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Abstract
Background and Objectives To test the hypothesis that a history of concussion (HOC) causes greater disturbances in cerebral blood flow (CBF) and white matter microstructure of midline brain structures after subsequent concussions, during the acute and chronic phases of recovery.
Methods In this longitudinal MRI study, 61 athletes with uncomplicated concussion (36 with HOC) were imaged at the acute phase of injury (1–7 days after injury), the subacute phase (8–14 days), medical clearance to return to play (RTP), 1 month after RTP, and 1 year after RTP. A normative group of 167 controls (73 with HOC) were also imaged. Each session assessed CBF of the cingulate cortex, along with fractional anisotropy (FA) and mean diffusivity (MD) of the corpus callosum. Linear mixed models tested for interactions of HOC with time since injury. The Sport Concussion Assessment Tool (SCAT) was also used to evaluate effects of HOC on symptoms, cognition, and balance.
Results Athletes with HOC had significantly greater declines in midcingulate CBF subacutely (z = −3.29, p = 0.002) and greater declines in posterior cingulate CBF at 1 year after RTP (z = −2.42, p = 0.007). No significant effects of HOC were seen for FA, whereas athletes with HOC had higher MD of the splenium at RTP (z = 2.54, p = 0.008). These effects were seen in the absence of significant differences in SCAT domains (|z| ≤ 1.14, p ≥ 0.256) or time to RTP (z = 0.23, p = 0.818).
Discussion Results indicate subacute and chronic effects of HOC on cingulate CBF and callosal microstructure in the absence of differences in clinical indices. These findings provide new insights into physiologic brain recovery after concussion, with cumulative effects of repeated injury detected among young, healthy athletes.
Glossary
- ACU=
- acute injury;
- AD=
- axial diffusivity;
- BSR=
- bootstrap ratio;
- CBF=
- cerebral blood flow;
- CI=
- confidence interval;
- FA=
- fractional anisotropy;
- FDR=
- false discovery rate;
- gCC=
- genu of the corpus callosum;
- HOC=
- history of concussion;
- LMM=
- linear mixed-effects model;
- MD=
- mean diffusivity;
- 1MO=
- 1 month after RTP;
- 1YR=
- 1 year after RTP;
- RD=
- radial diffusivity;
- RTP=
- return to play;
- SCAT=
- Sport Concussion Assessment Tool;
- SUB=
- subacute injury
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 567
- Received January 16, 2021.
- Accepted in final form June 22, 2021.
- © 2021 American Academy of Neurology
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