Citation

Fan F, Beare R, Takagi M, Anderson N, Bressan S, Clarke CJ, Davis GA, Dunne K, Fabiano F, Hearps SJC, Ignjatovic V, Parkin G, Rausa VC, Seal M, Shapiro JS, Babl FE, Anderson V. J. Neurosurg. Pediatr. 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, American Association of Neurological Surgeons)

DOI

10.3171/2023.3.PEDS2339

PMID

37086163

Abstract

OBJECTIVE: Persisting postconcussive symptoms (pPCS), particularly headache, can significantly disrupt children's recovery and functioning. However, the underlying pathophysiology of these symptoms remains unclear. The goal in this study was to determine whether pPCS are related to cerebral blood flow (CBF) at 2 weeks postconcussion. The authors also investigated whether variations in CBF can explain the increased risk of acute posttraumatic headache (PTH) in female children following concussion.

METHODS: As part of a prospective, longitudinal study, the authors recruited children 5-18 years old who were admitted to the emergency department of a tertiary pediatric hospital with a concussion sustained within 48 hours of admission. Participants underwent pseudocontinuous arterial spin labeling MRI at 2 weeks postconcussion to quantify global mean gray and white matter perfusion (in ml/100 g/min). Conventional frequentist analysis and Bayesian analysis were performed.

RESULTS: Comparison of recovered (n = 26) and symptomatic (n = 12) groups (mean age 13.15 years, SD 2.69 years; 28 male) found no differences in mean global gray and white matter perfusion at 2 weeks postconcussion (Bayes factors > 3). Although female sex was identified as a risk factor for PTH with migraine features (p = 0.003), there was no difference in CBF between female children with and without PTH.

CONCLUSIONS: Global CBF was not associated with pPCS and female PTH at 2 weeks after pediatric concussion. These findings provide evidence against the use of CBF measured by arterial spin labeling as an acute biomarker for pediatric concussion recovery.

Language: en

Keywords

trauma; traumatic brain injury; pediatric concussion; arterial spin labeling; Bayesian analysis; cerebral blood flow; persisting postconcussive symptoms; posttraumatic headache