Citation

Muftuler LT, Meier T, Keith M, Budde MD, Huber DL, McCrea M. J. Neurotrauma 2020; ePub(ePub): ePub.

Affiliation

Medical College of Wisconsin, Neurosurgery, Milwaukee, Wisconsin, United States; mmccrea@mcw.edu.

Copyright

(Copyright © 2020, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2020.6993

PMID

32253977

Abstract

Sport-related concussion (SRC) is common in contact sports, but there remains a lack of reliable, unbiased biomarkers of brain injury and recovery. Although the symptoms of SRC generally resolve over a period of days to weeks, the lack of a biomarker impairs detection and return-to-play decisions. To this date, the pathophysiological recovery profile and relationships between brain changes and symptoms remained unclear. In the current study, Diffusion Kurtosis Imaging (DKI) was used to monitor the effects of SRC on the brain and the trajectory of recovery in concussed American football players (n=96) at <48 hours, 8, 15 and 45-days post-injury and compared to a matched group of non-injured players (N=82). The concussed group reported significantly higher symptoms within 48 hours after injury compared to controls, which resolved by the 8-day follow-up. The concussed group also demonstrated poorer performance on balance testing at <48 hours and 8 days compared to controls. There were no significant differences between the groups in SAC, a cognitive screening measure. DKI data was acquired with 3mm isotropic resolution and analyzed using TBSS. Additionally, voxel and region of interest based analyses were also carried out. At <48 hours, the concussed group showed significantly higher axial kurtosis compared to the control group. These differences increased in extent and magnitude at 8 days, then receded at 15 days, and returned to the normal levels by 45 days. Kurtosis FA exhibited a delayed response, with a consistent increase by day 15 and 45. The results indicate that changes detected in the acute period appear to be prolonged compared to clinical recovery, but additional brain changes not observable acutely appear to progress. While further studies are needed to understand the pathological features of DKI changes after SRC, these findings highlight a potential disparity between clinical symptoms and pathophysiological recovery after SRC.

Language: en

Keywords

Diffusion Tensor Imaging; HEAD TRAUMA; MRI