, most existing brain extraction methods are optimized for structural T1-weighted MR images of fully myelinated brains. Due to differences in age and image contrast, these approaches do not translate well to pediatric ADC maps. To address this problem, we present a multi-atlas brain extraction framework that has 1) specificity: designed and optimized specifically for pediatric ADC maps; 2) generality: applicable to multi-platform and multi-institution data, and to subjects at various neuro-developmental stages across the first 6 years of life; 3) accuracy: highly accurate compared to expert annotations; and 4) consistency: consistently accurate regardless of sources of data and ages of subjects. We show how we achieve these goals, via optimizing major components in a multi-atlas brain extraction framework, and via developing and evaluating new criteria for its atlas ranking component. Moreover, we demonstrate that these goals can be achieved with a fixed set of atlases and a fixed set of parameters, which opens doors for our optimized framework to be used in large-scale and multi-institution neuro-developmental and clinical studies. In a pilot study, we use this framework in a dataset containing scanner-generated ADC maps from 308 pediatric patients collected during the course of routine clinical care. Our framework leads to successful quantifications of the changes in whole-brain volumes and mean ADC values across the first 6 years of life.
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Affiliation(s)
- Yangming Ou
- Psychiatric Neuroimaging, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 120 2nd Ave, Charlestown, MA 02129, USA; Laboratory for Computational Neuroimaging, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th St, Charlestown, MA 02129, USA.
| | - Randy L Gollub
- Psychiatric Neuroimaging, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 120 2nd Ave, Charlestown, MA 02129, USA; Laboratory for Computational Neuroimaging, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th St, Charlestown, MA 02129, USA
| | - Kallirroi Retzepi
- Psychiatric Neuroimaging, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 120 2nd Ave, Charlestown, MA 02129, USA; Laboratory for Computational Neuroimaging, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th St, Charlestown, MA 02129, USA
| | - Nathaniel Reynolds
- Psychiatric Neuroimaging, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 120 2nd Ave, Charlestown, MA 02129, USA; Laboratory for Computational Neuroimaging, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th St, Charlestown, MA 02129, USA
| | - Rudolph Pienaar
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Children's Hospital Boston, Harvard Medical School, 1 Autumn St, Boston, MA 02115, USA
| | - Steve Pieper
- Isomics, Inc., 55 Kirkland St, Cambridge, MA 02138, USA
| | - Shawn N Murphy
- Research Computing, Partners HealthCare, 1 Constitution Center, Charlestown, MA 02129, USA; Laboratory of Computer Science, Massachusetts General Hospital, Harvard Medical School, 50 Staniford St, Boston, MA 02114, USA
| | - P Ellen Grant
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Children's Hospital Boston, Harvard Medical School, 1 Autumn St, Boston, MA 02115, USA
| | - Lilla Zöllei
- Laboratory for Computational Neuroimaging, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th St, Charlestown, MA 02129, USA
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74
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Amyot F, Arciniegas DB, Brazaitis MP, Curley KC, Diaz-Arrastia R, Gandjbakhche A, Herscovitch P, Hinds SR, Manley GT, Pacifico A, Razumovsky A, Riley J, Salzer W, Shih R, Smirniotopoulos JG, Stocker D. A Review of the Effectiveness of Neuroimaging Modalities for the Detection of Traumatic Brain Injury. J Neurotrauma 2015; 32:1693-721. [PMID: 26176603 PMCID: PMC4651019 DOI: 10.1089/neu.2013.3306] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The incidence of traumatic brain injury (TBI) in the United States was 3.5 million cases in 2009, according to the Centers for Disease Control and Prevention. It is a contributing factor in 30.5% of injury-related deaths among civilians. Additionally, since 2000, more than 260,000 service members were diagnosed with TBI, with the vast majority classified as mild or concussive (76%). The objective assessment of TBI via imaging is a critical research gap, both in the military and civilian communities. In 2011, the Department of Defense (DoD) prepared a congressional report summarizing the effectiveness of seven neuroimaging modalities (computed tomography [CT], magnetic resonance imaging [MRI], transcranial Doppler [TCD], positron emission tomography, single photon emission computed tomography, electrophysiologic techniques [magnetoencephalography and electroencephalography], and functional near-infrared spectroscopy) to assess the spectrum of TBI from concussion to coma. For this report, neuroimaging experts identified the most relevant peer-reviewed publications and assessed the quality of the literature for each of these imaging technique in the clinical and research settings. Although CT, MRI, and TCD were determined to be the most useful modalities in the clinical setting, no single imaging modality proved sufficient for all patients due to the heterogeneity of TBI. All imaging modalities reviewed demonstrated the potential to emerge as part of future clinical care. This paper describes and updates the results of the DoD report and also expands on the use of angiography in patients with TBI.
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Affiliation(s)
- Franck Amyot
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - David B. Arciniegas
- Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston, Texas
- Brain Injury Research, TIRR Memorial Hermann, Houston, Texas
| | | | - Kenneth C. Curley
- Combat Casualty Care Directorate (RAD2), U.S. Army Medical Research and Materiel Command, Fort Detrick, Maryland
| | - Ramon Diaz-Arrastia
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Amir Gandjbakhche
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Peter Herscovitch
- Positron Emission Tomography Department, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Sidney R. Hinds
- Defense and Veterans Brain Injury Center, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury Silver Spring, Maryland
| | - Geoffrey T. Manley
- Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Anthony Pacifico
- Congressionally Directed Medical Research Programs, Fort Detrick, Maryland
| | | | - Jason Riley
- Queens University, Kingston, Ontario, Canada
- ArcheOptix Inc., Picton, Ontario, Canada
| | - Wanda Salzer
- Congressionally Directed Medical Research Programs, Fort Detrick, Maryland
| | - Robert Shih
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - James G. Smirniotopoulos
- Department of Radiology, Neurology, and Biomedical Informatics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Derek Stocker
- Walter Reed National Military Medical Center, Bethesda, Maryland
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75
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Brown JA, Dalecki M, Hughes C, Macpherson AK, Sergio LE. Cognitive-motor integration deficits in young adult athletes following concussion. BMC Sports Sci Med Rehabil 2015; 7:25. [PMID: 26491541 PMCID: PMC4612424 DOI: 10.1186/s13102-015-0019-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 10/09/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND The ability to perform visually-guided motor tasks requires the transformation of visual information into programmed motor outputs. When the guiding visual information does not align spatially with the motor output, the brain processes rules to integrate the information for an appropriate motor response. Here, we look at how performance on such tasks is affected in young adult athletes with concussion history. METHODS Participants displaced a cursor from a central to peripheral targets on a vertical display by sliding their finger along a touch sensitive screen in one of two spatial planes. The addition of a memory component, along with variations in cursor feedback increased task complexity across conditions. RESULTS Significant main effects between participants with concussion history and healthy controls without concussion history were observed in timing and accuracy measures. Importantly, the deficits were distinctly more pronounced for participants with concussion history compared to healthy controls, especially when the brain had to control movements having two levels of decoupling between vision and action. A discriminant analysis correctly classified athletes with a history of concussion based on task performance with an accuracy of 94 %, despite the majority of these athletes being rated asymptomatic by current standards. CONCLUSIONS These findings correspond to our previous work with adults at risk of developing dementia, and support the use of cognitive motor integration as an enhanced assessment tool for those who may have mild brain dysfunction. Such a task may provide a more sensitive metric of performance relevant to daily function than what is currently in use, to assist in return to play/work/learn decisions.
