References

2017

Asken, B M; Snyder, A R; Smith, M S; Zaremski, J L; Bauer, R M

Concussion-like symptom reporting in non-concussed adolescent athletes Journal Article

In: Clinical Neuropsychologist, vol. 31, no. 1, pp. 138–153, 2017.

Abstract | Links | BibTeX | Tags: Adolescent, biopsychosocial, Brain Injury, high school, Sport-related concussion

@article{Asken2017,

title = {Concussion-like symptom reporting in non-concussed adolescent athletes},

author = {Asken, B M and Snyder, A R and Smith, M S and Zaremski, J L and Bauer, R M},

doi = {10.1080/13854046.2016.1246672},

year  = {2017},

date = {2017-01-01},

journal = {Clinical Neuropsychologist},

volume = {31},

number = {1},

pages = {138--153},

abstract = {Objective: The primary goals of this study were (1) to report rates of concussion-like symptoms in healthy adolescent student athletes assessed using the Sport Concussion Assessment Tool, 3rd edition (SCAT3) at baseline, (2) to examine rates of psychiatric diagnoses in this population, and (3) to evaluate effects of baseline symptoms on SCAT3 cognitive and balance performance. Methods: 349 adolescent student athletes (245 male) were administered the SCAT3 during pre-participation physical examinations. We described the prevalence rate of student athletes meeting criteria for International Classification of Diseases, 10th revision, post-concussional syndrome (ICD-10 PCS) diagnosis at baseline, and evaluated associations between symptom reporting and demographic/medical history factors using chi-square tests. Rates of self-reported psychiatric diagnosis were compared to general population estimates with one-sample binomial tests. We also compared SCAT3 cognitive and balance performance between adolescents with and without baseline ICD-10 PCS symptoms. Results: Overall, 20.3% of participants met ICD-10 PCS criteria at baseline. Rates were similar across sexes and age groups. We found no statistical association with medical history factors. The proportion of student athletes reporting a history of psychiatric diagnosis (5.2%) was significantly lower than general population estimates (14.0%; p \<.001), and this effect was consistent across sexes and age groups. SCAT3 cognitive and balance performance did not differ based on baseline symptom reporting. Conclusions: Healthy adolescent student athletes frequently report concussion-like symptoms at baseline. Clinicians should factor pre-injury symptomatology and medical history into concussion management when determining symptom etiology throughout the course of recovery. © 2016 Informa UK Limited, trading as Taylor \& Francis Group.},

keywords = {Adolescent, biopsychosocial, Brain Injury, high school, Sport-related concussion},

pubstate = {published},

tppubtype = {article}

}

Mihalik, J P; Lynall, R C; Wasserman, E B; Guskiewicz, K M; Marshall, S W

Evaluating the "threshold Theory": Can Head Impact Indicators Help? Journal Article

In: Medicine & Science in Sports & Exercise, vol. 49, no. 2, pp. 247–253, 2017.

Abstract | Links | BibTeX | Tags: Biomechanics, Brain Injury, Concussion, sport injury

Klein, T A; Graves, J M

A Comparison of Psychiatric and Nonpsychiatric Nurse Practitioner Knowledge and Management Recommendations Regarding Adolescent Mild Traumatic Brain Injury Journal Article

In: Journal of the American Psychiatric Nurses Association, vol. 23, no. 1, pp. 37–49, 2017.

Abstract | Links | BibTeX | Tags: adolescents/adolescence, Brain Injury, Concussion, nurse practitioner

@article{Klein2017,

title = {A Comparison of Psychiatric and Nonpsychiatric Nurse Practitioner Knowledge and Management Recommendations Regarding Adolescent Mild Traumatic Brain Injury},

author = {Klein, T A and Graves, J M},

doi = {10.1177/1078390316668992},

year  = {2017},

date = {2017-01-01},

journal = {Journal of the American Psychiatric Nurses Association},

volume = {23},

number = {1},

pages = {37--49},

abstract = {BACKGROUND: Nurse practitioners (NPs) are statutorily authorized to provide assessment and cognitive recommendations for concussion in most states. Their scope of practice includes assessment and management of concussion sequalae including anxiety, insomnia, and depression, as well as return to school and activity guidance. OBJECTIVES: Analysis of symptom-based diagnosis of mild traumatic brain injury (TBI) in adolescents, including return to school and school workload recommendations comparing psychiatric and nonpsychiatric NPs. DESIGN: Cross-sectional Web-based survey with embedded videos using standardized actors and scripts randomized for patient sex and sport. A total of 4,849 NPs licensed in Oregon or Washington were invited by e-mail to view and respond to this study, with a response rate of 23%. RESULTS: Psychiatric mental health nurse practitioners (PMHNPs) were 44% less likely than family NPs to report using standardized concussion tools. 17% had completed continuing education on mild TBI compared to 54.5% of family NPs. Seven PMHNPs provided additional feedback related to discomfort in completing the survey due to lack of comfort or experience. Return to school recommendations and reduced workload advice did not significantly differ by NP type. CONCLUSION: PMHNPs may support individualized assessment through concussion evaluation, use of standardized tools, and differential consideration of TBI for mental health symptoms. More research is required related to the role and contribution of cognitive rest to full recovery. © 2016, © The Author(s) 2016.},

keywords = {adolescents/adolescence, Brain Injury, Concussion, nurse practitioner},

pubstate = {published},

tppubtype = {article}

}

2016

Cobb, B R; Zadnik, A M; Rowson, S

Comparative analysis of helmeted impact response of Hybrid III and National Operating Committee on Standards for Athletic Equipment headforms Journal Article

In: Proceedings of the Institution of Mechanical Engineers, Part P: Journal of Sports Engineering and Technology, vol. 230, no. 1, pp. 50–60, 2016.

Abstract | Links | BibTeX | Tags: Acceleration, Accident prevention, Angular acceleration, Biomechanics, Brain Injury, Coefficient of variation values, Comparative analysis, Concussion, Equipment, Evaluation protocol, helmet testing, Linear acceleration, Linear accelerations, Rotational acceleration, Safety devices, Sporting goods, standards

@article{Cobb2016,

title = {Comparative analysis of helmeted impact response of Hybrid III and National Operating Committee on Standards for Athletic Equipment headforms},

author = {Cobb, B R and Zadnik, A M and Rowson, S},

doi = {10.1177/1754337115599133},

year  = {2016},

date = {2016-01-01},

journal = {Proceedings of the Institution of Mechanical Engineers, Part P: Journal of Sports Engineering and Technology},

volume = {230},

number = {1},

pages = {50--60},

abstract = {As advanced helmet testing methodologies are developed, the effect headform selection may have on the biomechanical impact response must be considered. This study sought to assess response differences between two of the most commonly used headforms, the Hybrid III and National Operating Committee on Standards for Athletic Equipment headforms, through a series of helmeted impact tests. A total of 180 pendulum impact tests were conducted with three impactor velocities and six impact locations. Test condition-specific significant differences were found between the two headforms for peak linear and angular accelerations ($alpha$ = 0.05), although differences tended to be small. On average, the National Operating Committee on Standards for Athletic Equipment headform experienced higher peak linear (3.7 ± 7.8%) and angular (12.0 ± 21.6%) accelerations, with some of the largest differences associated with impacts to the facemask. Without the facemask impacts, the average differences in linear (1.8 ± 6.0%) and angular (9.6 ± 15.9%) acceleration would be lower. No significant differences were found in coefficient of variation values for linear (Hybrid III: 2.6 ± 2.3%, National Operating Committee on Standards for Athletic Equipment: 2.0 ± 1.4%) or angular (Hybrid III: 4.9 ± 4.0%; National Operating Committee on Standards for Athletic Equipment: 5.2 ± 5.8%) acceleration. These data have application toward development and validation of future helmet evaluation protocols and standards. © IMechE 2015.},

keywords = {Acceleration, Accident prevention, Angular acceleration, Biomechanics, Brain Injury, Coefficient of variation values, Comparative analysis, Concussion, Equipment, Evaluation protocol, helmet testing, Linear acceleration, Linear accelerations, Rotational acceleration, Safety devices, Sporting goods, standards},

pubstate = {published},

tppubtype = {article}

}

Puvenna, V; Engeler, M; Banjara, M; Brennan, C; Schreiber, P; Dadas, A; Bahrami, A; Solanki, J; Bandyopadhyay, A; Morris, J K; Bernick, C; Ghosh, C; Rapp, E; Bazarian, J J; Janigro, D

Is phosphorylated tau unique to chronic traumatic encephalopathy? Phosphorylated tau in epileptic brain and chronic traumatic encephalopathy Journal Article

In: Brain Research, vol. 1630, pp. 225–240, 2016.

