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Bastgen T, Evers J, Oedekoven C, Weide C, Herzog L, Ashton N, Zetterberg H, Blennow K, Albus A, Vidovic N, Kraff O, Deuschl C, Dodel R, Ross JA. Repetitive head injuries in German American football players do not change blood-based biomarker candidates for CTE during a single season. Neurol Res Pract 2024; 6:13. [PMID: 38419110 PMCID: PMC10903054 DOI: 10.1186/s42466-024-00307-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/28/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Repetitive traumatic brain injuries in American football players (AFPs) can lead to the neurodegenerative disease chronic traumatic encephalopathy (CTE). Clinical symptoms of CTE range from mood and behavioral changes to cognitive impairment, depression, and suicidality. So far, CTE cannot be diagnosed in vivo and thus specific diagnostic parameters for CTE need to be found, to observe and treat exposed athletes as early as possible. Promising blood-based biomarkers for CTE include total tau (tTau), hyperphosphorylated tau (pTau), neurofilament light protein (NF-L), glial fibrillary acidic protein (GFAP), amyloid-β40 (Aβ40), amyloid-β42 (Aβ42) and calcium-binding protein B (S100-B). Previous studies have found elevated levels of these biomarkers in subjects exposed to TBIs, whereas cerebrospinal fluid (CSF) levels of Aβ40 and Aβ42 were decreased in CTE subjects. Here, we investigated whether young AFPs already exhibit changes of these biomarker candidates during the course of a single active season. METHODS Blood samples were drawn from n = 18 American Football Players before and after a full season and n = 18 male age-matched control subjects. The plasma titers of tTau, pTau, NF-L, GFAP, Aβ40, Aβ42 and S100-B were determined. Additionally, Apathy, Depression, and Health status as well as the concussion history and medical care were assessed and analyzed for correlations. RESULTS Here we show, that the selected biomarker candidates for CTE do not change significantly during the seven-month period of a single active season of American Football in blood samples of AFPs compared to healthy controls. But interestingly, they exhibit generally elevated pTau titers. Furthermore, we found correlations of depression, quality-of-life, career length, training participation and training continuation with headache after concussion with various titers. CONCLUSION Our data indicates, that changes of CTE marker candidates either occur slowly over several active seasons of American Football or are exclusively found in CSF. Nevertheless, our results underline the importance of a long-term assessment of these biomarker candidates, which might be possible through repeated blood biomarker monitoring in exposed athletes in the future.
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Affiliation(s)
- Theres Bastgen
- Department of Geriatric Medicine and Center for Translational and Behavioral Neuroscience, University Duisburg-Essen, Essen, Germany
| | - Janis Evers
- Department of Geriatric Medicine and Center for Translational and Behavioral Neuroscience, University Duisburg-Essen, Essen, Germany
- Institute for Health Services Research and Clinical Epidemiology (IVE), Philipps-University, Marburg, Germany
| | - Christiane Oedekoven
- Department of Geriatric Medicine and Center for Translational and Behavioral Neuroscience, University Duisburg-Essen, Essen, Germany
| | - Caroline Weide
- Department of Radiology, University Hospital Essen, Essen, Germany
| | - Lars Herzog
- Department of Radiology, University Hospital Essen, Essen, Germany
| | - Nicholas Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
- Institute of Psychiatry, Psychology and Neuroscience Maurice Wohl Institute Clinical Neuroscience Institute, King's College London, London, UK
- NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation, London, UK
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin, University of Wisconsin-Madison, Madison, WI, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Alexandra Albus
- Therapy Research in Neurogeriatrics, Chair of Geriatric Medicine, University Duisburg-Essen, Virchowstrasse 171, 45174, Essen, Germany
| | - Natasha Vidovic
- Therapy Research in Neurogeriatrics, Chair of Geriatric Medicine, University Duisburg-Essen, Virchowstrasse 171, 45174, Essen, Germany
| | - Oliver Kraff
- Erwin L. Hahn Institute for MR Imaging, University of Duisburg-Essen, Essen, Germany
| | | | - Richard Dodel
- Department of Geriatric Medicine and Center for Translational and Behavioral Neuroscience, University Duisburg-Essen, Essen, Germany.
- Therapy Research in Neurogeriatrics, Chair of Geriatric Medicine, University Duisburg-Essen, Virchowstrasse 171, 45174, Essen, Germany.
