Citation

Brett BL, Wu YC, Mustafi SM, Saykin AJ, Koch KM, Nencka AS, Giza CC, Goldman J, Guskiewicz KM, Mihalik JP, Duma SM, Broglio SP, McAllister TW, McCrea MA, Meier TB. Front. Neurol. 2019; 10: e1345.

Affiliation

Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, United States.

Copyright

(Copyright © 2019, Frontiers Research Foundation)

DOI

10.3389/fneur.2019.01345

PMID

32038451

PMCID

PMC6990104

Abstract

Objective: A recent systematic review determined that the physiological effects of concussion may persist beyond clinical recovery. Preclinical models suggest that ongoing physiological effects are accompanied by increased cerebral vulnerability that is associated with risk for subsequent, more severe injury. This study examined the association between signal alterations on diffusion tensor imaging following clinical recovery of sport-related concussion in athletes with and without a subsequent second concussion. Methods: Average mean diffusivity (MD) was calculated in a region of interest (ROI) in which concussed athletes (n = 82) showed significantly elevated MD acutely after injury (<48 h), at an asymptomatic time point, 7 days post-return to play (RTP), and 6 months relative to controls (n = 69). The relationship between MD in the identified ROI and likelihood of sustaining a subsequent concussion over a 1-year period was examined with a binary logistic regression (re-injured, yes/no). Results: Eleven of 82 concussed athletes (13.4%) sustained a second concussion within 12 months of initial injury. Mean MD at 7 days post-RTP was significantly higher in those athletes who went on to sustain a repeat concussion within 1 year of initial injury than those who did not (p = 0.048; d = 0.75). In this underpowered sample, the relationship between MD at 7 days post-RTP and likelihood of sustaining a secondary injury approached significance [χ²₍₁₎ = 4.17, p = 0.057; B = 0.03, SE = 0.017; OR = 1.03, CI = 0.99, 1.07]. Conclusions: These preliminary findings raise the hypothesis that persistent signal abnormalities in diffusion imaging metrics at RTP following concussion may be predictive of a repeat concussion. This may reflect a window of cerebral vulnerability or increased susceptibility following concussion, though understanding the clinical significance of these findings requires further study.

Copyright © 2020 Brett, Wu, Mustafi, Saykin, Koch, Nencka, Giza, Goldman, Guskiewicz, Mihalik, Duma, Broglio, McAllister, McCrea and Meier.

Language: en

Keywords

CARE; diffusion tensor imaging; head injury; mTBI; sport-related concussion; white matter