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Affiliation(s)
- Jeffrey A Brown
- School of Kinesiology and Health Science, York University, 357 Bethune College, 4700 Keele Street, Toronto, M3J 1P3 ON Canada
| | - Marc Dalecki
- School of Kinesiology and Health Science, York University, 357 Bethune College, 4700 Keele Street, Toronto, M3J 1P3 ON Canada ; Centre for Vision Research, York University, Toronto, Canada
| | - Cindy Hughes
- School of Kinesiology and Health Science, York University, 357 Bethune College, 4700 Keele Street, Toronto, M3J 1P3 ON Canada ; York University Sport Medicine Team, York University, Toronto, Canada
| | - Alison K Macpherson
- School of Kinesiology and Health Science, York University, 357 Bethune College, 4700 Keele Street, Toronto, M3J 1P3 ON Canada ; York University Sport Medicine Team, York University, Toronto, Canada
| | - Lauren E Sergio
- School of Kinesiology and Health Science, York University, 357 Bethune College, 4700 Keele Street, Toronto, M3J 1P3 ON Canada ; Centre for Vision Research, York University, Toronto, Canada ; York University Sport Medicine Team, York University, Toronto, Canada ; Southlake Regional Health Centre, Newmarket, ON Canada
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76
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Ghodadra A, Alhilali L, Fakhran S. Principal Component Analysis of Diffusion Tensor Images to Determine White Matter Injury Patterns Underlying Postconcussive Headache. AJNR Am J Neuroradiol 2015; 37:274-8. [PMID: 26405087 DOI: 10.3174/ajnr.a4505] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 07/02/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND PURPOSE Principal component analysis, a data-reduction algorithm, generates a set of principal components that are independent, linear combinations of the original dataset. Our study sought to use principal component analysis of fractional anisotropy maps to identify white matter injury patterns that correlate with posttraumatic headache after mild traumatic brain injury. MATERIALS AND METHODS Diffusion tensor imaging and neurocognitive testing with the Immediate Post-Concussion Assessment and Cognitive Test were performed in 40 patients with mild traumatic brain injury and 24 without posttraumatic headache. Principal component analysis of coregistered fractional anisotropy maps was performed. Regression analysis of the major principal components was used to identify those correlated with posttraumatic headache. Finally, each principal component that correlated with posttraumatic headache was screened against other postconcussive symptoms and demographic factors. RESULTS Principal component 4 (mean, 7.1 ± 10.3) correlated with the presence of posttraumatic headache in mild traumatic brain injury (odds ratio per SD, 2.32; 95% CI, 1.29-4.67; P = .01). Decreasing principal component 4 corresponded with decreased fractional anisotropy in the midsplenium and increased fractional anisotropy in the genu of the corpus callosum. Principal component 4 identified patients with posttraumatic headache with an area under the receiver operating characteristic curve of 0.73 and uniquely correlated with posttraumatic headache and no other postconcussive symptom or demographic factors. CONCLUSIONS Principal component analysis can be an effective data-mining method to identify white matter injury patterns on DTI that correlate with clinically relevant symptoms in mild traumatic brain injury. A pattern of reduced fractional anisotropy in the splenium and increased fractional anisotropy in the genu of the corpus callosum identified by principal component analysis can help identify patients at risk for posttraumatic headache after mild traumatic brain injury.
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Affiliation(s)
- A Ghodadra
- From the Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - L Alhilali
- From the Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - S Fakhran
- From the Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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77
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Abstract
While much is known regarding the pathophysiology surrounding concussion injuries in the acute phase, there is little evidence to support many of the theorized etiologies to post-concussion syndrome (PCS); the chronic phase of concussion occurring in ∼ 10-15% of concussed patients. This paper reviews the existing literature surrounding the numerous proposed theories of PCS and introduces another potential, and very treatable, cause of this chronic condition; cervical spine dysfunction due to concomitant whiplash-type injury. We also discuss a short case-series of five patients with diagnosed PCS having very favorable outcomes following various treatment and rehabilitative techniques aimed at restoring cervical spine function.
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Affiliation(s)
- Cameron M Marshall
- a 1 Department of Graduate Studies, Canadian Memorial Chiropractic College , 6100 Leslie Street, Toronto, Ontario, Canada
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78
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Urban KJ, Barlow KM, Jimenez JJ, Goodyear BG, Dunn JF. Functional near-infrared spectroscopy reveals reduced interhemispheric cortical communication after pediatric concussion. J Neurotrauma 2015; 32:833-40. [PMID: 25387354 PMCID: PMC4449632 DOI: 10.1089/neu.2014.3577] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Concussion, or mild traumatic brain injury (mTBI), is a growing concern, especially among the pediatric population. By age 25, as many as 30% of the population are likely to have had a concussion. Many result in long-term disability, with some evolving to postconcussion syndrome. Treatments are being developed, but are difficult to assess given the lack of measures to quantitatively monitor concussion. There is no accepted quantitative imaging metric for monitoring concussion. We hypothesized that because cognitive function and fiber tracks are often impacted in concussion, interhemispheric brain communication may be impaired. We used functional near-infrared spectroscopy (fNIRS) to quantify functional coherence between the left and right motor cortex as a marker of interhemispheric communication. Studies were undertaken during the resting state and with a finger-tapping task to activate the motor cortex. Pediatric patients (ages 12-18) had symptoms for 31-473 days, compared to controls, who have not had reported a previous concussion. We detected differences between patients and controls in coherence between the contralateral motor cortices using measurements of total hemoglobin and oxy-hemoglobin with a p<0.01 (n=8, control; n=12 mTBI). Given the critical need for a quantitative biomarker for recovery after a concussion, we present these data to highlight the potential of fNIRS coupled with interhemispheric coherence analysis as a biomarker of concussion injury.