| | - J Alexander Ross
- Department of Geriatric Medicine and Center for Translational and Behavioral Neuroscience, University Duisburg-Essen, Essen, Germany
- Therapy Research in Neurogeriatrics, Chair of Geriatric Medicine, University Duisburg-Essen, Virchowstrasse 171, 45174, Essen, Germany
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Dhote VV, Samundre P, Upaganlawar AB, Ganeshpurkar A. Gene Therapy for Chronic Traumatic Brain Injury: Challenges in Resolving Long-term Consequences of Brain Damage. Curr Gene Ther 2023; 23:3-19. [PMID: 34814817 DOI: 10.2174/1566523221666211123101441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 02/08/2023]
Abstract
The gene therapy is alluring not only for CNS disorders but also for other pathological conditions. Gene therapy employs the insertion of a healthy gene into the identified genome to replace or replenish genes responsible for pathological disorder or damage due to trauma. The last decade has seen a drastic change in the understanding of vital aspects of gene therapy. Despite the complexity of traumatic brain injury (TBI), the advent of gene therapy in various neurodegenerative disorders has reinforced the ongoing efforts of alleviating TBI-related outcomes with gene therapy. The review highlights the genes modulated in response to TBI and evaluates their impact on the severity and duration of the injury. We have reviewed strategies that pinpointed the most relevant gene targets to restrict debilitating events of brain trauma and utilize vector of choice to deliver the gene of interest at the appropriate site. We have made an attempt to summarize the long-term neurobehavioral consequences of TBI due to numerous pathometabolic perturbations associated with a plethora of genes. Herein, we shed light on the basic pathological mechanisms of brain injury, genetic polymorphism in individuals susceptible to severe outcomes, modulation of gene expression due to TBI, and identification of genes for their possible use in gene therapy. The review also provides insights on the use of vectors and challenges in translations of this gene therapy to clinical practices.
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Affiliation(s)
- Vipin V Dhote
- Faculty of Pharmacy, VNS Group of Institutions, Bhopal, MP, 462044, India
| | - Prem Samundre
- Faculty of Pharmacy, VNS Group of Institutions, Bhopal, MP, 462044, India
| | - Aman B Upaganlawar
- SNJB's Shree Sureshdada Jain College of Pharmacy, Chandwad, Nasik, Maharashtra, 423101, India
| | - Aditya Ganeshpurkar
- Department of Pharmacy, Shri Ram Institute of Technology, Jabalpur, MP, India
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3
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Mustafi SM, Yang HC, Harezlak J, Meier TB, Brett BL, Giza CC, Goldman J, Guskiewicz KM, Mihalik JP, LaConte SM, Duma SM, Broglio SP, McCrea MA, McAllister TW, Wu YC. Effects of White-Matter Tract Length in Sport-Related Concussion: A Tractography Study from the NCAA-DoD CARE Consortium. J Neurotrauma 2022; 39:1495-1506. [PMID: 35730116 PMCID: PMC9689766 DOI: 10.1089/neu.2021.0239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Sport-related concussion (SRC) is an important public health issue. White-matter alterations after SRC are widely studied by neuroimaging approaches, such as diffusion magnetic resonance imaging (MRI). Although the exact anatomical location of the alterations may differ, significant white-matter alterations are commonly observed in long fiber tracts, but are never proven. In the present study, we performed streamline tractography to characterize the association between tract length and white-matter microstructural alterations after SRC. Sixty-eight collegiate athletes diagnosed with acute concussion (24-48 h post-injury) and 64 matched contact-sport controls were included in this study. The athletes underwent diffusion tensor imaging (DTI) in 3.0 T MRI scanners across three study sites. DTI metrics were used for tract-based spatial statistics to map white-matter regions-of-interest (ROIs) with significant group differences. Whole-brain white-mater streamline tractography was performed to extract "affected" white-matter streamlines (i.e., streamlines passing through the identified ROIs). In the concussed athletes, streamline counts and DTI metrics of the affected white-matter fiber tracts were summarized and compared with unaffected white-matter tracts across tract length in the same participant. The affected white-matter tracts had a high streamline count at length of 80-100 mm and high length-adjusted affected ratio for streamline length longer than 80 mm. DTI mean diffusivity was higher in the affected streamlines longer than 100 mm with significant associations with the Brief Symptom Inventory score. Our findings suggest that long fibers in the brains of collegiate athletes are more vulnerable to acute SRC with higher mean diffusivity and a higher affected ratio compared with the whole distribution.
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Affiliation(s)
- Sourajit M. Mustafi
- Institute of Genetics, San Diego, California, USA
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ho-Ching Yang
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Timothy B. Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Benjamin L. Brett
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christopher C. Giza
- Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
- Division of Pediatric Neurology, Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, California, USA
| | - Joshua Goldman
- Family Medicine, Ronald Reagan UCLA Medical Center, UCLA Health - Santa Monica Medical Center, Los Angeles, California, USA
| | - Kevin M. Guskiewicz
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina, at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jason P. Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina, at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephen M. LaConte
- School of Biomedical Engineering and Sciences, Wake-Forest and Virginia Tech University, Blacksburg, Virginia, USA
- Virginia Tech Carilion Research Institute, Roanoke, Virginia, USA
| | - Stefan M. Duma
- School of Biomedical Engineering and Sciences, Wake-Forest and Virginia Tech University, Blacksburg, Virginia, USA
| | - Steven P. Broglio
- Michigan Concussion Center, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael A. McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Thomas W. McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Yu-Chien Wu
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Relationship Between Time-Weighted Head Impact Exposure on Directional Changes in Diffusion Imaging in Youth Football Players. Ann Biomed Eng 2021; 49:2852-2862. [PMID: 34549344 PMCID: PMC8978207 DOI: 10.1007/s10439-021-02862-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/26/2021] [Indexed: 01/04/2023]
Abstract
Approximately 3.5 million youth and adolescents in the US play football, a sport with one of the highest rates of concussion. Repeated subconcussive head impact exposure (HIE) may lead to negative neurological sequelae. To understand HIE as an independent predictive variable, quantitative cumulative kinematic metrics have been developed to capture the volume (i.e., number), severity (i.e., magnitude), and frequency (i.e., time-weighting by the interval between head impacts). In this study, time-weighted cumulative HIE metrics were compared with directional changes in diffusion tensor imaging (DTI) metrics. Changes in DTI conducted on a per-season, per-player basis were assessed as a dependent variable. Directional changes were defined separately as increases and decreases in the number of abnormal voxels relative to non-contact sport controls. Biomechanical and imaging data from 117 athletes (average age 11.9 ± 1.0 years) enrolled in this study was analyzed. Cumulative HIE metrics were more strongly correlated with increases in abnormal voxels than decreases in abnormal voxels. Additionally, across DTI sub-measures, increases and decreases in mean diffusivity (MD) had the strongest relationships with HIE metrics (increases in MD: average R2 = 0.1753, average p = 0.0002; decreases in MD: average R2 = 0.0997, average p = 0.0073). This encourages further investigation into the physiological phenomena represented by directional changes.