Abstract | BibTeX | Tags: *Brain Injury, *Brain/me [Metabolism], *Epilepsy/me [Metabolism], *tau Proteins/me [Metabolism], 0 (MAPT protein, 0 (tau Proteins), 80 and over, Adolescent, adult, aged, Brain Injury, Brain/pa [Pathology], Brain/su [Surgery], Child, Chronic/me [Metabolism], Chronic/pa [Pathology], ENZYME-linked immunosorbent assay, Epilepsy/pa [Pathology], Epilepsy/su [Surgery], Female, human), Humans, immunohistochemistry, Infant, Male, middle aged, Phosphorylation, Preschool, Young Adult

@article{Puvenna2016,

title = {Is phosphorylated tau unique to chronic traumatic encephalopathy? Phosphorylated tau in epileptic brain and chronic traumatic encephalopathy},

author = {Puvenna, V and Engeler, M and Banjara, M and Brennan, C and Schreiber, P and Dadas, A and Bahrami, A and Solanki, J and Bandyopadhyay, A and Morris, J K and Bernick, C and Ghosh, C and Rapp, E and Bazarian, J J and Janigro, D},

year  = {2016},

date = {2016-01-01},

journal = {Brain Research},

volume = {1630},

pages = {225--240},

abstract = {Repetitive traumatic brain injury (rTBI) is one of the major risk factors for the abnormal deposition of phosphorylated tau (PT) in the brain and chronic traumatic encephalopathy (CTE). CTE and temporal lobe epilepsy (TLE) affect the limbic system, but no comparative studies on PT distribution in TLE and CTE are available. It is also unclear whether PT pathology results from repeated head hits (rTBI). These gaps prevent a thorough understanding of the pathogenesis and clinical significance of PT, limiting our ability to develop preventative and therapeutic interventions. We quantified PT in TLE and CTE to unveil whether a history of rTBI is a prerequisite for PT accumulation in the brain. Six postmortem CTE (mean 73.3 years) and age matched control samples were compared to 19 surgically resected TLE brain specimens (4 months-58 years; mean 27.6 years). No history of TBI was present in TLE or control; all CTE patients had a history of rTBI. TLE and CTE brain displayed increased levels of PT as revealed by immunohistochemistry. No age-dependent changes were noted, as PT was present as early as 4 months after birth. In TLE and CTE, cortical neurons, perivascular regions around penetrating pial vessels and meninges were immunopositive for PT; white matter tracts also displayed robust expression of extracellular PT organized in bundles parallel to venules. Microscopically, there were extensive tau-immunoreactive neuronal, astrocytic and degenerating neurites throughout the brain. In CTE perivascular tangles were most prominent. Overall, significant differences in staining intensities were found between CTE and control (P\<0.01) but not between CTE and TLE (P=0.08). pS199 tau analysis showed that CTE had the most high molecular weight tangle-associated tau, whereas epileptic brain contained low molecular weight tau. Tau deposition may not be specific to rTBI since TLE recapitulated most of the pathological features of CTE. Copyright © 2015 Elsevier B.V. All rights reserved.},

keywords = {*Brain Injury, *Brain/me [Metabolism], *Epilepsy/me [Metabolism], *tau Proteins/me [Metabolism], 0 (MAPT protein, 0 (tau Proteins), 80 and over, Adolescent, adult, aged, Brain Injury, Brain/pa [Pathology], Brain/su [Surgery], Child, Chronic/me [Metabolism], Chronic/pa [Pathology], ENZYME-linked immunosorbent assay, Epilepsy/pa [Pathology], Epilepsy/su [Surgery], Female, human), Humans, immunohistochemistry, Infant, Male, middle aged, Phosphorylation, Preschool, Young Adult},

pubstate = {published},

tppubtype = {article}

}

Repetitive traumatic brain injury (rTBI) is one of the major risk factors for the abnormal deposition of phosphorylated tau (PT) in the brain and chronic traumatic encephalopathy (CTE). CTE and temporal lobe epilepsy (TLE) affect the limbic system, but no comparative studies on PT distribution in TLE and CTE are available. It is also unclear whether PT pathology results from repeated head hits (rTBI). These gaps prevent a thorough understanding of the pathogenesis and clinical significance of PT, limiting our ability to develop preventative and therapeutic interventions. We quantified PT in TLE and CTE to unveil whether a history of rTBI is a prerequisite for PT accumulation in the brain. Six postmortem CTE (mean 73.3 years) and age matched control samples were compared to 19 surgically resected TLE brain specimens (4 months-58 years; mean 27.6 years). No history of TBI was present in TLE or control; all CTE patients had a history of rTBI. TLE and CTE brain displayed increased levels of PT as revealed by immunohistochemistry. No age-dependent changes were noted, as PT was present as early as 4 months after birth. In TLE and CTE, cortical neurons, perivascular regions around penetrating pial vessels and meninges were immunopositive for PT; white matter tracts also displayed robust expression of extracellular PT organized in bundles parallel to venules. Microscopically, there were extensive tau-immunoreactive neuronal, astrocytic and degenerating neurites throughout the brain. In CTE perivascular tangles were most prominent. Overall, significant differences in staining intensities were found between CTE and control (P<0.01) but not between CTE and TLE (P=0.08). pS199 tau analysis showed that CTE had the most high molecular weight tangle-associated tau, whereas epileptic brain contained low molecular weight tau. Tau deposition may not be specific to rTBI since TLE recapitulated most of the pathological features of CTE. Copyright © 2015 Elsevier B.V. All rights reserved.

Lucke-Wold, B P; Turner, R C; Logsdon, A F; Nguyen, L; Bailes, J E; Lee, J M; Robson, M J; Omalu, B I; Huber, J D; Rosen, C L

Endoplasmic reticulum stress implicated in chronic traumatic encephalopathy Journal Article

In: Journal of Neurosurgery, vol. 124, no. 3, pp. 687–702, 2016.

Abstract | BibTeX | Tags: *Blast Injuries/px [Psychology], *Brain Injury, *Endoplasmic Reticulum Stress/ph [Physiology], *Football/in [Injuries], *Wrestling/in [Injuries], adult, animal, Animals, Blast Injuries/et [Etiology], Blast Injuries/pa [Pathology], Brain Injury, Chronic/et [Etiology], Chronic/pa [Pathology], Chronic/px [Psychology], Disease Models, Humans, Male, Rats, Sprague-Dawley

@article{Lucke-Wold2016,

title = {Endoplasmic reticulum stress implicated in chronic traumatic encephalopathy},

author = {Lucke-Wold, B P and Turner, R C and Logsdon, A F and Nguyen, L and Bailes, J E and Lee, J M and Robson, M J and Omalu, B I and Huber, J D and Rosen, C L},

year  = {2016},

date = {2016-01-01},

journal = {Journal of Neurosurgery},

volume = {124},

number = {3},

pages = {687--702},

abstract = {OBJECTIVE: Chronic traumatic encephalopathy is a progressive neurodegenerative disease characterized by neurofibrillary tau tangles following repetitive neurotrauma. The underlying mechanism linking traumatic brain injury to chronic traumatic encephalopathy has not been elucidated. The authors investigate the role of endoplasmic reticulum stress as a link between acute neurotrauma and chronic neurodegeneration. METHODS: The authors used pharmacological, biochemical, and behavioral tools to assess the role of endoplasmic reticulum stress in linking acute repetitive traumatic brain injury to the development of chronic neurodegeneration. Data from the authors' clinically relevant and validated rodent blast model were compared with those obtained from postmortem human chronic traumatic encephalopathy specimens from a National Football League player and World Wrestling Entertainment wrestler. RESULTS: The results demonstrated strong correlation of endoplasmic reticulum stress activation with subsequent tau hyperphosphorylation. Various endoplasmic reticulum stress markers were increased in human chronic traumatic encephalopathy specimens, and the endoplasmic reticulum stress response was associated with an increase in the tau kinase, glycogen synthase kinase-3beta. Docosahexaenoic acid, an endoplasmic reticulum stress inhibitor, improved cognitive performance in the rat model 3 weeks after repetitive blast exposure. The data showed that docosahexaenoic acid administration substantially reduced tau hyperphosphorylation (t = 4.111, p \< 0.05), improved cognition (t = 6.532, p \< 0.001), and inhibited C/EBP homology protein activation (t = 5.631, p \< 0.01). Additionally the data showed, for the first time, that endoplasmic reticulum stress is involved in the pathophysiology of chronic traumatic encephalopathy. CONCLUSIONS: Docosahexaenoic acid therefore warrants further investigation as a potential therapeutic agent for the prevention of chronic traumatic encephalopathy.},