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Affiliation(s)
- Karolina J. Urban
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Experimental Imaging Center, University of Calgary, Calgary, Alberta, Canada
| | - Karen M. Barlow
- Department of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jon J. Jimenez
- Experimental Imaging Center, University of Calgary, Calgary, Alberta, Canada
| | - Bradley G. Goodyear
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jeff F. Dunn
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Experimental Imaging Center, University of Calgary, Calgary, Alberta, Canada
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79
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Astafiev SV, Shulman GL, Metcalf NV, Rengachary J, MacDonald CL, Harrington DL, Maruta J, Shimony JS, Ghajar J, Diwakar M, Huang MX, Lee RR, Corbetta M. Abnormal White Matter Blood-Oxygen-Level-Dependent Signals in Chronic Mild Traumatic Brain Injury. J Neurotrauma 2015; 32:1254-71. [PMID: 25758167 DOI: 10.1089/neu.2014.3547] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Concussion, or mild traumatic brain injury (mTBI), can cause persistent behavioral symptoms and cognitive impairment, but it is unclear if this condition is associated with detectable structural or functional brain changes. At two sites, chronic mTBI human subjects with persistent post-concussive symptoms (three months to five years after injury) and age- and education-matched healthy human control subjects underwent extensive neuropsychological and visual tracking eye movement tests. At one site, patients and controls also performed the visual tracking tasks while blood-oxygen-level-dependent (BOLD) signals were measured with functional magnetic resonance imaging. Although neither neuropsychological nor visual tracking measures distinguished patients from controls at the level of individual subjects, abnormal BOLD signals were reliably detected in patients. The most consistent changes were localized in white matter regions: anterior internal capsule and superior longitudinal fasciculus. In contrast, BOLD signals were normal in cortical regions, such as the frontal eye field and intraparietal sulcus, that mediate oculomotor and attention functions necessary for visual tracking. The abnormal BOLD signals accurately differentiated chronic mTBI patients from healthy controls at the single-subject level, although they did not correlate with symptoms or neuropsychological performance. We conclude that subjects with persistent post-concussive symptoms can be identified years after their TBI using fMRI and an eye movement task despite showing normal structural MRI and DTI.
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Affiliation(s)
- Serguei V Astafiev
- 1 Department of Neurology, Washington University in St. Louis , St. Louis, Missouri
| | - Gordon L Shulman
- 1 Department of Neurology, Washington University in St. Louis , St. Louis, Missouri
| | - Nicholas V Metcalf
- 1 Department of Neurology, Washington University in St. Louis , St. Louis, Missouri
| | - Jennifer Rengachary
- 1 Department of Neurology, Washington University in St. Louis , St. Louis, Missouri
| | | | - Deborah L Harrington
- 2 Department of Radiology, University of California , San Diego, San Diego, California
| | - Jun Maruta
- 3 Brain Trauma Foundation , New York, New York
| | | | - Jamshid Ghajar
- 3 Brain Trauma Foundation , New York, New York.,4 Department of Neurological Surgery, Weill Cornell Medical College , New York, New York
| | - Mithun Diwakar
- 2 Department of Radiology, University of California , San Diego, San Diego, California
| | - Ming-Xiong Huang
- 2 Department of Radiology, University of California , San Diego, San Diego, California
| | - Roland R Lee
- 2 Department of Radiology, University of California , San Diego, San Diego, California
| | - Maurizio Corbetta
- 1 Department of Neurology, Washington University in St. Louis , St. Louis, Missouri
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80
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Terry DP, Adams TE, Ferrara MS, Miller LS. FMRI hypoactivation during verbal learning and memory in former high school football players with multiple concussions. Arch Clin Neuropsychol 2015; 30:341-55. [PMID: 25903375 DOI: 10.1093/arclin/acv020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2015] [Indexed: 01/05/2023] Open
Abstract
Multiple concussions before the age of 18 may be associated with late-life memory deficits. This study examined neural activation associated with verbal encoding and memory retrieval in former athletes ages 40-65 who received at least two concussions (median = 3; range = 2-15) playing high school football and a group of former high school football players with no reported history of concussions matched on age, education, and pre-morbid IQ. Functional magnetic resonance imaging data collected during a modified verbal paired associates paradigm indicated that those with concussive histories had hypoactivation in left hemispheric language regions, including the inferior/middle frontal gyri and angular gyrus compared with controls. However, concussive history was not associated with worse memory functioning on neuropsychological tests or worse behavioral performance during the paradigm, suggesting that multiple early-life concussions may be associated with subtle changes in the verbal encoding system that limits one from accessing higher-order semantic networks, but this difference does not translate into measurable cognitive performance deficits.
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Affiliation(s)
- Douglas P Terry
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - T Eric Adams
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Michael S Ferrara
- College of Health & Human Services, University of New Hampshire, Durham, USA
| | - L Stephen Miller
- Department of Psychology, University of Georgia, Athens, GA, USA BioImaging Research Center, Biomedical & Health Science Institute, University of Georgia, Athens, GA, USA
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81
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Dodd AB, Epstein K, Ling JM, Mayer AR. Diffusion tensor imaging findings in semi-acute mild traumatic brain injury. J Neurotrauma 2015; 31:1235-48. [PMID: 24779720 DOI: 10.1089/neu.2014.3337] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The past 10 years have seen a rapid increase in the use of diffusion tensor imaging to identify biomarkers of traumatic brain injury (TBI). Although the literature generally indicates decreased anisotropic diffusion at more chronic injury periods and in more severe injuries, considerable debate remains regarding the direction (i.e., increased or decreased) of anisotropic diffusion in the acute to semi-acute phase (here defined as less than 3 months post-injury) of mild TBI (mTBI). A systematic review of the literature was therefore performed to (1) determine the prevalence of different anisotropic diffusion findings (increased, decreased, bidirectional, or null) during the semi-acute injury phase of mTBI and to (2) identify clinical (e.g., age of injury, post-injury scan time, etc.) and experimental factors (e.g., number of unique directions, field strength) that may influence these findings. Results from the literature review indicated 31 articles with independent samples of semi-acute mTBI patients, with 13 studies reporting decreased anisotropic diffusion, 11 reporting increased diffusion, 2 reporting bidirectional findings, and 5 reporting null findings. Chi-squared analyses indicated that the total number of diffusion-weighted (DW) images was significantly associated with findings of either increased (DW ≥ 30) versus decreased (DW ≤ 25) anisotropic diffusion. Other clinical and experimental factors were not statistically significant for direction of anisotropic diffusion, but these results may have been limited by the relatively small number of studies within each domain (e.g., pediatric studies). In summary, current results indicate roughly equivalent number of studies reporting increased versus decreased anisotropic diffusion during semi-acute mTBI, with the number of unique diffusion images being statistically associated with the direction of findings.