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Dhote VV, Raja MKMM, Samundre P, Sharma S, Anwikar S, Upaganlawar AB. Sports Related Brain Injury and Neurodegeneration in Athletes. Curr Mol Pharmacol 2021; 15:51-76. [PMID: 34515018 DOI: 10.2174/1874467214666210910114324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/03/2021] [Accepted: 06/03/2021] [Indexed: 11/22/2022]
Abstract
Sports deserve a special place in human life to impart healthy and refreshing wellbeing. However, sports activities, especially contact sports, renders athlete vulnerable to brain injuries. Athletes participating in a contact sport like boxing, rugby, American football, wrestling, and basketball are exposed to traumatic brain injuries (TBI) or concussions. The acute and chronic nature of these heterogeneous injuries provides a spectrum of dysfunctions that alters the neuronal, musculoskeletal, and behavioral responses of an athlete. Many sports-related brain injuries go unreported, but these head impacts trigger neurometabolic disruptions that contribute to long-term neuronal impairment. The pathophysiology of post-concussion and its underlying mechanisms are undergoing intense research. It also shed light on chronic disorders like Parkinson's disease, Alzheimer's disease, and dementia. In this review, we examined post-concussion neurobehavioral changes, tools for early detection of signs, and their impact on the athlete. Further, we discussed the role of nutritional supplements in ameliorating neuropsychiatric diseases in athletes.
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Affiliation(s)
- Vipin V Dhote
- Faculty of Pharmacy, VNS Group of Institutions, Bhopal, MP,462044. India
| | | | - Prem Samundre
- Faculty of Pharmacy, VNS Group of Institutions, Bhopal, MP,462044. India
| | - Supriya Sharma
- Faculty of Pharmacy, VNS Group of Institutions, Bhopal, MP,462044. India
| | - Shraddha Anwikar
- Faculty of Pharmacy, VNS Group of Institutions, Bhopal, MP,462044. India
| | - Aman B Upaganlawar
- Faculty of Pharmacy, VNS Group of Institutions, Bhopal, MP,462044. India
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6
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Clark JE, Sirois E. The possible role of hydration in concussions and long-term symptoms of concussion for athletes. A review of the evidence. JOURNAL OF CONCUSSION 2020. [DOI: 10.1177/2059700220939404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this review is to address what is known, speculated, and hypothesized regarding the issue of hydration and concussions. Based on the question, “What impact does hydration have on the relative risk for suffering concussive injuries along with long-term ramifications that have been associated with concussive (and repeated subconcussive) traumas to the cerebral cortex?,” a search of available literature was performed through June 2019. Deducing from the available literature, we can stipulate that changes in hydration within the cerebral cortex increase the likelihood for disruption of neurofilament proteins, dysregulation of membrane dynamics of the neurons and exacerbate inflammation responses following head trauma. As such, it can be speculated that differences in incidence rates may be attributed to difference in tissue fluid based on athlete demographics, level of whole-body water balance, and degree of tissue dehydration more than selection of sport. Moreover, tissue hydration in combination with other inflammation factors provides the scaffolding for the development of long-term issues (e.g. chronic traumatic encephalopathy) associated with repetitive head trauma in athletes.
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Affiliation(s)
- James E Clark
- Scientific Health: Education and Human Performance, Brentwood, CA, USA
| | - Emily Sirois
- Scientific Health: Education and Human Performance, Brentwood, CA, USA
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7
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Visual working memory deficits in undergraduates with a history of mild traumatic brain injury. Atten Percept Psychophys 2020; 81:2597-2603. [PMID: 31218600 DOI: 10.3758/s13414-019-01774-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We investigated whether a history of mild traumatic brain injury (mTBI), or concussion, has any effect on visual working memory (WM) performance. In most cases, cognitive performance is thought to return to premorbid levels soon after injury, without further medical intervention. We tested this assumption in undergraduates, among whom a history of mTBI is prevalent. Notably, participants with a history of mTBI performed worse than their colleagues with no such history. Experiment 1 was based on a change detection paradigm in which we manipulated visual WM set size from one to three items, which revealed a significant deficit at set size 3. In Experiment 2 we investigated whether feedback could rescue WM performance in the mTBI group, and found that it failed. In Experiment 3 we manipulated WM maintenance duration (set size 3, 500-1,500 ms) to investigate a maintenance-related deficit. Across all durations, the mTBI group was impaired. In Experiment 4 we tested whether retrieval demands contributed to WM deficits and showed a consistent deficit across recognition and recall probes. In short, even years after an mTBI, undergraduates perform differently on visual WM tasks than their peers with no such history. Given the prevalence of mTBI, these data may benefit other researchers who see high variability in their data. Clearly, further studies will be needed to determine the breadth of the cognitive deficits in those with a history of mTBI and to identify relevant factors that contribute to positive cognitive outcomes.