keywords = {*Blast Injuries/px [Psychology], *Brain Injury, *Endoplasmic Reticulum Stress/ph [Physiology], *Football/in [Injuries], *Wrestling/in [Injuries], adult, animal, Animals, Blast Injuries/et [Etiology], Blast Injuries/pa [Pathology], Brain Injury, Chronic/et [Etiology], Chronic/pa [Pathology], Chronic/px [Psychology], Disease Models, Humans, Male, Rats, Sprague-Dawley},

pubstate = {published},

tppubtype = {article}

}

OBJECTIVE: Chronic traumatic encephalopathy is a progressive neurodegenerative disease characterized by neurofibrillary tau tangles following repetitive neurotrauma. The underlying mechanism linking traumatic brain injury to chronic traumatic encephalopathy has not been elucidated. The authors investigate the role of endoplasmic reticulum stress as a link between acute neurotrauma and chronic neurodegeneration. METHODS: The authors used pharmacological, biochemical, and behavioral tools to assess the role of endoplasmic reticulum stress in linking acute repetitive traumatic brain injury to the development of chronic neurodegeneration. Data from the authors' clinically relevant and validated rodent blast model were compared with those obtained from postmortem human chronic traumatic encephalopathy specimens from a National Football League player and World Wrestling Entertainment wrestler. RESULTS: The results demonstrated strong correlation of endoplasmic reticulum stress activation with subsequent tau hyperphosphorylation. Various endoplasmic reticulum stress markers were increased in human chronic traumatic encephalopathy specimens, and the endoplasmic reticulum stress response was associated with an increase in the tau kinase, glycogen synthase kinase-3beta. Docosahexaenoic acid, an endoplasmic reticulum stress inhibitor, improved cognitive performance in the rat model 3 weeks after repetitive blast exposure. The data showed that docosahexaenoic acid administration substantially reduced tau hyperphosphorylation (t = 4.111, p < 0.05), improved cognition (t = 6.532, p < 0.001), and inhibited C/EBP homology protein activation (t = 5.631, p < 0.01). Additionally the data showed, for the first time, that endoplasmic reticulum stress is involved in the pathophysiology of chronic traumatic encephalopathy. CONCLUSIONS: Docosahexaenoic acid therefore warrants further investigation as a potential therapeutic agent for the prevention of chronic traumatic encephalopathy.

Kroshus, E; Gillard, D; Haarbauer‐Krupa, J; Goldman, R E; Bickham, D S

Talking with young children about concussions: An exploratory study Journal Article

In: Child: Care, Health and Development, 2016, ISBN: 0305-1862 1365-2214.

Abstract | Links | BibTeX | Tags: 2016, Brain Injury, children, Concussion, No terms assigned, Parents, Sport

@article{Kroshus2016b,

title = {Talking with young children about concussions: An exploratory study},

author = {Kroshus, E and Gillard, D and Haarbauer‐Krupa, J and Goldman, R E and Bickham, D S},

doi = {10.1111/cch.12433},

isbn = {0305-1862

1365-2214},

year  = {2016},

date = {2016-01-01},

journal = {Child: Care, Health and Development},

publisher = {Wiley-Blackwell Publishing Ltd.},

address = {United Kingdom},

abstract = {Background Concussion education for children early in their participation in organized sport may help shape lasting attitudes about concussion safety. However, existing programming and research focus on older ages. Methods Qualitative interviews about concussions were conducted with twenty children between the ages of six and eight. Structural, descriptive and pattern coding were used to organize the transcribed interviews and identify emergent themes. Results Eighteen of the participants indicated that they had heard of the word concussion, with 12 describing the injury as related to the brain or head. The most frequently described mechanisms of injury were impacts to the head or falls, and symptoms tended to be somatic, such as generalized pain. The most frequently endorsed strategy to avoid sustaining a concussion was to ‘follow the rules.’ Multiple participants referenced parents as an informal source of information about concussions. Conclusions While most participants demonstrated some awareness about concussions, there were clear knowledge gaps that can be addressed with developmentally appropriate concussion education programming. Consistent with their developmental stage, interventions targeted at children in this age range may be most successful if they use basic logic, concrete ideas, provide rules to be followed and engage parents in dissemination. (PsycINFO Database Record (c) 2016 APA, all rights reserved)},

keywords = {2016, Brain Injury, children, Concussion, No terms assigned, Parents, Sport},

pubstate = {published},

tppubtype = {article}

}

Mez, J; Solomon, T M; Daneshvar, D H; Stein, T D; McKee, A C

Pathologically Confirmed Chronic Traumatic Encephalopathy in a 25-Year-Old Former College Football Player Journal Article

In: JAMA Neurology, vol. 73, no. 3, pp. 353–355, 2016.

BibTeX | Tags: *Athletic Injuries/co [Complications], *Brain Injury, *Football, adult, Bacterial, Brain Injury, Chronic/et [Etiology], Chronic/pa [Pathology], Chronic/pp [Physiopathology], Endocarditis, Fatal Outcome, Heart Arrest, Humans, Male, Staphylococcal Infections

Aomura, S; Zhang, Y; Nakadate, H; Koyama, T; Nishimura, A

Brain injury risk estimation of collegiate football player based on game video of concussion suspected accident Journal Article

In: Journal of Biomechanical Science and Engineering, vol. 11, no. 4, 2016.

Abstract | Links | BibTeX | Tags: Accidents, Brain Injury, Brain injury risk estimation, Collision accidents, DIAGNOSIS, FEM, Finite element method, FOOTBALL players, Game video, Game videos, Health risks, Initial conditions, Mechanical parameters, Motion analysis, Relative positions, RISK assessment, Risk perception, Rotational velocity, Sports, Sports-related concussion

@article{Aomura2016,

title = {Brain injury risk estimation of collegiate football player based on game video of concussion suspected accident},

author = {Aomura, S and Zhang, Y and Nakadate, H and Koyama, T and Nishimura, A},

doi = {10.1299/jbse.16-00393},

year  = {2016},

date = {2016-01-01},

journal = {Journal of Biomechanical Science and Engineering},

volume = {11},

number = {4},

abstract = {The collision accident in collegiate football game was simulated based on the game video and the concussive impact on the head was analyzed. First, the collision motion of players was reproduced based on the video by using motion analysis, and the translational and rotational velocities, relative position and contact location of the struck and the striking players' heads just before the collision were calculated. Then the data obtained were input to two helmeted finite element (FE) human head models as the initial condition, and the brain injury risk was evaluated by using the impact analysis. The FE helmet model was validated by a drop test of the helmet in which the head impactor was embedded. In the present study, two concussion suspected accident cases were analyzed; then the concussion was evaluated by ten mechanical parameters generated inside the skull caused by the collision. The injury risk evaluated by multi parameters belonged to the dangerous range that may cause concussion and was consistent with the diagnosis of the medical team doctor. The brain injury risk can be successfully estimated by the reconstructed simulation of the game video and FE analysis. To our knowledge, this study is the first attempt in Japan to estimate the brain injury risk systematically by a combination of game video analysis which is originally introduced for the players' health care and FE analysis by helmeted human head model. In the future, brain injury risk caused by an accident can be evaluated with higher accuracy by analyzing more accident cases. © 2016 The Japan Society of Mechanical Engineers.},

keywords = {Accidents, Brain Injury, Brain injury risk estimation, Collision accidents, DIAGNOSIS, FEM, Finite element method, FOOTBALL players, Game video, Game videos, Health risks, Initial conditions, Mechanical parameters, Motion analysis, Relative positions, RISK assessment, Risk perception, Rotational velocity, Sports, Sports-related concussion},

pubstate = {published},

tppubtype = {article}

}

O'Kane, J W

Is Heading in Youth Soccer Dangerous Play? Journal Article

In: Physician & Sportsmedicine, vol. 44, no. 2, pp. 190–194, 2016.