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Affiliation(s)
- Andrew B Dodd
- 1 The Mind Research Network/Lovelace Biomedical and Environmental Research Institute , Albuquerque, New Mexico
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82
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Yue JK, Pronger AM, Ferguson AR, Temkin NR, Sharma S, Rosand J, Sorani MD, McAllister TW, Barber J, Winkler EA, Burchard EG, Hu D, Lingsma HF, Cooper SR, Puccio AM, Okonkwo DO, Diaz-Arrastia R, Manley GT. Association of a common genetic variant within ANKK1 with six-month cognitive performance after traumatic brain injury. Neurogenetics 2015; 16:169-80. [PMID: 25633559 DOI: 10.1007/s10048-015-0437-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 01/02/2015] [Indexed: 01/18/2023]
Abstract
Genetic association analyses suggest that certain common single nucleotide polymorphisms (SNPs) may adversely impact recovery from traumatic brain injury (TBI). Delineating their causal relationship may aid in development of novel interventions and in identifying patients likely to respond to targeted therapies. We examined the influence of the (C/T) SNP rs1800497 of ANKK1 on post-TBI outcome using data from two prospective multicenter studies: the Citicoline Brain Injury Treatment (COBRIT) trial and Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot). We included patients with ANKK1 genotyping results and cognitive outcomes at six months post-TBI (n = 492: COBRIT n = 272, TRACK-TBI Pilot n = 220). Using the California Verbal Learning Test Second Edition (CVLT-II) Trial 1-5 Standard Score, we found a dose-dependent effect for the T allele, with T/T homozygotes scoring lowest on the CVLT-II Trial 1-5 Standard Score (T/T 45.1, C/T 51.1, C/C 52.1, ANOVA, p = 0.008). Post hoc testing with multiple comparison-correction indicated that T/T patients performed significantly worse than C/T and C/C patients. Similar effects were observed in a test of non-verbal processing (Wechsler Adult Intelligence Scale, Processing Speed Index). Our findings extend those of previous studies reporting a negative relationship of the ANKK1 T allele with cognitive performance after TBI. In this study, we demonstrate the value of pooling shared clinical, biomarker, and outcome variables from two large datasets applying the NIH TBI Common Data Elements. The results have implications for future multicenter investigations to further elucidate the role of ANKK1 in post-TBI outcome.
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Affiliation(s)
- John K Yue
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
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83
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Dean PJA, Sato JR, Vieira G, McNamara A, Sterr A. Multimodal imaging of mild traumatic brain injury and persistent postconcussion syndrome. Brain Behav 2015; 5:45-61. [PMID: 25722949 PMCID: PMC4321394 DOI: 10.1002/brb3.292] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/21/2014] [Accepted: 09/15/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Persistent postconcussion syndrome (PCS) occurs in around 5-10% of individuals after mild traumatic brain injury (mTBI), but research into the underlying biology of these ongoing symptoms is limited and inconsistent. One reason for this could be the heterogeneity inherent to mTBI, with individualized injury mechanisms and psychological factors. A multimodal imaging study may be able to characterize the injury better. AIM To look at the relationship between functional (fMRI), structural (diffusion tensor imaging), and metabolic (magnetic resonance spectroscopy) data in the same participants in the long term (>1 year) after injury. It was hypothesized that only those mTBI participants with persistent PCS would show functional changes, and that these changes would be related to reduced structural integrity and altered metabolite concentrations. METHODS Functional changes associated with persistent PCS after mTBI (>1 year postinjury) were investigated in participants with and without PCS (both n = 8) and non-head injured participants (n = 9) during performance of working memory and attention/processing speed tasks. Correlation analyses were performed to look at the relationship between the functional data and structural and metabolic alterations in the same participants. RESULTS There were no behavioral differences between the groups, but participants with greater PCS symptoms exhibited greater activation in attention-related areas (anterior cingulate), along with reduced activation in temporal, default mode network, and working memory areas (left prefrontal) as cognitive load was increased from the easiest to the most difficult task. Functional changes in these areas correlated with reduced structural integrity in corpus callosum and anterior white matter, and reduced creatine concentration in right dorsolateral prefrontal cortex. CONCLUSION These data suggest that the top-down attentional regulation and deactivation of task-irrelevant areas may be compensating for the reduction in working memory capacity and variation in white matter transmission caused by the structural and metabolic changes after injury. This may in turn be contributing to secondary PCS symptoms such as fatigue and headache. Further research is required using multimodal data to investigate the mechanisms of injury after mTBI, but also to aid individualized diagnosis and prognosis.
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Affiliation(s)
| | - Joao R Sato
- Center of Mathematics, Computation and Cognition, Universidade Federal do ABCSão Paulo, Brazil
- NIF/LIM44, Departamento de Radiologia da Faculdade de Medicina da Universidade de São PauloSão Paulo, Brazil
| | - Gilson Vieira
- NIF/LIM44, Departamento de Radiologia da Faculdade de Medicina da Universidade de São PauloSão Paulo, Brazil
| | - Adam McNamara
- School of Psychology, University Of SurreyGuildford, UK
| | - Annette Sterr
- School of Psychology, University Of SurreyGuildford, UK
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84
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Zhu DC, Covassin T, Nogle S, Doyle S, Russell D, Pearson RL, Monroe J, Liszewski CM, DeMarco JK, Kaufman DI. A potential biomarker in sports-related concussion: brain functional connectivity alteration of the default-mode network measured with longitudinal resting-state fMRI over thirty days. J Neurotrauma 2014; 32:327-41. [PMID: 25116397 DOI: 10.1089/neu.2014.3413] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Current diagnosis and monitoring of sports-related concussion rely on clinical signs and symptoms, and balance, vestibular, and neuropsychological examinations. Conventional brain imaging often does not reveal abnormalities. We sought to assess if the longitudinal change of functional and structural connectivity of the default-mode network (DMN) can serve as a potential biomarker. Eight concussed Division I collegiate football student-athletes in season (one participated twice) and 11 control subjects participated in this study. ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) was administered over the course of recovery. High-resolution three dimensional T1-weighted, T2*-weighted diffusion-tensor images and resting-state functional magnetic resonance imaging (rs-fMRI) scans were collected from each subject within 24 h, 7±1 d and 30±1 d after concussion. Both network based and whole-brain based functional correlation analyses on DMN were performed. ImPACT findings demonstrated significant cognitive impairment across multiple categories and a significant increase of symptom severity on Day 1 following a concussion but full recovery by 6.0±2.4 d. While the structural connectivity within DMN and gross anatomy appeared unchanged, a significantly reduced functional connectivity within DMN from Day 1 to Day 7 was found in the concussed group in this small pilot study. This reduction was seen in eight of our nine concussion cases. Compared with the control group, there appears a general trend of increased DMN functional connectivity on Day 1, a significant drop on Day 7, and partial recovery on Day 30. The results of this pilot study suggest that the functional connectivity of DMN measured with longitudinal rs-fMRI can serve as a potential biomarker to monitor the dynamically changing brain function after sports-related concussion, even in patients who have shown clinical improvement.