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8
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Jang I, Chun IY, Brosch JR, Bari S, Zou Y, Cummiskey BR, Lee TA, Lycke RJ, Poole VN, Shenk TE, Svaldi DO, Tamer GG, Dydak U, Leverenz LJ, Nauman EA, Talavage TM. Every hit matters: White matter diffusivity changes in high school football athletes are correlated with repetitive head acceleration event exposure. NEUROIMAGE-CLINICAL 2019; 24:101930. [PMID: 31630026 PMCID: PMC6807364 DOI: 10.1016/j.nicl.2019.101930] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 06/29/2019] [Accepted: 07/09/2019] [Indexed: 11/29/2022]
Abstract
Recent evidence of short-term alterations in brain physiology associated with repeated exposure to moderate intensity subconcussive head acceleration events (HAEs), prompts the question whether these alterations represent an underlying neural injury. A retrospective analysis combining counts of experienced HAEs and longitudinal diffusion-weighted imaging explored whether greater exposure to incident mechanical forces was associated with traditional diffusion-based measures of neural injury—reduced fractional anisotropy (FA) and increased mean diffusivity (MD). Brains of high school athletes (N = 61) participating in American football exhibited greater spatial extents (or volumes) experiencing substantial changes (increases and decreases) in both FA and MD than brains of peers who do not participate in collision-based sports (N = 15). Further, the spatial extents of the football athlete brain exhibiting traditional diffusion-based markers of neural injury were found to be significantly correlated with the cumulative exposure to HAEs having peak translational acceleration exceeding 20 g. This finding demonstrates that subconcussive HAEs induce low-level neurotrauma, with prolonged exposure producing greater accumulation of neural damage. The duration and extent of recovery associated with periods in which athletes do not experience subconcussive HAEs now represents a priority for future study, such that appropriate participation and training schedules may be developed to minimize the risk of long-term neurological dysfunction. Brain volumes evidencing injury are larger in football athletes than controls. Spatial extent of decreased FA correlates with head acceleration event exposure. Spatial extent of increased MD correlates with head acceleration event exposure.
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Affiliation(s)
- Ikbeom Jang
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America.
| | - Il Yong Chun
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Jared R Brosch
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Sumra Bari
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Yukai Zou
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America; College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States of America
| | - Brian R Cummiskey
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Taylor A Lee
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Roy J Lycke
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Victoria N Poole
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Trey E Shenk
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Diana O Svaldi
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Gregory G Tamer
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Ulrike Dydak
- School of Health Sciences, Purdue University, West Lafayette, IN, United States of America
| | - Larry J Leverenz
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States of America
| | - Eric A Nauman
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America; School of Mechanical Engineering, Purdue University, West Lafayette, IN, United States of America; Department of Basic Medical Sciences, Purdue University, West Lafayette, IN, United States of America
| | - Thomas M Talavage
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States of America; Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States of America
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9
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Bigler ED. Structural neuroimaging in sport-related concussion. Int J Psychophysiol 2018; 132:105-123. [DOI: 10.1016/j.ijpsycho.2017.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 09/03/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
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Deng H, Ordaz A, Upadhyayula PS, Gillis-Buck EM, Suen CG, Melhado CG, Mohammed N, Lam T, Yue JK. Apolipoprotein E Epsilon 4 Genotype, Mild Traumatic Brain Injury, and the Development of Chronic Traumatic Encephalopathy. Med Sci (Basel) 2018; 6:E78. [PMID: 30223506 PMCID: PMC6163513 DOI: 10.3390/medsci6030078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 09/04/2018] [Accepted: 09/12/2018] [Indexed: 12/14/2022] Open
Abstract
The annual incidence of mild traumatic brain injury (MTBI) is 3.8 million in the USA with 10⁻15% experiencing persistent morbidity beyond one year. Chronic traumatic encephalopathy (CTE), a neurodegenerative disease characterized by accumulation of hyperphosphorylated tau, can occur with repetitive MTBI. Risk factors for CTE are challenging to identify because injury mechanisms of MTBI are heterogeneous, clinical manifestations and management vary, and CTE is a postmortem diagnosis, making prospective studies difficult. There is growing interest in the genetic influence on head trauma and development of CTE. Apolipoprotein epsilon 4 (APOE-ε4) associates with many neurologic diseases, and consensus on the ε4 allele as a risk factor is lacking. This review investigates the influence of APOE-ε4 on MTBI and CTE. A comprehensive PubMed literature search (1966 to 12 June 2018) identified 24 unique reports on the topic (19 MTBI studies: 8 athletic, 5 military, 6 population-based; 5 CTE studies: 4 athletic and military, 1 leucotomy group). APOE-ε4 genotype is found to associate with outcomes in 4/8 athletic reports, 3/5 military reports, and 5/6 population-based reports following MTBI. Evidence on the association between APOE-ε4 and CTE from case series is equivocal. Refining modalities to aid CTE diagnosis in larger samples is needed in MTBI.
