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Controlled Clinical Trial
. 2017 Mar 1;34(5):996-1004.
doi: 10.1089/neu.2016.4634. Epub 2016 Nov 21.

Cerebral Perfusion Changes in Post-Concussion Syndrome: A Prospective Controlled Cohort Study

Karen M Barlow  1   2   3 , Lorenzo D Marcil  4 , Deborah Dewey  1   3   5 , Helen L Carlson  3   6 , Frank P MacMaster  1   3   7   8   9 , Brian L Brooks  1   2   3   6   10 , R Marc Lebel  3   11   12   13
Affiliations
Controlled Clinical Trial

Cerebral Perfusion Changes in Post-Concussion Syndrome: A Prospective Controlled Cohort Study

Karen M Barlow et al. J Neurotrauma. .

Abstract

The biology of post-concussive symptoms is unclear. Symptoms are often increased during activities, and have been linked to decreased cerebrovascular reactivity and perfusion. The aim of this study was to examine cerebral blood flow (CBF) in children with different clinical recovery patterns following mild traumatic brain injury (mTBI). This was a prospective controlled cohort study of children with mTBI (ages 8 to 18 years) who were symptomatic with post-concussive symptoms at one month post-injury (symptomatic, n = 27) and children who had recovered quickly (asymptomatic, n = 24). Pseudo continuous arterial spin labeling magnetic resonance imaging (MRI) was used to quantify CBF. The mTBI groups were imaged at 40 days post-injury. Global and regional CBF were compared with healthy controls of similar age and sex but without a history of mTBI (n = 21). Seventy-two participants (mean age: 14.1 years) underwent neuroimaging. Significant differences in CBF were found: global CBF was higher in the symptomatic group and lower in the asymptomatic group compared with controls, (F(2,69) 9.734; p < 0.001). Post-injury symptom score could be predicted by pre-injury symptoms and CBF in presence of mTBI (adjusted R2 = 0.424; p < 0.001). Altered patterns of cerebral perfusion are seen following mTBI and are associated with the recovery trajectory. Symptomatic children have higher CBF. Children who "recovered" quickly, have decreased CBF suggesting that clinical recovery precedes the cerebral recovery. Further longitudinal studies are required to determine if these perfusion patterns continue to change over time.

Keywords: arterial spin labeling; cerebral blood flow; pediatric brain injury; recovery; traumatic brain injury.

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Conflict of interest statement

Drs. Barlow, Dewey, MacMaster, and Mr. Marcil have no competing financial interests. Dr. Brooks receives royalties for the sales of a pediatric forensic textbook (Oxford University Press) and pediatric neuropsychological tests (PAR Inc.). He has previously received support (in-kind test credits) from CNS Vital Signs. Dr. Lebel is a stakeholder in GE Healthcare. This study was funded by the Canadian Institutes of Health Research (grant number: 293375); the Faculty of Medicine, University of Calgary; and the Markin Undergraduate Student Research Program, University of Calgary. These funding sources had no role in the design of this study and did not have any role during its execution, analyses, interpretation of the data, or decision to submit results. The design, management, analysis, and reporting of the study were entirely independent of any manufacturers of melatonin.

Figures

<b>FIG. 1.</b>
FIG. 1.
Consort diagram depicting enrollment through to analysis: Children with mTBI were identified in the ED (n = 244) and enrolled at 3 to 4 weeks post-injury (n = 84). ED, emergency department; mTBI, mild traumatic brain injury.
<b>FIG. 2.</b>
FIG. 2.
A scatterplot demonstrating the correlation between cognitive function (Neurocognition Index) and global CBF. Cognitive function was predicted by CBF only in the mTBI group (significant interaction effect between CBF and mTBI; beta = –2.16, p = 0.028), R2 = 0.165, p = 0.008. CBF, cerebral blood flow; mTBI, mild traumatic brain injury.
<b>FIG. 3.</b>
FIG. 3.
The regions where cerebral perfusion is significantly greater in children who remained symptomatic at 40 days following an mTBI when compared with healthy controls are shown. The cluster size and coordinates of these areas are reported in the table. MNI, Montreal Neurological Institute; mTBI, mild traumatic brain injury.
<b>FIG. 4.</b>
FIG. 4.
The regions where perfusion in the symptomatic group is significantly greater than the asymptomatic group at 40 days post-injury are shown. The cluster size and coordinates of these areas are given in the table. MNI, Montreal Neurological Institute.
<b>FIG. 5.</b>
FIG. 5.
The regions where cerebral perfusion is significantly decreased in children who were asymptomatic at 40 days following an mTBI when compared with healthy controls are shown. The cluster size and coordinates of the areas are reported in the table (overall pcrit <0.05, voxel cluster-level >100). MNI, Montreal Neurological Institute; mTBI, mild traumatic brain injury.
See this image and copyright information in PMC

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