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Affiliation(s)
- David C Zhu
- 1 Department of Radiology, Michigan State University , East Lansing, Michigan
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85
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Functional magnetic resonance imaging of mild traumatic brain injury. Neurosci Biobehav Rev 2014; 49:8-18. [PMID: 25434880 DOI: 10.1016/j.neubiorev.2014.11.016] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/02/2014] [Accepted: 11/20/2014] [Indexed: 12/12/2022]
Abstract
Functional magnetic resonance imaging (fMRI) offers great promise for elucidating the neuropathology associated with a single or repetitive mild traumatic brain injury (mTBI). The current review discusses the physiological underpinnings of the blood-oxygen level dependent response and how trauma affects the signal. Methodological challenges associated with fMRI data analyses are considered next, followed by a review of current mTBI findings. The majority of evoked studies have examined working memory and attentional functioning, with results suggesting a complex relationship between cognitive load/attentional demand and neuronal activation. Researchers have more recently investigated how brain trauma affects functional connectivity, and the benefits/drawbacks of evoked and functional connectivity studies are also discussed. The review concludes by discussing the major clinical challenges associated with fMRI studies of brain-injured patients, including patient heterogeneity and variations in scan-time post-injury. We conclude that the fMRI signal represents a complex filter through which researchers can measure the physiological correlates of concussive symptoms, an important goal for the burgeoning field of mTBI research.
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86
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Zhu D, Zhang T, Jiang X, Hu X, Chen H, Yang N, Lv J, Han J, Guo L, Liu T. Fusing DTI and fMRI data: a survey of methods and applications. Neuroimage 2014; 102 Pt 1:184-91. [PMID: 24103849 PMCID: PMC4012015 DOI: 10.1016/j.neuroimage.2013.09.071] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 05/20/2013] [Accepted: 09/27/2013] [Indexed: 01/20/2023] Open
Abstract
The relationship between brain structure and function has been one of the centers of research in neuroimaging for decades. In recent years, diffusion tensor imaging (DTI) and functional magnetic resonance imaging (fMRI) techniques have been widely available and popular in cognitive and clinical neurosciences for examining the brain's white matter (WM) micro-structures and gray matter (GM) functions, respectively. Given the intrinsic integration of WM/GM and the complementary information embedded in DTI/fMRI data, it is natural and well-justified to combine these two neuroimaging modalities together to investigate brain structure and function and their relationships simultaneously. In the past decade, there have been remarkable achievements of DTI/fMRI fusion methods and applications in neuroimaging and human brain mapping community. This survey paper aims to review recent advancements on methodologies and applications in incorporating multimodal DTI and fMRI data, and offer our perspectives on future research directions. We envision that effective fusion of DTI/fMRI techniques will play increasingly important roles in neuroimaging and brain sciences in the years to come.
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Affiliation(s)
- Dajiang Zhu
- Cortical Architecture Imaging and Discovery Lab, Department of Computer Science, The University of Georgia, Athens, GA, USA
| | - Tuo Zhang
- School of Automation, Northwestern Polytechnical University, Xi'an, China
| | - Xi Jiang
- Cortical Architecture Imaging and Discovery Lab, Department of Computer Science, The University of Georgia, Athens, GA, USA
| | - Xintao Hu
- School of Automation, Northwestern Polytechnical University, Xi'an, China
| | - Hanbo Chen
- Cortical Architecture Imaging and Discovery Lab, Department of Computer Science, The University of Georgia, Athens, GA, USA
| | - Ning Yang
- School of Automation, Northwestern Polytechnical University, Xi'an, China
| | - Jinglei Lv
- School of Automation, Northwestern Polytechnical University, Xi'an, China
| | - Junwei Han
- School of Automation, Northwestern Polytechnical University, Xi'an, China
| | - Lei Guo
- School of Automation, Northwestern Polytechnical University, Xi'an, China
| | - Tianming Liu
- Cortical Architecture Imaging and Discovery Lab, Department of Computer Science, The University of Georgia, Athens, GA, USA; BioImaging Research Center, The University of Georgia, Athens, GA, USA
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87
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Sinopoli KJ, Chen JK, Wells G, Fait P, Ptito A, Taha T, Keightley M. Imaging “Brain Strain” in Youth Athletes with Mild Traumatic Brain Injury during Dual-Task Performance. J Neurotrauma 2014; 31:1843-59. [DOI: 10.1089/neu.2014.3326] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Katia J. Sinopoli
- Department of Psychology, Division of Neurology, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jen-Kai Chen
- McGill University Health Centre and Montreal Neurological Institute, Montreal, Quebec, Canada
| | - Greg Wells
- Department of Kinesiology and Physical Education, University of Toronto, Ontario, Canada
- Department of Physiology and Experimental Medicine, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Philippe Fait
- Department of Physical Activity Science, University of Quebec at Trois-Rivières, Canada
- Research Group on Neuromusculoskeletal Dysfunctions, University of Quebec at Trois-Rivières, Canada
| | - Alain Ptito
- McGill University Health Centre and Montreal Neurological Institute, Montreal, Quebec, Canada
| | - Tim Taha
- Department of Kinesiology and Physical Education, University of Toronto, Ontario, Canada
| | - Michelle Keightley
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy and Graduate Department of Rehabilitation Science and Psychology, University of Toronto, Ontario, Canada
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88
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Tremblay S, Henry LC, Bedetti C, Larson-Dupuis C, Gagnon JF, Evans AC, Théoret H, Lassonde M, De Beaumont L. Diffuse white matter tract abnormalities in clinically normal ageing retired athletes with a history of sports-related concussions. Brain 2014; 137:2997-3011. [PMID: 25186429 PMCID: PMC4208464 DOI: 10.1093/brain/awu236] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/20/2014] [Accepted: 07/14/2014] [Indexed: 12/14/2022] Open
Abstract
Sports-related concussions have been shown to lead to persistent subclinical anomalies of the motor and cognitive systems in young asymptomatic athletes. In advancing age, these latent alterations correlate with detectable motor and cognitive function decline. Until now, the interacting effects of concussions and the normal ageing process on white matter tract integrity remain unknown. Here we used a tract-based spatial statistical method to uncover potential white matter tissue damage in 15 retired athletes with a history of concussions, free of comorbid medical conditions. We also investigated potential associations between white matter integrity and declines in cognitive and motor functions. Compared to an age- and education-matched control group of 15 retired athletes without concussions, former athletes with concussions exhibited widespread white matter anomalies along many major association, interhemispheric, and projection tracts. Group contrasts revealed decreases in fractional anisotropy, as well as increases in mean and radial diffusivity measures in the concussed group. These differences were primarily apparent in fronto-parietal networks as well as in the frontal aspect of the corpus callosum. The white matter anomalies uncovered in concussed athletes were significantly associated with a decline in episodic memory and lateral ventricle expansion. Finally, the expected association between frontal white matter integrity and motor learning found in former non-concussed athletes was absent in concussed participants. Together, these results show that advancing age in retired athletes presenting with a history of sports-related concussions is linked to diffuse white matter abnormalities that are consistent with the effects of traumatic axonal injury and exacerbated demyelination. These changes in white matter integrity might explain the cognitive and motor function declines documented in this population.