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Affiliation(s)
- Hansen Deng
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94122, USA.
| | - Angel Ordaz
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94122, USA.
| | - Pavan S Upadhyayula
- Department of Neurological Surgery, University of California San Diego, San Diego, CA 92093, USA.
| | - Eva M Gillis-Buck
- Department of Surgery, University of California San Francisco, San Francisco, CA 94122, USA.
- Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA.
| | - Catherine G Suen
- Department of Neurology, University of Utah, Salt Lake City, UT 84112, USA.
| | - Caroline G Melhado
- Department of Surgery, University of California San Francisco, San Francisco, CA 94122, USA.
| | - Nebil Mohammed
- Department of Pathology, University of California San Francisco, San Francisco, CA 94122, USA.
| | - Troy Lam
- Department of Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA 94122, USA.
| | - John K Yue
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94122, USA.
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Mustafi SM, Harezlak J, Koch KM, Nencka AS, Meier TB, West JD, Giza CC, DiFiori JP, Guskiewicz KM, Mihalik JP, LaConte SM, Duma SM, Broglio SP, Saykin AJ, McCrea M, McAllister TW, Wu YC. Acute White-Matter Abnormalities in Sports-Related Concussion: A Diffusion Tensor Imaging Study from the NCAA-DoD CARE Consortium. J Neurotrauma 2018; 35:2653-2664. [PMID: 29065805 DOI: 10.1089/neu.2017.5158] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Sports-related concussion (SRC) is an important public health issue. Although standardized assessment tools are useful in the clinical management of acute concussion, the underlying pathophysiology of SRC and the time course of physiological recovery after injury remain unclear. In this study, we used diffusion tensor imaging (DTI) to detect white matter alterations in football players within 48 h after SRC. As part of the NCAA-DoD CARE Consortium study of SRC, 30 American football players diagnosed with acute concussion and 28 matched controls received clinical assessments and underwent advanced magnetic resonance imaging scans. To avoid selection bias and partial volume effects, whole-brain skeletonized white matter was examined by tract-based spatial statistics to investigate between-group differences in DTI metrics and their associations with clinical outcome measures. Mean diffusivity was significantly higher in brain white matter of concussed athletes, particularly in frontal and subfrontal long white matter tracts. In the concussed group, axial diffusivity was significantly correlated with the Brief Symptom Inventory and there was a similar trend with the symptom severity score of the Sport Concussion Assessment Tool. In addition, concussed athletes with higher fractional anisotropy performed better on the cognitive component of the Standardized Assessment of Concussion. Overall, the results of this study are consistent with the hypothesis that SRC is associated with changes in white matter tracts shortly after injury, and these differences are correlated clinically with acute symptoms and functional impairments.
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Affiliation(s)
- Sourajit Mitra Mustafi
- 1 Department of Radiology and Imaging Sciences, Indiana University School of Medicine , Indianapolis, Indiana
| | - Jaroslaw Harezlak
- 2 Department of Epidemiology and Biostatistics, School of Public Health, Indiana University , Bloomington, Indiana
| | - Kevin M Koch
- 3 Department of Radiology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Andrew S Nencka
- 3 Department of Radiology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Timothy B Meier
- 4 Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - John D West
- 1 Department of Radiology and Imaging Sciences, Indiana University School of Medicine , Indianapolis, Indiana
| | - Christopher C Giza
- 5 Department of Neurosurgery, David Geffen School of Medicine at University of California Los Angeles, Division of Pediatric Neurology, Mattel Children's Hospital-UCLA Los Angeles , California
| | - John P DiFiori
- 6 Division of Sports Medicine, Departments of Family Medicine and Orthopedics, University of California Los Angeles , Los Angeles, California
| | - Kevin M Guskiewicz
- 7 Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Jason P Mihalik
- 7 Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Stephen M LaConte
- 8 School of Biomedical Engineering and Sciences, Wake-Forest and Virginia Tech University , Virginia Tech Carilion Research Institute, Roanoke, Virginia
| | - Stefan M Duma
- 9 School of Biomedical Engineering and Sciences, Wake-Forest and Virginia Tech University , Blacksburg, Virginia
| | - Steven P Broglio
- 10 NeuroTrauma Research Laboratory, School of Kinesiology, University of Michigan , Ann Arbor, Michigan
| | - Andrew J Saykin
- 1 Department of Radiology and Imaging Sciences, Indiana University School of Medicine , Indianapolis, Indiana
| | - Michael McCrea
- 4 Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Thomas W McAllister
- 11 Department of Psychology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Yu-Chien Wu
- 1 Department of Radiology and Imaging Sciences, Indiana University School of Medicine , Indianapolis, Indiana
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12
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Ho ML. Arterial spin labeling: Clinical applications. J Neuroradiol 2018; 45:276-289. [PMID: 30016705 DOI: 10.1016/j.neurad.2018.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 05/28/2018] [Accepted: 06/07/2018] [Indexed: 12/28/2022]
Abstract
Arterial spin labeling (ASL) is a magnetic resonance imaging perfusion technique that enables quantification of cerebral blood flow (CBF) without the use of intravenous gadolinium contrast. An understanding of the technical basis of ASL and physiologic variations in perfusion are important for recognizing normal variants and artifacts. Pathologic variations in perfusion can be seen in a number of disorders including acute and chronic ischemia, vasculopathy, vascular malformations, tumors, trauma, infection/inflammation, epilepsy and dementia.