Abstract | BibTeX | Tags: *Brain Injuries/et [Etiology], *Brain Injury, *Soccer/in [Injuries], Adolescent, Brain Concussion/et [Etiology], Brain Concussion/pc [Prevention & Control], Brain Injuries/pc [Prevention & Control], Brain Injury, Child, Chronic/et [Etiology], Chronic/pc [Prevention & Control], Humans, Risk Factors, UNITED States

@article{OKane2016,

title = {Is Heading in Youth Soccer Dangerous Play?},

author = {O'Kane, J W},

year  = {2016},

date = {2016-01-01},

journal = {Physician \& Sportsmedicine},

volume = {44},

number = {2},

pages = {190--194},

abstract = {BACKGROUND: Soccer is among the most popular youth sports with over 3 million youth players registered in the U.S. Soccer is unique in that players intentionally use their head to strike the ball, leading to concerns that heading could cause acute or chronic brain injury, especially in the immature brains of children. METHODS: Pub Med search without date restriction was conducted in November 2014 and August 2015 using the terms soccer and concussion, heading and concussion, and youth soccer and concussion. 310 articles were identified and reviewed for applicable content specifically relating to youth athletes, heading, and/or acute or chronic brain injury from soccer. RESULTS: Soccer is a low-risk sport for catastrophic head injury, but concussions are relatively common and heading often plays a role. At all levels of play, concussions are more likely to occur in the act of heading than with other facets of the game. While concussion from heading the ball without other contact to the head appears rare in adult players, some data suggests children are more susceptible to concussion from heading primarily in game situations. Contributing factors include biomechanical forces, less developed technique, and the immature brain's susceptibility to injury. CONCLUSIONS: There is no evidence that heading in youth soccer causes any permanent brain injury and there is limited evidence that heading in youth soccer can cause concussion. A reasonable approach based on U.S. Youth Soccer recommendations is to teach heading after age 10 in controlled settings, and heading in games should be delayed until skill acquisition and physical maturity allow the youth player to head correctly with confidence.},

keywords = {*Brain Injuries/et [Etiology], *Brain Injury, *Soccer/in [Injuries], Adolescent, Brain Concussion/et [Etiology], Brain Concussion/pc [Prevention \&amp; Control], Brain Injuries/pc [Prevention \&amp; Control], Brain Injury, Child, Chronic/et [Etiology], Chronic/pc [Prevention \&amp; Control], Humans, Risk Factors, UNITED States},

pubstate = {published},

tppubtype = {article}

}

Keener, A B

Tackling the brain: Clues emerge about the pathology of sports-related brain trauma Journal Article

In: Nature Medicine, vol. 22, no. 4, pp. 326–329, 2016.

Links | BibTeX | Tags: amnesia, Article, astrocyte, athlete, Athletic Injuries, behavior change, blood vessel injury, brain, Brain Injuries, Brain Injury, cognitive defect, Concussion, confusion, degenerative disease, Epilepsy, head injury, headache, hearing impairment, human, Humans, Neck pain, nerve cell, nervous system inflammation, neurofibrillary tangle, nonhuman, Pathophysiology, postconcussion syndrome, priority journal, sport injury, traumatic brain injury, unsteadiness, Vision, wrestling

Ojo, J O; Mouzon, B C; Crawford, F

Repetitive head trauma, chronic traumatic encephalopathy and tau: Challenges in translating from mice to men Journal Article

In: Experimental Neurology, vol. 275, pp. 389–404, 2016.

Abstract | Links | BibTeX | Tags: amyloid beta protein, animal, Animal models, Animals, Astroglial tangles, Brain Injury, cell activation, Chronic, complication, Concussion, Craniocerebral Trauma, CTE, diffuse axonal injury, disease duration, disease model, Disease Models, genetic predisposition, gliosis, head injury, hippocampus, human, Humans, lifestyle modification, lithium, metabolism, Mice, microglia, minocycline, mouse, nervous system inflammation, Neurobehaviour, Neurofibrillary tangles, neuropathology, nonhuman, pathogenesis, pathology, priority journal, procedures, protein aggregation, protein analysis, protein blood level, protein cleavage, Repetitive TBI, Review, sex difference, stress activated protein kinase inhibitor, Systematic Review, Tau, tau protein, tau Proteins, Transgenic mice, Translational Medical Research, translational research, traumatic brain injury, trends

@article{Ojo2016,

title = {Repetitive head trauma, chronic traumatic encephalopathy and tau: Challenges in translating from mice to men},

author = {Ojo, J O and Mouzon, B C and Crawford, F},

doi = {10.1016/j.expneurol.2015.06.003},

year  = {2016},

date = {2016-01-01},

journal = {Experimental Neurology},

volume = {275},

pages = {389--404},

abstract = {Chronic traumatic encephalopathy (CTE) is a neurological and psychiatric condition marked by preferential perivascular foci of neurofibrillary and glial tangles (composed of hyperphosphorylated-tau proteins) in the depths of the sulci. Recent retrospective case series published over the last decade on athletes and military personnel have added considerably to our clinical and histopathological knowledge of CTE. This has marked a vital turning point in the traumatic brain injury (TBI) field, raising public awareness of the potential long-term effects of mild and moderate repetitive TBI, which has been recognized as one of the major risk factors associated with CTE. Although these human studies have been informative, their retrospective design carries certain inherent limitations that should be cautiously interpreted. In particular, the current overriding issue in the CTE literature remains confusing in regard to appropriate definitions of terminology, variability in individual pathologies and the potential case selection bias in autopsy based studies. There are currently no epidemiological or prospective studies on CTE. Controlled preclinical studies in animals therefore provide an alternative means for specifically interrogating aspects of CTE pathogenesis. In this article, we review the current literature and discuss difficulties and challenges of developing in-vivo TBI experimental paradigms to explore the link between repetitive head trauma and tau-dependent changes. We provide our current opinion list of recommended features to consider for successfully modeling CTE in animals to better understand the pathobiology and develop therapeutics and diagnostics, and critical factors, which might influence outcome. We finally discuss the possible directions of future experimental research in the repetitive TBI/CTE field. © 2015 Elsevier Inc..},

keywords = {amyloid beta protein, animal, Animal models, Animals, Astroglial tangles, Brain Injury, cell activation, Chronic, complication, Concussion, Craniocerebral Trauma, CTE, diffuse axonal injury, disease duration, disease model, Disease Models, genetic predisposition, gliosis, head injury, hippocampus, human, Humans, lifestyle modification, lithium, metabolism, Mice, microglia, minocycline, mouse, nervous system inflammation, Neurobehaviour, Neurofibrillary tangles, neuropathology, nonhuman, pathogenesis, pathology, priority journal, procedures, protein aggregation, protein analysis, protein blood level, protein cleavage, Repetitive TBI, Review, sex difference, stress activated protein kinase inhibitor, Systematic Review, Tau, tau protein, tau Proteins, Transgenic mice, Translational Medical Research, translational research, traumatic brain injury, trends},

pubstate = {published},

tppubtype = {article}

}

Buckley, T A; Vallabhajosula, S; Oldham, J R; Munkasy, B A; Evans, K M; Krazeise, D A; Ketcham, C J; Hall, E E

Evidence of a conservative gait strategy in athletes with a history of concussions Journal Article

In: Journal of Sport and Health Science, vol. 5, no. 4, pp. 417–423, 2016.

