Citation

Cubon VA, Putukian M, Boyer C, Dettwiler A. J. Neurotrauma 2011; 28(2): 189-201.

Affiliation

Princeton University, Princeton Neuroscience Institute, Green Hall, Washington Road, Princeton, New Jersey, United States, 08544, 609-258-0775; vcubon@princeton.edu.

Copyright

(Copyright © 2011, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2010.1430

PMID

21083414

PMCID

PMC3037804

Abstract

Recognizing and managing the effects of cerebral concussion is very challenging, given the discrete symptomatology. Most individuals with sports-related concussion will not score below 15 on the Glasgow coma scale, but will present with rapid onset of short-lived neurological impairment demonstrating no structural changes in traditional MRI (magnetic resonance imaging) and CT (computerized tomography) scans. The return-to-play decision is one of the most difficult responsibilities facing the physician and so far this decision has been primarily based on neurological examination, symptom checklists and neuropsychological (NP) testing. Diffusion tensor imaging (DTI) may be a more objective tool to assess the severity and recovery of function after concussion. We assessed white matter (WM) fiber tract integrity in varsity level college athletes with sports-related concussion without loss of consciousness who experienced protracted symptoms for at least one month after injury. Evaluation of fractional anisotropy (FA) and mean diffusivity (MD) on the WM skeleton using tract-based spatial statistics (TBSS), revealed a large cluster of significantly increased MD for concussed subjects in several WM fiber tracts in the left hemisphere, including parts of the inferior/superior longitudinal and fronto-occipital fasciculi, retrolenticular part of internal capsule, posterior thalamic and acoustic radiations. Qualitative comparison of average FA and MD suggests that with increasing level of injury severity (ranging from sports-related concussion to severe TBI) MD might be more sensitive at detecting mild injury whereas FA captures more severe injuries. In conclusion, the TBSS analysis used to evaluate diffuse axonal injury on the WM skeleton seems sensitive enough to detect structural changes in sports-related concussion.

Language: en