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Affiliation(s)
- Mai-Lan Ho
- Division of Neuroradiology, Mayo Clinic, 200 First St. SW, 55905 Rochester, MN, United States.
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13
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Ruprecht R, Scheurer E, Lenz C. Systematic review on the characterization of chronic traumatic encephalopathy by MRI and MRS. J Magn Reson Imaging 2018; 49:212-228. [PMID: 29717792 DOI: 10.1002/jmri.26162] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 04/10/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that is found in people who have suffered from chronic traumatic brain injury (TBI). Up to now, diagnosis of CTE could only be made based on postmortem histopathological examinations. The application of MR techniques might offer a promising possibility for in vivo diagnoses. PURPOSE/HYPOTHESIS To provide a critical systematic review of the characterization of chronic TBI and CTE by considering the range of MR techniques. STUDY TYPE This was a systematic review for which the electronic databases PubMed and Embase were searched using the terms ("chronic traumatic encephalopathy" OR "punch drunk syndrome" OR "chronic traumatic brain injury" OR "dementia pugilistica" OR "chronic head trauma") AND ("magnetic resonance imaging" OR mri OR imaging OR mrs OR "magnetic resonance spectroscopy" OR spectroscopy). POPULATION/SUBJECTS/PHANTOM/SPECIMEN/ANIMAL MODEL Of the 432 studies identified by the database search, 25 were included in this review. FIELD STRENGTH/SEQUENCE Diffusion, structural, and functional MRI sequences and MR spectroscopy were evaluated at 1.5T or 3T and at 11.74T for the ex vivo studies. ASSESSMENT Data were extracted by two reviewers independently. Specific inclusion and exclusion criteria like the study design, publication type, and applied MR techniques were used to select studies for review. STATISTICAL TESTS Results of the original research articles were stated in this review as significant if P ≤ 0.05. RESULTS Of the included articles, two were ex vivo studies focusing on the coregistration of histology and MRI. All other studies were based on in vivo data. DATA CONCLUSION The included studies varied considerably regarding study setup, MR techniques, and results. Nevertheless, this work aims to establish links between the studies and discusses the results and limitations associated with the characterization of chronic TBI and CTE based on MR. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:212-228.
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Affiliation(s)
- Rahel Ruprecht
- Institute of Forensic Medicine, University of Basel, Basel, Switzerland
| | - Eva Scheurer
- Institute of Forensic Medicine, University of Basel, Basel, Switzerland
| | - Claudia Lenz
- Institute of Forensic Medicine, University of Basel, Basel, Switzerland
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14
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Lucke-Wold BP, Logsdon AF, Turner RC, Huber JD, Rosen CL. Endoplasmic Reticulum Stress Modulation as a Target for Ameliorating Effects of Blast Induced Traumatic Brain Injury. J Neurotrauma 2017; 34:S62-S70. [PMID: 28077004 PMCID: PMC5749601 DOI: 10.1089/neu.2016.4680] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Blast traumatic brain injury (bTBI) has been shown to contribute to progressive neurodegenerative disease. Recent evidence suggests that endoplasmic reticulum (ER) stress is a mechanistic link between acute neurotrauma and progressive tauopathy. We propose that ER stress contributes to extensive behavioral changes associated with a chronic traumatic encephalopathy (CTE)-like phenotype. Targeting ER stress is a promising option for the treatment of neurotrauma-related neurodegeneration, which warrants investigation. Utilizing our validated and clinically relevant Sprague-Dawley blast model, we investigated a time course of mechanistic changes that occur following bTBI (50 psi) including: ER stress activation, iron-mediated toxicity, and tauopathy via Western blot and immunohistochemistry. These changes were associated with behavioral alterations measured by the Elevated Plus Maze (EPM), Forced Swim Test (FST), and Morris Water Maze (MWM). Following characterization, salubrinal, an ER stress modulator, was given at a concentration of 1 mg/kg post-blast, and its mechanism of action was determined in vitro. bTBI significantly increased markers of injury in the cortex of the left hemisphere: p-PERK and p-eIF2α at 30 min, p-T205 tau at 6 h, and iron at 24 h. bTBI animals spent more time immobile on the FST at 72 h and more time in the open arm of the EPM at 7 days. Further, bTBI caused a significant learning disruption measured with MWM at 21 days post-blast, with persistent tau changes. Salubrinal successfully reduced ER stress markers in vivo and in vitro while significantly improving performance on the EPM. bTBI causes robust biochemical changes that contribute to neurodegeneration, but these changes may be targeted with ER stress modulators.