Abstract | Links | BibTeX | Tags: Balance, Brain Injury, Gait performance, Locomotion, Mild traumatic, postural control, postural stability, Variability

@article{Buckley2016a,

title = {Evidence of a conservative gait strategy in athletes with a history of concussions},

author = {Buckley, T A and Vallabhajosula, S and Oldham, J R and Munkasy, B A and Evans, K M and Krazeise, D A and Ketcham, C J and Hall, E E},

doi = {10.1016/j.jshs.2015.03.010},

year  = {2016},

date = {2016-01-01},

journal = {Journal of Sport and Health Science},

volume = {5},

number = {4},

pages = {417--423},

abstract = {Background A history of 3 or more concussions is frequently associated with numerous short- and long-term neuropathologies. Impairments in postural control are a known acute consequence of concussion; however, limited evidence exists on the effects of multiple concussions on gait. The purpose of this study was to assess gait stepping characteristics in collegiate aged student-athletes based on concussion history. Methods There were 63 participants divided into 3 even groups based on concussion history: ≥3 concussions, 1\textendash2 concussions, and 0 concussion. All participants completed 10 trials of gait on a 4.9 m instrumented walkway. The dependent variables of interest included both gait stepping characteristics (step velocity, length, and width, double support time, and the percentage of the gait cycle in stance) and coefficient of variability (CoV) measures (step length, time, and width). The gait stepping characteristics were compared first with a MANOVA with follow-up 1-way ANOVAs and Tukey post hoc tests as appropriate. The CoV measures were compared with 1-way ANOVAs and Tukey post hoc tests. Results There were main effects for group for step velocity, length, width, and double support time. Overall, the 0 concussion group displayed typical healthy young gait parameters and performed significantly better than either concussion group. The 0 concussion group had a significantly greater step length CoV, but there were no differences in the step time or width CoV. Conclusion This finding provides evidence of subtle impairments in postural control during gait among individuals with prior history of concussion which could be an early indicator of future neurological deficiencies. The limited difference in the variability measures is consistent with prior static stance studies and could suggest the individuals constrain their motor systems to reduce variability. Taken together, these findings suggest a conservative gait strategy which is adopted by individuals with a history of concussions. © 2016},

keywords = {Balance, Brain Injury, Gait performance, Locomotion, Mild traumatic, postural control, postural stability, Variability},

pubstate = {published},

tppubtype = {article}

}

Background A history of 3 or more concussions is frequently associated with numerous short- and long-term neuropathologies. Impairments in postural control are a known acute consequence of concussion; however, limited evidence exists on the effects of multiple concussions on gait. The purpose of this study was to assess gait stepping characteristics in collegiate aged student-athletes based on concussion history. Methods There were 63 participants divided into 3 even groups based on concussion history: ≥3 concussions, 1–2 concussions, and 0 concussion. All participants completed 10 trials of gait on a 4.9 m instrumented walkway. The dependent variables of interest included both gait stepping characteristics (step velocity, length, and width, double support time, and the percentage of the gait cycle in stance) and coefficient of variability (CoV) measures (step length, time, and width). The gait stepping characteristics were compared first with a MANOVA with follow-up 1-way ANOVAs and Tukey post hoc tests as appropriate. The CoV measures were compared with 1-way ANOVAs and Tukey post hoc tests. Results There were main effects for group for step velocity, length, width, and double support time. Overall, the 0 concussion group displayed typical healthy young gait parameters and performed significantly better than either concussion group. The 0 concussion group had a significantly greater step length CoV, but there were no differences in the step time or width CoV. Conclusion This finding provides evidence of subtle impairments in postural control during gait among individuals with prior history of concussion which could be an early indicator of future neurological deficiencies. The limited difference in the variability measures is consistent with prior static stance studies and could suggest the individuals constrain their motor systems to reduce variability. Taken together, these findings suggest a conservative gait strategy which is adopted by individuals with a history of concussions. © 2016

Steiger, B

Meet Bennet Omalu, Md: The Physician Leader Whose Research Inspired the Movie Concussion Journal Article

In: Physician Leadership Journal, vol. 3, no. 2, pp. 8–10, 2016.

Abstract | BibTeX | Tags: *Brain Concussion/co [Complications], *Brain Injury, *Football, Athletic Injuries/co [Complications], Brain Injury, Chronic, Chronic/et [Etiology], Humans, Motion Pictures as Topic

Terwilliger, V K; Pratson, L; Vaughan, C G; Gioia, G A

Additional Post-Concussion Impact Exposure May Affect Recovery in Adolescent Athletes Journal Article

In: Journal of Neurotrauma, vol. 33, no. 8, pp. 761–765, 2016.

Abstract | Links | BibTeX | Tags: Adolescent, Article, athlete, Athletes, brain concussion, Brain Injury, clinical article, Concussion, controlled study, CONVALESCENCE, Female, human, Male, mTBI, Parent, postconcussion syndrome, retrospective study, risk factor, sport injury

@article{Terwilliger2016,

title = {Additional Post-Concussion Impact Exposure May Affect Recovery in Adolescent Athletes},

author = {Terwilliger, V K and Pratson, L and Vaughan, C G and Gioia, G A},

doi = {10.1089/neu.2015.4082},

year  = {2016},

date = {2016-01-01},

journal = {Journal of Neurotrauma},

volume = {33},

number = {8},

pages = {761--765},

abstract = {Repeat concussion has been associated with risk for prolonged and pronounced clinical recovery in athletes. In this study of adolescent athletes, we examined whether an additional head impact within 24 h of a sports-related concussion (SRC) is associated with higher symptom burden and prolonged clinical recovery compared with a single-injury group. Forty-two student-athletes (52% male, mean age = 14.9 years) diagnosed with an SRC in a concussion clinic were selected for this study: (1) 21 athletes who sustained an additional significant head impact within 24 h of the initial injury (additional-impact group); (2) 21 single-injury athletes, age and gender matched, who sustained only one discrete concussive blow to the head (single-injury group). Groups did not differ on initial injury characteristics or pre-injury risk factors. The effect of injury status (single-vs. additional-impact) was examined on athlete-and parent-reported symptom burden (at first clinic visit) and length of recovery (LOR). Higher symptom burden was reported by the athletes and parents in the additional-impact group at the time of first visit. The additional-impact group also had a significantly longer LOR compared with the single-injury group. These findings provide preliminary, hypothesis-generating evidence for the importance of immediate removal from play following an SRC to protect athletes from re-injury, which may worsen symptoms and prolong recovery. The retrospective study design from a specialized clinical sample points to the need for future prospective studies of the relationship between single-and additional-impact injuries on symptom burden and LOR. © 2016 Mary Ann Liebert, Inc.},

keywords = {Adolescent, Article, athlete, Athletes, brain concussion, Brain Injury, clinical article, Concussion, controlled study, CONVALESCENCE, Female, human, Male, mTBI, Parent, postconcussion syndrome, retrospective study, risk factor, sport injury},

pubstate = {published},

tppubtype = {article}

}

Iverson, G L

Suicide and Chronic Traumatic Encephalopathy Journal Article

In: Journal of Neuropsychiatry & Clinical Neurosciences, vol. 28, no. 1, pp. 9–16, 2016.

Abstract | BibTeX | Tags: *Brain Injury, *Football/in [Injuries], *Suicide/px [Psychology], Athletic Injuries/di [Diagnosis], Athletic Injuries/ep [Epidemiology], Athletic Injuries/px [Psychology], Brain Injury, Chronic/di [Diagnosis], Chronic/ep [Epidemiology], Chronic/px [Psychology], Football/px [Psychology], Humans, Male, Risk Factors, Suicide/td [Trends]

2015

Morgan, C D; Zuckerman, S L; King, L E; Beaird, S E; Sills, A K; Solomon, G S

Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging Journal Article

In: Child's Nervous System, vol. 31, no. 12, pp. 2305–2309, 2015.