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Affiliation(s)
- Sebastien Tremblay
- 1 Integrated Program in Neuroscience, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Luke C Henry
- 2 University of Pittsburgh Medical Centre, Pittsburgh, PA, USA
| | | | - Camille Larson-Dupuis
- 3 Hôpital du Sacré-Coeur de Montréal Research Center, Montreal, Canada 4 Department of Psychology, Université de Montréal, Montreal, Canada
| | - Jean-François Gagnon
- 3 Hôpital du Sacré-Coeur de Montréal Research Center, Montreal, Canada 5 Department of Psychology, Université du Québec à Montréal, Montréal, Canada
| | - Alan C Evans
- 6 McConnell Brain Imaging Centre, McGill University, Montréal, Canada 7 Montreal Neurological Institute, Montréal, Canada
| | - Hugo Théoret
- 4 Department of Psychology, Université de Montréal, Montreal, Canada 8 Centre de recherche en Neuropsychologie et Cognition, Université de Montréal, Montreal, Canada
| | - Maryse Lassonde
- 4 Department of Psychology, Université de Montréal, Montreal, Canada 8 Centre de recherche en Neuropsychologie et Cognition, Université de Montréal, Montreal, Canada
| | - Louis De Beaumont
- 3 Hôpital du Sacré-Coeur de Montréal Research Center, Montreal, Canada 9 Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
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90
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Poole VN, Abbas K, Shenk TE, Breedlove EL, Breedlove KM, Robinson ME, Leverenz LJ, Nauman EA, Talavage TM, Dydak U. MR Spectroscopic Evidence of Brain Injury in the Non-Diagnosed Collision Sport Athlete. Dev Neuropsychol 2014; 39:459-73. [DOI: 10.1080/87565641.2014.940619] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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91
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Abstract
This article focuses on advancements in neuroimaging techniques, compares the advantages of each of the modalities in the evaluation of mild traumatic brain injury, and discusses their contribution to our understanding of the pathophysiology as it relates to prognosis. Advanced neuroimaging techniques discussed include anatomic/structural imaging techniques, such as diffusion tensor imaging and susceptibility-weighted imaging, and functional imaging techniques, such as functional magnetic resonance imaging, perfusion-weighted imaging, magnetic resonance spectroscopy, and positron emission tomography.
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Affiliation(s)
- Laszlo L Mechtler
- Department of Neurology and Neuro-Oncology, State University of New York at Buffalo, 3435 Main Street, Buffalo, NY 14223, USA; Dent Neurologic Institute, 3980A Sheridan Drive, Suite 101, Amherst, NY 14226, USA.
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92
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Narayana PA, Yu X, Hasan KM, Wilde EA, Levin HS, Hunter JV, Miller ER, Patel VKS, Robertson CS, McCarthy JJ. Multi-modal MRI of mild traumatic brain injury. Neuroimage Clin 2014; 7:87-97. [PMID: 25610770 PMCID: PMC4299969 DOI: 10.1016/j.nicl.2014.07.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/20/2014] [Accepted: 07/22/2014] [Indexed: 11/26/2022]
Abstract
Multi-modal magnetic resonance imaging (MRI) that included high resolution structural imaging, diffusion tensor imaging (DTI), magnetization transfer ratio (MTR) imaging, and magnetic resonance spectroscopic imaging (MRSI) were performed in mild traumatic brain injury (mTBI) patients with negative computed tomographic scans and in an orthopedic-injured (OI) group without concomitant injury to the brain. The OI group served as a comparison group for mTBI. MRI scans were performed both in the acute phase of injury (~24 h) and at follow-up (~90 days). DTI data was analyzed using tract based spatial statistics (TBSS). Global and regional atrophies were calculated using tensor-based morphometry (TBM). MTR values were calculated using the standard method. MRSI was analyzed using LC Model. At the initial scan, the mean diffusivity (MD) was significantly higher in the mTBI cohort relative to the comparison group in several white matter (WM) regions that included internal capsule, external capsule, superior corona radiata, anterior corona radiata, posterior corona radiata, inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, forceps major and forceps minor of the corpus callosum, superior longitudinal fasciculus, and corticospinal tract in the right hemisphere. TBSS analysis failed to detect significant differences in any DTI measures between the initial and follow-up scans either in the mTBI or OI group. No significant differences were found in MRSI, MTR or morphometry between the mTBI and OI cohorts either at the initial or follow-up scans with or without family wise error (FWE) correction. Our study suggests that a number of WM tracts are affected in mTBI in the acute phase of injury and that these changes disappear by 90 days. This study also suggests that none of the MRI-modalities used in this study, with the exception of DTI, is sensitive in detecting changes in the acute phase of mTBI.