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Affiliation(s)
- Brandon P. Lucke-Wold
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Aric F. Logsdon
- Department of Basic Pharmaceutical Sciences, West Virginia University School of Pharmacy, Morgantown, West Virginia
| | - Ryan C. Turner
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Jason D. Huber
- Department of Basic Pharmaceutical Sciences, West Virginia University School of Pharmacy, Morgantown, West Virginia
| | - Charles L. Rosen
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, West Virginia
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15
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Yue JK, Robinson CK, Burke JF, Winkler EA, Deng H, Cnossen MC, Lingsma HF, Ferguson AR, McAllister TW, Rosand J, Burchard EG, Sorani MD, Sharma S, Nielson JL, Satris GG, Talbott JF, Tarapore PE, Korley FK, Wang KK, Yuh EL, Mukherjee P, Diaz‐Arrastia R, Valadka AB, Okonkwo DO, Manley GT. Apolipoprotein E epsilon 4 (APOE-ε 4) genotype is associated with decreased 6-month verbal memory performance after mild traumatic brain injury. Brain Behav 2017; 7:e00791. [PMID: 28948085 PMCID: PMC5607554 DOI: 10.1002/brb3.791] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 06/28/2017] [Accepted: 07/02/2017] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The apolipoprotein E (APOE) ε4 allele associates with memory impairment in neurodegenerative diseases. Its association with memory after mild traumatic brain injury (mTBI) is unclear. METHODS mTBI patients (Glasgow Coma Scale score 13-15, no neurosurgical intervention, extracranial Abbreviated Injury Scale score ≤1) aged ≥18 years with APOE genotyping results were extracted from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot) study. Cohorts determined by APOE-ε4(+/-) were assessed for associations with 6-month verbal memory, measured by California Verbal Learning Test, Second Edition (CVLT-II) subscales: Immediate Recall Trials 1-5 (IRT), Short-Delay Free Recall (SDFR), Short-Delay Cued Recall (SDCR), Long-Delay Free Recall (LDFR), and Long-Delay Cued Recall (LDCR). Multivariable regression controlled for demographic factors, seizure history, loss of consciousness, posttraumatic amnesia, and acute intracranial pathology on computed tomography (CT). RESULTS In 114 mTBI patients (APOE-ε4(-)=79; APOE-ε4(+)=35), ApoE-ε4(+) was associated with long-delay verbal memory deficits (LDFR: B = -1.17 points, 95% CI [-2.33, -0.01], p = .049; LDCR: B = -1.58 [-2.63, -0.52], p = .004), and a marginal decrease on SDCR (B = -1.02 [-2.05, 0.00], p = .050). CT pathology was the strongest predictor of decreased verbal memory (IRT: B = -8.49, SDFR: B = -2.50, SDCR: B = -1.85, LDFR: B = -2.61, LDCR: B = -2.60; p < .001). Seizure history was associated with decreased short-term memory (SDFR: B = -1.32, p = .037; SDCR: B = -1.44, p = .038). CONCLUSION The APOE-ε4 allele may confer an increased risk of impairment of 6-month verbal memory for patients suffering mTBI, with implications for heightened surveillance and targeted therapies. Acute intracranial pathology remains the driver of decreased verbal memory performance at 6 months after mTBI.
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Affiliation(s)
- John K. Yue
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Caitlin K. Robinson
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - John F. Burke
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Ethan A. Winkler
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Hansen Deng
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Maryse C. Cnossen
- Department of Public HealthErasmus Medical CenterRotterdamThe Netherlands
| | - Hester F. Lingsma
- Department of Public HealthErasmus Medical CenterRotterdamThe Netherlands
| | - Adam R. Ferguson
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | | | - Jonathan Rosand
- Program in Medical and Population GeneticsThe Broad Institute at MIT and HarvardCambridgeMAUSA
- Department of NeurologyHarvard Medical SchoolBostonMAUSA
| | - Esteban G. Burchard
- Department of Bioengineering and Therapeutic SciencesUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Marco D. Sorani
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Sourabh Sharma
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Stritch School of Medicine at Loyola UniversityMaywoodILUSA
| | - Jessica L. Nielson
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Gabriela G. Satris
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Jason F. Talbott
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
- Department of RadiologyUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Phiroz E. Tarapore
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Frederick K. Korley
- Department of Emergency MedicineUniversity of Michigan at Ann ArborAnn ArborMIUSA
| | - Kevin K.W. Wang
- Departments of Psychiatry and NeuroscienceUniversity of FloridaGainesvilleFLUSA
| | - Esther L. Yuh
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Department of RadiologyUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Pratik Mukherjee
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Department of RadiologyUniversity of California, San FranciscoSan FranciscoCAUSA
| | | | - Alex B. Valadka
- Department of Neurological SurgeryVirginia Commonwealth UniversityRichmondVAUSA
| | - David O. Okonkwo
- Department of Neurological SurgeryUniversity of Pittsburgh Medical CenterPittsburghPAUSA
| | - Geoffrey T. Manley
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
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16
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Rao V, Syeda A, Roy D, Peters ME, Vaishnavi S. Neuropsychiatric aspects of concussion: acute and chronic sequelae. ACTA ACUST UNITED AC 2017; 2:CNC29. [PMID: 30202570 PMCID: PMC6094361 DOI: 10.2217/cnc-2016-0018] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/16/2016] [Indexed: 01/05/2023]
Abstract
Concussion – also known as mild traumatic brain injury – is a transient disturbance of neurological function resulting from traumatic forces imparted to the brain that often produce cognitive, behavioral and systemic symptoms. In this review of the literature, we discuss the pathophysiology of both acute and chronic neuropsychiatric sequelae of concussions, followed by a brief overview of evaluation and management of these sequelae.