Abstract | Links | BibTeX | Tags: Adolescent, arachnoid cyst, Article, brain, Brain Injury, Child, Computed tomography (CT) neuroimaging, computer assisted tomography, Computer-Assisted, Concussion, cost effectiveness analysis, cost utility analysis, DECISION making, diagnostic value, DSM-IV, Female, human, Humans, image processing, Magnetic Resonance Imaging, Magnetic resonance imaging (MRI), major clinical study, Male, mild traumatic brain injury, neuroimaging, neurosurgery, nuclear magnetic resonance, nuclear magnetic resonance imaging, pathology, Post-Concussion Syndrome, postconcussion syndrome, Preschool, preschool child, priority journal, Radiography, Retrospective Studies, retrospective study, Sports, STATISTICS, Tomography, traumatic brain injury, X ray, X-Ray Computed

@article{Morgan2015,

title = {Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging},

author = {Morgan, C D and Zuckerman, S L and King, L E and Beaird, S E and Sills, A K and Solomon, G S},

doi = {10.1007/s00381-015-2916-y},

year  = {2015},

date = {2015-01-01},

journal = {Child's Nervous System},

volume = {31},

number = {12},

pages = {2305--2309},

abstract = {Purpose: Approximately 90% of concussions are transient, with symptoms resolving within 10\textendash14 days. However, a minority of patients remain symptomatic several months post-injury, a condition known as post-concussion syndrome (PCS). The treatment of these patients can be challenging. The goal of our study was to assess the utility and cost-effectiveness of neurologic imaging two or more weeks post-injury in a cohort of youth with PCS. Methods: We conducted a retrospective study of 52 pediatric patients with persistent post-concussion symptoms after 3 months. We collected demographics and neuroimaging results obtained greater than 2 weeks post-concussion. Neuroimaging ordered in the first 2 weeks post-concussion was excluded, except to determine the rate of re-imaging. Descriptive statistics and corresponding cost data were collected. Results: Of 52 patients with PCS, 23/52 (44 %) had neuroimaging at least 2 weeks after the initial injury, for a total of 32 diagnostic studies. In summary, 1/19 MRIs (5.3 %), 1/8 CTs (13 %), and 0/5 x-rays (0 %) yielded significant positive findings, none of which altered clinical management. Chronic phase neuroimaging estimated costs from these 52 pediatric patients totaled $129,025. We estimate the cost to identify a single positive finding was $21,000 for head CT and $104,500 for brain MRI. Conclusions: In this cohort of pediatric PCS patients, brain imaging in the chronic phase (defined as more than 2 weeks after concussion) was pursued in almost half the study sample, had low diagnostic yield, and had poor cost-effectiveness. Based on these results, outpatient management of pediatric patients with long-term post-concussive symptoms should rarely include repeat neuroimaging beyond the acute phase. © 2015, Springer-Verlag Berlin Heidelberg.},

keywords = {Adolescent, arachnoid cyst, Article, brain, Brain Injury, Child, Computed tomography (CT) neuroimaging, computer assisted tomography, Computer-Assisted, Concussion, cost effectiveness analysis, cost utility analysis, DECISION making, diagnostic value, DSM-IV, Female, human, Humans, image processing, Magnetic Resonance Imaging, Magnetic resonance imaging (MRI), major clinical study, Male, mild traumatic brain injury, neuroimaging, neurosurgery, nuclear magnetic resonance, nuclear magnetic resonance imaging, pathology, Post-Concussion Syndrome, postconcussion syndrome, Preschool, preschool child, priority journal, Radiography, Retrospective Studies, retrospective study, Sports, STATISTICS, Tomography, traumatic brain injury, X ray, X-Ray Computed},

pubstate = {published},

tppubtype = {article}

}

Smith, A M; Stuart, M J; Dodick, D W; Roberts, W O; Alford, P W; Ashare, A B; Aubrey, M; Benson, B W; Burke, C J; Dick, R; Eickhoff, C; Emery, C A; Flashman, L A; Gaz, D; Giza, C C; Greenwald, R M; Herring, S; Hoshizaki, T B; Hudziak, J J; Huston 3rd, J; Krause, D; LaVoi, N; Leaf, M; Leddy, J J; MacPherson, A; McKee, A C; Mihalik, J P; Moessner, A M; Montelpare, W J; Putukian, M; Schneider, K J; Szalkowski, R; Tabrum, M; Whitehead, J; Wiese-Bjornstal, D M

Ice Hockey Summit II: zero tolerance for head hits and fighting.[Erratum appears in Clin J Sport Med. 2015 Jul;25(4):379] Journal Article

In: Clinical Journal of Sport Medicine, vol. 25, no. 2, pp. 78–87, 2015.

Abstract | BibTeX | Tags: *Brain Concussion/pc [Prevention & Control], *Brain Injury, *Hockey/in [Injuries], *Violence/pc [Prevention & Control], Adolescent, adult, Brain Concussion/th [Therapy], Brain Injury, Child, Chronic/pc [Prevention & Control], Chronic/th [Therapy], Congresses as Topic, Evidence-Based Medicine, Head Protective Devices/st [Standards], Hockey/st [Standards], Humans, policy, Young Adult

@article{Smith2015a,

title = {Ice Hockey Summit II: zero tolerance for head hits and fighting.[Erratum appears in Clin J Sport Med. 2015 Jul;25(4):379]},

author = {Smith, A M and Stuart, M J and Dodick, D W and Roberts, W O and Alford, P W and Ashare, A B and Aubrey, M and Benson, B W and Burke, C J and Dick, R and Eickhoff, C and Emery, C A and Flashman, L A and Gaz, D and Giza, C C and Greenwald, R M and Herring, S and Hoshizaki, T B and Hudziak, J J and {Huston 3rd}, J and Krause, D and LaVoi, N and Leaf, M and Leddy, J J and MacPherson, A and McKee, A C and Mihalik, J P and Moessner, A M and Montelpare, W J and Putukian, M and Schneider, K J and Szalkowski, R and Tabrum, M and Whitehead, J and Wiese-Bjornstal, D M},

year  = {2015},

date = {2015-01-01},

journal = {Clinical Journal of Sport Medicine},

volume = {25},

number = {2},

pages = {78--87},

abstract = {OBJECTIVE: To present currently known basic science and on-ice influences of sport-related concussion (SRC) in hockey, building on the Ice Hockey Summit I action plan (2011) to reduce SRC. METHODS: The prior summit proceedings included an action plan intended to reduce SRC. As such, the proceedings from Summit I served as a point of departure, for the science and discussion held during Summit II (Mayo Clinic, Rochester MN, October 2013). Summit II focused on (1) Basic Science of Concussions in Ice Hockey: Taking Science Forward; (2) Acute and Chronic Concussion Care: Making a Difference; (3) Preventing Concussions via Behavior, Rules, Education and Measuring Effectiveness; (4) Updates in Equipment: their Relationship to Industry Standards; and (5) Policies and Plans at State, National and Federal Levels to reduce SRC. Action strategies derived from the presentations and discussion described in these sectors were subsequently voted on for purposes of prioritization. The following proceedings include knowledge and research shared by invited faculty, many of whom are health care providers and clinical investigators. RESULTS: The Summit II evidence-based action plan emphasizes the rapidly evolving scientific content of hockey SRC. It includes the most highly prioritized strategies voted on for implementation to decrease concussion. CONCLUSIONS: The highest priority action items identified from the Summit includes the following: (1) eliminate head hits from all levels of ice hockey, (2) change body-checking policies, and (3) eliminate fighting in all amateur and professional hockey.},

keywords = {*Brain Concussion/pc [Prevention \&amp; Control], *Brain Injury, *Hockey/in [Injuries], *Violence/pc [Prevention \&amp; Control], Adolescent, adult, Brain Concussion/th [Therapy], Brain Injury, Child, Chronic/pc [Prevention \&amp; Control], Chronic/th [Therapy], Congresses as Topic, Evidence-Based Medicine, Head Protective Devices/st [Standards], Hockey/st [Standards], Humans, policy, Young Adult},

pubstate = {published},

tppubtype = {article}

}

Stein, T D; Montenigro, P H; Alvarez, V E; Xia, W; Crary, J F; Tripodis, Y; Daneshvar, D H; Mez, J; Solomon, T; Meng, G; Kubilus, C A; Cormier, K A; Meng, S; Babcock, K; Kiernan, P; Murphy, L; Nowinski, C J; Martin, B; Dixon, D; Stern, R A; Cantu, R C; Kowall, N W; McKee, A C

Beta-amyloid deposition in chronic traumatic encephalopathy Journal Article

In: Acta Neuropathologica, vol. 130, no. 1, pp. 21–34, 2015.