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Key Words
- Diffusion tensor imaging
- Magnetic resonance imaging
- Magnetic resonance spectroscopic imaging
- Magnetization transfer ratio
- Mild traumatic brain injury
- Orthopedic injury
- Tensor based morphometry
- acr, anterior region of corona radiata
- alic, anterior limb of internal capsule
- cc, corpus callosum
- cg, cingulate gyrus
- cs, centrum semiovale
- cst, corticospinal tract
- ec, external capsule
- ic, internal capsule
- ifo, inferior fronto-occipital fasciculus
- ilf, inferior longitudinal fasciculus
- jlc, juxtapositional lobule cortex
- mfg, superior frontal gyrus
- pcg, paracingulate gyrus
- pcr, posterior region of corona radiata
- plic, posterior limb of internal capsule
- scr, superior region of corona radiata
- sfg, superior frontal gyrus
- sfo, superior fronto-occipital fasciculus
- slf, superior longitudinal fasciculus
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Affiliation(s)
- Ponnada A. Narayana
- Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Xintian Yu
- Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Khader M. Hasan
- Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Elisabeth A. Wilde
- Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Harvey S. Levin
- Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | | | - Emmy R. Miller
- Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Vipul Kumar S. Patel
- Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - James J. McCarthy
- Emergency Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
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93
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Bennett RE, Brody DL. Acute reduction of microglia does not alter axonal injury in a mouse model of repetitive concussive traumatic brain injury. J Neurotrauma 2014; 31:1647-63. [PMID: 24797413 DOI: 10.1089/neu.2013.3320] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The pathological processes that lead to long-term consequences of multiple concussions are unclear. Primary mechanical damage to axons during concussion is likely to contribute to dysfunction. Secondary damage has been hypothesized to be induced or exacerbated by inflammation. The main inflammatory cells in the brain are microglia, a type of macrophage. This research sought to determine the contribution of microglia to axon degeneration after repetitive closed-skull traumatic brain injury (rcTBI) using CD11b-TK (thymidine kinase) mice, a valganciclovir-inducible model of macrophage depletion. Low-dose (1 mg/mL) valganciclovir was found to reduce the microglial population in the corpus callosum and external capsule by 35% after rcTBI in CD11b-TK mice. At both acute (7 days) and subacute (21 days) time points after rcTBI, reduction of the microglial population did not alter the extent of axon injury as visualized by silver staining. Further reduction of the microglial population by 56%, using an intermediate dose (10 mg/mL), also did not alter the extent of silver staining, amyloid precursor protein accumulation, neurofilament labeling, or axon injury evident by electron microscopy at 7 days postinjury. Longer treatment of CD11b-TK mice with intermediate dose and treatment for 14 days with high-dose (50 mg/mL) valganciclovir were both found to be toxic in this injury model. Altogether, these data are most consistent with the idea that microglia do not contribute to acute axon degeneration after multiple concussive injuries. The possibility of longer-term effects on axon structure or function cannot be ruled out. Nonetheless, alternative strategies directly targeting injury to axons may be a more beneficial approach to concussion treatment than targeting secondary processes of microglial-driven inflammation.
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Affiliation(s)
- Rachel E Bennett
- Department of Neurology, Washington University , St. Louis, Missouri
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94
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Chamard E, Lassonde M, Henry L, Tremblay J, Boulanger Y, De Beaumont L, Théoret H. Neurometabolic and microstructural alterations following a sports-related concussion in female athletes. Brain Inj 2014; 27:1038-46. [PMID: 23834633 DOI: 10.3109/02699052.2013.794968] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Sports-related concussions are a major public health concern affecting millions of individuals annually. Neurometabolic and microstructural alterations have been reported in the chronic phase following a concussion in male athletes, while no study has investigated these alterations in female athletes. METHODS Neurometabolic and microstructural alterations following a concussion were investigated by comparing 10 female athletes with a concussion and 10 control female athletes, using magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI). Athletes with concussion were scanned at least 7 months post-concussion (mean = 18.9 months). RESULTS MRS revealed a significant lower level of myo-inositol in the hippocampus and the primary motor cortices (M1) bilaterally. DTI analysis using Tract-Based Spatial Statistics (TBSS) showed no difference in fractional anisotropy (FA) while higher level of mean diffusivity (MD) in athletes with concussion was detected in large white matter tracts including the forceps minors, inferior/superior longitudinal fasciculi, inferior fronto-occipital fasciculus, cingulum, uncinate fasciculus, anterior thalamic radiations and corticospinal tract. Moreover, a region of interest approach for the corpus callosum revealed a significant lower level of FA in the segment containing fibres projecting to M1. CONCLUSIONS This study demonstrates persistent neurometabolic and microstructural alterations in female athletes suffering a sports-related concussion.
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Affiliation(s)
- Emilie Chamard
- Centre de Recherche en Neuropsychologie et Cognition, Department of Psychology, University of Montreal, Montréal, Québec, Canada.
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95
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Dimou S, Lagopoulos J. Toward objective markers of concussion in sport: a review of white matter and neurometabolic changes in the brain after sports-related concussion. J Neurotrauma 2014; 31:413-24. [PMID: 24266534 DOI: 10.1089/neu.2013.3050] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Abstract Sports-related concussion is an issue that has piqued the public's attention of late as concerns surrounding potential long-term sequelae as well as new methods of characterizing the effects of this form of injury continue to develop. For the most part, diagnosis of concussion is based on subjective clinical measures and thus is prone to under-reporting. In the current environment, where conventional imaging modalities, such as computed tomography and magnetic resonance imaging, are unable to elucidate the degree of white matter damage and neurometabolic change, a discussion of two advanced imaging techniques-diffusion tensor imaging (DTI) and magnetic resonance spectroscopy (MRS)-is undertaken with a view to highlighting their potential utility. Our aim is to outline a variety of the approaches to concussion research that have been employed, with special attention given to the clinical considerations and acute complications attributed to concussive injury. DTI and MRS have been at the forefront of research as a result of their noninvasiveness and ease of acquisition, and hence it is thought that the use of these neuroimaging modalities has the potential to aid clinical decision making and management, including guiding return-to-play protocols.