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Affiliation(s)
- Vani Rao
- Department Of Psychiatry, Johns Hopkins University & School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, USA.,Department Of Psychiatry, Johns Hopkins University & School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, USA
| | - Arshiya Syeda
- Department Of Psychiatry, Johns Hopkins University & School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, USA.,Department Of Psychiatry, Johns Hopkins University & School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, USA
| | - Durga Roy
- Department Of Psychiatry, Johns Hopkins University & School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, USA.,Department Of Psychiatry, Johns Hopkins University & School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, USA
| | - Matthew E Peters
- Department Of Psychiatry, Johns Hopkins University & School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, USA.,Department Of Psychiatry, Johns Hopkins University & School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, USA
| | - Sandeep Vaishnavi
- The Preston Robert Tisch Brain Tumor Center, Duke Medicine; Department of Psychiatry & Behavioral Sciences & Community & Family Medicine, Duke University Medical Center, Durham, NC, USA; The Neuropsychiatric Clinic at Carolina Partners, Raleigh, NC, USA.,The Preston Robert Tisch Brain Tumor Center, Duke Medicine; Department of Psychiatry & Behavioral Sciences & Community & Family Medicine, Duke University Medical Center, Durham, NC, USA; The Neuropsychiatric Clinic at Carolina Partners, Raleigh, NC, USA
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17
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Barkovich E, Robinson C, Gropman A. Brain biomarkers and neuroimaging to diagnose urea cycle disorders and assess prognosis. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1242407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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18
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Whiplash Injury or Concussion? A Possible Biomechanical Explanation for Concussion Symptoms in Some Individuals Following a Rear-End Collision. J Orthop Sports Phys Ther 2016; 46:874-885. [PMID: 27690834 DOI: 10.2519/jospt.2016.7049] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Finite element modeling of experimental data. Background The clinical presentations of whiplash injury and concussion have considerable overlap. Both diagnoses are generally based on presenting signs and symptoms, and a history of neck or head trauma. With incomplete knowledge of the trauma, differentiating between whiplash injury and concussion can be clinically challenging. Objectives To estimate the brain strains that develop during rear-end car crashes, evaluate how these strains vary with different head kinematic parameters, and compare these strains to those generated during potentially concussive football helmet impacts. Methods Head kinematic data were analyzed from 2 prior studies, one that focused on head restraint impacts in rear-end crash tests and another that focused on football helmet impacts. These data were used as inputs to a finite element model of the human brain. Brain strains were calculated and compared to different peak kinematic parameters and between the 2 impact conditions. Results Brain strains correlated best with the head's angular velocity change for both impact conditions. The 4 crashes with head angular velocity changes greater than 30 rad/s (greater than 1719°/s) generated the highest brain stains. One crash, in which the head wrapped onto the top of the head restraint, generated brain strains similar to a 9.3-m/s rear football helmet impact, a level previously associated with concussion. Conclusion This work provides new insight into a potential biomechanical link between whiplash injury and concussion, and advances our understanding of how head restraint interaction during a rear-end crash may cause an injury more typically associated with sports-related head impacts. J Orthop Sports Phys Ther 2016;46(10):874-885. doi:10.2519/jospt.2016.7049.
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19
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Aksenov DP, Miller MJ, Li L, Wyrwicz AM. Eyeblink classical conditioning and BOLD fMRI of anesthesia-induced changes in the developing brain. Physiol Behav 2016; 167:10-15. [PMID: 27591109 DOI: 10.1016/j.physbeh.2016.08.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 07/21/2016] [Accepted: 08/29/2016] [Indexed: 01/19/2023]
Abstract
Millions of children undergo general anesthesia each year in the USA alone, and a growing body of literature from animals and humans suggests that exposure to anesthesia at an early age can impact neuronal development, leading to learning and memory impairments later in childhood. Although a number of studies have reported behavioral and structural effects of anesthesia exposure during infancy, the functional manifestation of these changes has not been previous examined. In this study we used BOLD fMRI to measure the functional response to stimulation in the whisker barrel cortex of awake rabbits before and after learning a trace eyeblink classical conditioning paradigm. The functional changes, in terms of activated volume and time course, in rabbits exposed to isoflurane anesthesia during infancy was compared to unanesthetized controls when both groups reached young adulthood. Our findings show that whereas both groups exhibited decreased BOLD response duration after learning, the anesthesia-exposed group also showed a decrease in BOLD response volume in the whisker barrel cortex, particularly in the deeper infragranular layer. These results suggest that anesthesia exposure during infancy may affect the intracortical processes that mediate learning-related plasticity.
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Affiliation(s)
| | | | - Limin Li
- NorthShore University HealthSystem, Evanston, IL, 60201, USA
| | - Alice M Wyrwicz
- NorthShore University HealthSystem, Evanston, IL, 60201, USA
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