Abstract | BibTeX | Tags: *Amyloid beta-Peptides/me [Metabolism], *Brain Injury, *Brain/pa [Pathology], *Neurodegenerative Diseases/pa [Pathology], *tau Proteins/me [Metabolism], 0 (Amyloid beta-Peptides), 0 (Apolipoprotein E4), 0 (MAPT protein, 0 (tau Proteins), 80 and over, adult, Age Factors, aged, Amyloid/et [Etiology], Amyloid/me [Metabolism], Amyloid/pa [Pathology], Apolipoprotein E4/ge [Genetics], Athletes, Athletic Injuries/ep [Epidemiology], Athletic Injuries/ge [Genetics], Athletic Injuries/me [Metabolism], Athletic Injuries/pa [Pathology], Brain Injury, Brain/me [Metabolism], Chronic/ep [Epidemiology], Chronic/ge [Genetics], Chronic/me [Metabolism], Chronic/pa [Pathology], Cohort Studies, comorbidity, human), Humans, middle aged, Neurodegenerative Diseases/ep [Epidemiology], Neurodegenerative Diseases/ge [Genetics], Neurodegenerative Diseases/me [Metabolism], Plaque, SEVERITY of illness index, veterans, War-Related Injuries/ep [Epidemiology], War-Related Injuries/ge [Genetics], War-Related Injuries/me [Metabolism], War-Related Injuries/pa [Pathology]

@article{Stein2015b,

title = {Beta-amyloid deposition in chronic traumatic encephalopathy},

author = {Stein, T D and Montenigro, P H and Alvarez, V E and Xia, W and Crary, J F and Tripodis, Y and Daneshvar, D H and Mez, J and Solomon, T and Meng, G and Kubilus, C A and Cormier, K A and Meng, S and Babcock, K and Kiernan, P and Murphy, L and Nowinski, C J and Martin, B and Dixon, D and Stern, R A and Cantu, R C and Kowall, N W and McKee, A C},

year  = {2015},

date = {2015-01-01},

journal = {Acta Neuropathologica},

volume = {130},

number = {1},

pages = {21--34},

abstract = {Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with repetitive mild traumatic brain injury. It is defined pathologically by the abnormal accumulation of tau in a unique pattern that is distinct from other tauopathies, including Alzheimer's disease (AD). Although trauma has been suggested to increase amyloid beta peptide (Abeta) levels, the extent of Abeta deposition in CTE has not been thoroughly characterized. We studied a heterogeneous cohort of deceased athletes and military veterans with neuropathologically diagnosed CTE (n = 114, mean age at death = 60) to test the hypothesis that Abeta deposition is altered in CTE and associated with more severe pathology and worse clinical outcomes. We found that Abeta deposition, either as diffuse or neuritic plaques, was present in 52 % of CTE subjects. Moreover, Abeta deposition in CTE occurred at an accelerated rate and with altered dynamics in CTE compared to a normal aging population (OR = 3.8, p \< 0.001). We also found a clear pathological and clinical dichotomy between those CTE cases with Abeta plaques and those without. Abeta deposition was significantly associated with the presence of the APOE epsilon4 allele (p = 0.035), older age at symptom onset (p \< 0.001), and older age at death (p \< 0.001). In addition, when controlling for age, neuritic plaques were significantly associated with increased CTE tauopathy stage (beta = 2.43},

keywords = {*Amyloid beta-Peptides/me [Metabolism], *Brain Injury, *Brain/pa [Pathology], *Neurodegenerative Diseases/pa [Pathology], *tau Proteins/me [Metabolism], 0 (Amyloid beta-Peptides), 0 (Apolipoprotein E4), 0 (MAPT protein, 0 (tau Proteins), 80 and over, adult, Age Factors, aged, Amyloid/et [Etiology], Amyloid/me [Metabolism], Amyloid/pa [Pathology], Apolipoprotein E4/ge [Genetics], Athletes, Athletic Injuries/ep [Epidemiology], Athletic Injuries/ge [Genetics], Athletic Injuries/me [Metabolism], Athletic Injuries/pa [Pathology], Brain Injury, Brain/me [Metabolism], Chronic/ep [Epidemiology], Chronic/ge [Genetics], Chronic/me [Metabolism], Chronic/pa [Pathology], Cohort Studies, comorbidity, human), Humans, middle aged, Neurodegenerative Diseases/ep [Epidemiology], Neurodegenerative Diseases/ge [Genetics], Neurodegenerative Diseases/me [Metabolism], Plaque, SEVERITY of illness index, veterans, War-Related Injuries/ep [Epidemiology], War-Related Injuries/ge [Genetics], War-Related Injuries/me [Metabolism], War-Related Injuries/pa [Pathology]},

pubstate = {published},

tppubtype = {article}

}

Meehan 3rd, W; Mannix, R; Zafonte, R; Pascual-Leone, A

Chronic traumatic encephalopathy and athletes Journal Article

In: Neurology, vol. 85, no. 17, pp. 1504–1511, 2015.

Abstract | BibTeX | Tags: *Athletic Injuries/pa [Pathology], *Brain Concussion/pa [Pathology], *Brain Injury, *Brain/pa [Pathology], *Cognition Disorders/pa [Pathology], *Suicidal Ideation, Aggression/px [Psychology], Athletes, Athletic Injuries/co [Complications], Athletic Injuries/px [Psychology], Brain Concussion/co [Complications], Brain Concussion/px [Psychology], Brain Injury, Chronic/et [Etiology], Chronic/pa [Pathology], Chronic/px [Psychology], Cognition Disorders/et [Etiology], Cognition Disorders/px [Psychology], Headache/et [Etiology], Headache/pa [Pathology], Humans, Mood Disorders/et [Etiology], Mood Disorders/pa [Pathology], Mood Disorders/px [Psychology], Speech Disorders/et [Etiology], Speech Disorders/pa [Pathology], Speech Disorders/px [Psychology]

@article{Meehan3rd2015a,

title = {Chronic traumatic encephalopathy and athletes},

author = {{Meehan 3rd}, W and Mannix, R and Zafonte, R and Pascual-Leone, A},

year  = {2015},

date = {2015-01-01},

journal = {Neurology},

volume = {85},

number = {17},

pages = {1504--1511},

abstract = {Recent case reports have described athletes previously exposed to repetitive head trauma while participating in contact sports who later in life developed mood disorders, headaches, cognitive difficulties, suicidal ideation, difficulties with speech, and aggressive behavior. Postmortem discoveries show that some of these athletes have pathologic findings that are collectively termed chronic traumatic encephalopathy (CTE). Current hypotheses suggest that concussions or perhaps blows to the head that do not cause the signs and symptoms necessary for making the diagnosis of concussion, so-called subconcussive blows, cause both the clinical and pathologic findings. There are, however, some athletes who participate in contact sports who do not develop the findings ascribed to CTE. Furthermore, there are people who have headaches, mood disorders, cognitive difficulties, suicidal ideation, and other clinical problems who have neither been exposed to repeated head trauma nor possessed the pathologic postmortem findings of those currently diagnosed with CTE. The current lack of prospective data and properly designed case-control studies limits the current understanding of CTE, leading to debate about the causes of the neuropathologic findings and the clinical observations. Given the potential for referral and recall bias in available studies, it remains unclear whether or not the pathologic findings made postmortem cause the presumed neurobehavioral sequela and whether the presumed risk factors, such as sports activity, cerebral concussions, and subconcussive blows, are solely causative of the clinical signs and symptoms. This article discusses the current evidence and the associated limitations. Copyright © 2015 American Academy of Neurology.},

keywords = {*Athletic Injuries/pa [Pathology], *Brain Concussion/pa [Pathology], *Brain Injury, *Brain/pa [Pathology], *Cognition Disorders/pa [Pathology], *Suicidal Ideation, Aggression/px [Psychology], Athletes, Athletic Injuries/co [Complications], Athletic Injuries/px [Psychology], Brain Concussion/co [Complications], Brain Concussion/px [Psychology], Brain Injury, Chronic/et [Etiology], Chronic/pa [Pathology], Chronic/px [Psychology], Cognition Disorders/et [Etiology], Cognition Disorders/px [Psychology], Headache/et [Etiology], Headache/pa [Pathology], Humans, Mood Disorders/et [Etiology], Mood Disorders/pa [Pathology], Mood Disorders/px [Psychology], Speech Disorders/et [Etiology], Speech Disorders/pa [Pathology], Speech Disorders/px [Psychology]},

pubstate = {published},

tppubtype = {article}

}

Faden, A I; Loane, D J

Chronic neurodegeneration after traumatic brain injury: Alzheimer disease, chronic traumatic encephalopathy, or persistent neuroinflammation? Journal Article

In: Neurotherapeutics, vol. 12, no. 1, pp. 143–150, 2015.