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Affiliation(s)
- Stefan Dimou
- 1 Brain and Mind Research Institute, The University of Sydney , Camperdown, New South Wales, Australia
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96
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Rabinowitz AR, Li X, Levin HS. Sport and Nonsport Etiologies of Mild Traumatic Brain Injury: Similarities and Differences. Annu Rev Psychol 2014; 65:301-31. [DOI: 10.1146/annurev-psych-010213-115103] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Amanda R. Rabinowitz
- Department of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104;
| | - Xiaoqi Li
- Physical Medicine and Rehabilitation Alliance, Baylor College of Medicine and the University of Texas-Houston Medical School, Houston, Texas 77030
| | - Harvey S. Levin
- Physical Medicine and Rehabilitation Alliance, Baylor College of Medicine and the University of Texas-Houston Medical School, Houston, Texas 77030
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97
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Wäljas M, Lange RT, Hakulinen U, Huhtala H, Dastidar P, Hartikainen K, Öhman J, Iverson GL. Biopsychosocial Outcome after Uncomplicated Mild Traumatic Brain Injury. J Neurotrauma 2014; 31:108-24. [DOI: 10.1089/neu.2013.2941] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Minna Wäljas
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland
- University of Tampere Medical School, Tampere, Finland
| | - Rael T. Lange
- University of British Columbia, Vancouver, Canada
- Defense and Veterans Brain Injury Center, North Bethesda, Maryland
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Ullamari Hakulinen
- Department of Radiology, Medical Imaging Centre and Hospital Pharmacy, Tampere University Hospital, Tampere, Finland
- Department of Electronics and Communications Engineering, Tampere University of Technology, Tampere, Finland
| | - Heini Huhtala
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Prasun Dastidar
- University of Tampere Medical School, Tampere, Finland
- Department of Radiology, Medical Imaging Centre and Hospital Pharmacy, Tampere University Hospital, Tampere, Finland
| | - Kaisa Hartikainen
- Behavioral Neurology Research Unit, Pirkanmaa Hospital District, Tampere, Finland
| | - Juha Öhman
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland
- University of Tampere Medical School, Tampere, Finland
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School; Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts
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98
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McAllister TW, Ford JC, Flashman LA, Maerlender A, Greenwald RM, Beckwith JG, Bolander RP, Tosteson TD, Turco JH, Raman R, Jain S. Effect of head impacts on diffusivity measures in a cohort of collegiate contact sport athletes. Neurology 2013; 82:63-9. [PMID: 24336143 DOI: 10.1212/01.wnl.0000438220.16190.42] [Citation(s) in RCA: 174] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether exposure to repetitive head impacts over a single season affects white matter diffusion measures in collegiate contact sport athletes. METHODS A prospective cohort study at a Division I NCAA athletic program of 80 nonconcussed varsity football and ice hockey players who wore instrumented helmets that recorded the acceleration-time history of the head following impact, and 79 non-contact sport athletes. Assessment occurred preseason and shortly after the season with diffusion tensor imaging and neurocognitive measures. RESULTS There was a significant (p = 0.011) athlete-group difference for mean diffusivity (MD) in the corpus callosum. Postseason fractional anisotropy (FA) differed (p = 0.001) in the amygdala (0.238 vs 0.233). Measures of head impact exposure correlated with white matter diffusivity measures in several brain regions, including the corpus callosum, amygdala, cerebellar white matter, hippocampus, and thalamus. The magnitude of change in corpus callosum MD postseason was associated with poorer performance on a measure of verbal learning and memory. CONCLUSION This study suggests a relationship between head impact exposure, white matter diffusion measures, and cognition over the course of a single season, even in the absence of diagnosed concussion, in a cohort of college athletes. Further work is needed to assess whether such effects are short term or persistent.
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Affiliation(s)
- Thomas W McAllister
- From the Departments of Psychiatry (T.W.M., J.C.F., L.A.F., A.M.), Community and Family Medicine (T.D.T.), and Medicine (J.H.T.), Geisel School of Medicine at Dartmouth College, Hanover, NH; Simbex, LLC (R.M.G., J.G.B., R.P.B.), Lebanon, NH; Thayer School of Engineering (R.M.G.), Dartmouth College, Hanover, NH; and Biostatistics Research Center (R.R., S.J.), Department of Family and Preventive Medicine, University of California, San Diego
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99
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Lange RT, Shewchuk JR, Heran MKS, Rauscher A, Jarrett M, Brubacher JR, Iverson GL. To exclude or not to exclude: further examination of the influence of white matter hyperintensities in diffusion tensor imaging research. J Neurotrauma 2013; 31:198-205. [PMID: 23952763 DOI: 10.1089/neu.2013.2866] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
White matter hyperintensities (WMHIs) visible on magnetic resonance imaging (MRI) are common in both healthy adults and in those with medical or psychiatric problems. A practical methodological issue for diffusion tensor imaging (DTI) researchers is whether to include, or exclude, participants from a control group who have WMHIs. The aim of this study was to compare the influence of WMHIs on whole-brain DTI in trauma control subjects. Participants were 48 patients (no-WMHIs, n=36; 2+WMHIs, n=12) prospectively recruited from the Emergency Department of Vancouver General Hospital (British Columbia, Canada). Participants completed an MRI brain scan at 6-8 weeks postinjury (mean, 47.3 days; standard deviation [SD], 6.2; range, 39-66). DTI was used to examine the integrity of white matter (WM) in 50 regions of the brain using measures of fractional anisotropy (FA), and mean (MD), radial (RD), and axial (AD) diffusivity. FA values that were >2 SDs below the mean, and MD, RD, and AD values that were >2 SDs above the mean, were classified as "abnormal scores" indicative of reduced WM integrity. In the entire sample, the 2+WMHI group had a greater number of abnormal FA, MD, and RD scores, compared to the no-WMHI group (p<0.015 and Cohen's d >0.82, indicating large to very large effect sizes, for all comparisons). When controlling for the effects of age using a matched-groups design, the 2+WMHI group still had a significantly greater number of abnormal FA, MD, and RD scores, compared to the no-WMHI group (all p<0.012, all d >0.89, large to very large effect sizes). Researchers should be aware that the inclusion or exclusion of subjects with incidental WMHIs will influence the results of DTI studies.
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Affiliation(s)
- Rael T Lange
- 1 Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center , Bethesda, Maryland
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100
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Dettwiler A, Murugavel M, Putukian M, Cubon V, Furtado J, Osherson D. Persistent differences in patterns of brain activation after sports-related concussion: a longitudinal functional magnetic resonance imaging study. J Neurotrauma 2013; 31:180-8. [PMID: 23914845 DOI: 10.1089/neu.2013.2983] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Avoiding recurrent injury in sports-related concussion (SRC) requires understanding the neural mechanisms involved during the time of recovery after injury. The decision for return-to-play is one of the most difficult responsibilities facing the physician, and so far this decision has been based primarily on neurological examination, symptom checklists, and neuropsychological (NP) testing. Functional magnetic resonance imaging (fMRI) may be an additional, more objective tool to assess the severity and recovery of function after concussion. The purpose of this study was to define neural correlates of SRC during the 2 months after injury in varsity contact sport athletes who suffered a SRC. All athletes were scanned as they performed an n-back task, for n=1, 2, 3. Subjects were scanned within 72 hours (session one), at 2 weeks (session two), and 2 months (session three) post-injury. Compared with age and sex matched normal controls, concussed subjects demonstrated persistent, significantly increased activation for the 2 minus 1 n-back contrast in bilateral dorsolateral prefrontal cortex (DLPFC) in all three sessions and in the inferior parietal lobe in session one and two (α≤0.01 corrected). Measures of task performance revealed no significant differences between concussed versus control groups at any of the three time points with respect to any of the three n-back tasks. These findings suggest that functional brain activation differences persist at 2 months after injury in concussed athletes, despite the fact that their performance on a standard working memory task is comparable to normal controls and normalization of clinical and NP test results. These results might indicate a delay between neural and behaviorally assessed recovery after SRC.
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Affiliation(s)
- Annegret Dettwiler
- 1 Princeton Neuroscience Institute, Princeton University , Princeton, New Jersey
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