Abstract | BibTeX | Tags: *Alzheimer Disease/et [Etiology], *Brain Injuries/co [Complications], *Brain Injury, *Encephalitis/et [Etiology], *Nerve Degeneration/et [Etiology], Alzheimer Disease/pa [Pathology], Animals, Brain Injury, Chronic/et [Etiology], Chronic/pa [Pathology], Encephalitis/pa [Pathology], Humans, Nerve Degeneration/pa [Pathology]

@article{Faden2015,

title = {Chronic neurodegeneration after traumatic brain injury: Alzheimer disease, chronic traumatic encephalopathy, or persistent neuroinflammation?},

author = {Faden, A I and Loane, D J},

year  = {2015},

date = {2015-01-01},

journal = {Neurotherapeutics},

volume = {12},

number = {1},

pages = {143--150},

abstract = {It has long been suggested that prior traumatic brain injury (TBI) increases the subsequent incidence of chronic neurodegenerative disorders, including Alzheimer disease, Parkinson disease, and amyotrophic lateral sclerosis. Among these, the association with Alzheimer disease has the strongest support. There is also a long-recognized association between repeated concussive insults and progressive cognitive decline or other neuropsychiatric abnormalities. The latter was first described in boxers as dementia pugilistica, and has received widespread recent attention in contact sports such as professional American football. The term chronic traumatic encephalopathy was coined to attempt to define a "specific" entity marked by neurobehavioral changes and the extensive deposition of phosphorylated tau protein. Nearly lost in the discussions of post-traumatic neurodegeneration after traumatic brain injury has been the role of sustained neuroinflammation, even though this association has been well established pathologically since the 1950s, and is strongly supported by subsequent preclinical and clinical studies. Manifested by extensive microglial and astroglial activation, such chronic traumatic brain inflammation may be the most important cause of post-traumatic neurodegeneration in terms of prevalence. Critically, emerging preclinical studies indicate that persistent neuroinflammation and associated neurodegeneration may be treatable long after the initiating insult(s).},

keywords = {*Alzheimer Disease/et [Etiology], *Brain Injuries/co [Complications], *Brain Injury, *Encephalitis/et [Etiology], *Nerve Degeneration/et [Etiology], Alzheimer Disease/pa [Pathology], Animals, Brain Injury, Chronic/et [Etiology], Chronic/pa [Pathology], Encephalitis/pa [Pathology], Humans, Nerve Degeneration/pa [Pathology]},

pubstate = {published},

tppubtype = {article}

}

Bieniek, K F; Ross, O A; Cormier, K A; Walton, R L; Soto-Ortolaza, A; Johnston, A E; DeSaro, P; Boylan, K B; Graff-Radford, N R; Wszolek, Z K; Rademakers, R; Boeve, B F; McKee, A C; Dickson, D W

Chronic traumatic encephalopathy pathology in a neurodegenerative disorders brain bank Journal Article

In: Acta Neuropathologica, vol. 130, no. 6, pp. 877–889, 2015.

Abstract | BibTeX | Tags: *Brain Injury, *Brain/pa [Pathology], *Neurodegenerative Diseases/et [Etiology], *Neurodegenerative Diseases/pa [Pathology], 0 (Apolipoproteins E), 0 (MAPT protein, 0 (Membrane Proteins), 0 (Nerve Tissue Proteins), 0 (tau Proteins), 0 (TMEM106B protein, aged, Apolipoproteins E/ge [Genetics], Athletic Injuries/co [Complications], Athletic Injuries/ge [Genetics], Athletic Injuries/me [Metabolism], Athletic Injuries/pa [Pathology], Brain Injury, Brain/me [Metabolism], Chronic/et [Etiology], Chronic/ge [Genetics], Chronic/me [Metabolism], Chronic/pa [Pathology], Female, human), Humans, immunohistochemistry, Male, Membrane Proteins/ge [Genetics], Nerve Tissue Proteins/ge [Genetics], Neurodegenerative Diseases/ge [Genetics], Neurodegenerative Diseases/me [Metabolism], Retrospective Studies, tau Proteins/ge [Genetics], tau Proteins/me [Metabolism], Tissue Banks

@article{Bieniek2015,

title = {Chronic traumatic encephalopathy pathology in a neurodegenerative disorders brain bank},

author = {Bieniek, K F and Ross, O A and Cormier, K A and Walton, R L and Soto-Ortolaza, A and Johnston, A E and DeSaro, P and Boylan, K B and Graff-Radford, N R and Wszolek, Z K and Rademakers, R and Boeve, B F and McKee, A C and Dickson, D W},

year  = {2015},

date = {2015-01-01},

journal = {Acta Neuropathologica},

volume = {130},

number = {6},

pages = {877--889},

abstract = {Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disorder linked to repetitive traumatic brain injury (TBI) and characterized by deposition of hyperphosphorylated tau at the depths of sulci. We sought to determine the presence of CTE pathology in a brain bank for neurodegenerative disorders for individuals with and without a history of contact sports participation. Available medical records of 1721 men were reviewed for evidence of past history of injury or participation in contact sports. Subsequently, cerebral cortical samples were processed for tau immunohistochemistry in cases with a documented history of sports exposure as well as age- and disease-matched men and women without such exposure. For cases with available frozen tissue, genetic analysis was performed for variants in APOE, MAPT, and TMEM106B. Immunohistochemistry revealed 21 of 66 former athletes had cortical tau pathology consistent with CTE. CTE pathology was not detected in 198 individuals without exposure to contact sports, including 33 individuals with documented single-incident TBI sustained from falls, motor vehicle accidents, domestic violence, or assaults. Among those exposed to contact sports, those with CTE pathology did not differ from those without CTE pathology with respect to noted clinicopathologic features. There were no significant differences in genetic variants for those with CTE pathology, but we observed a slight increase in MAPT H1 haplotype, and there tended to be fewer homozygous carriers of the protective TMEM106B rs3173615 minor allele in those with sports exposure and CTE pathology compared to those without CTE pathology. In conclusion, this study has identified a small, yet significant, subset of individuals with neurodegenerative disorders and concomitant CTE pathology. CTE pathology was only detected in individuals with documented participation in contact sports. Exposure to contact sports was the greatest risk factor for CTE pathology. Future studies addressing clinical correlates of CTE pathology are needed.},

keywords = {*Brain Injury, *Brain/pa [Pathology], *Neurodegenerative Diseases/et [Etiology], *Neurodegenerative Diseases/pa [Pathology], 0 (Apolipoproteins E), 0 (MAPT protein, 0 (Membrane Proteins), 0 (Nerve Tissue Proteins), 0 (tau Proteins), 0 (TMEM106B protein, aged, Apolipoproteins E/ge [Genetics], Athletic Injuries/co [Complications], Athletic Injuries/ge [Genetics], Athletic Injuries/me [Metabolism], Athletic Injuries/pa [Pathology], Brain Injury, Brain/me [Metabolism], Chronic/et [Etiology], Chronic/ge [Genetics], Chronic/me [Metabolism], Chronic/pa [Pathology], Female, human), Humans, immunohistochemistry, Male, Membrane Proteins/ge [Genetics], Nerve Tissue Proteins/ge [Genetics], Neurodegenerative Diseases/ge [Genetics], Neurodegenerative Diseases/me [Metabolism], Retrospective Studies, tau Proteins/ge [Genetics], tau Proteins/me [Metabolism], Tissue Banks},

pubstate = {published},

tppubtype = {article}

}

Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disorder linked to repetitive traumatic brain injury (TBI) and characterized by deposition of hyperphosphorylated tau at the depths of sulci. We sought to determine the presence of CTE pathology in a brain bank for neurodegenerative disorders for individuals with and without a history of contact sports participation. Available medical records of 1721 men were reviewed for evidence of past history of injury or participation in contact sports. Subsequently, cerebral cortical samples were processed for tau immunohistochemistry in cases with a documented history of sports exposure as well as age- and disease-matched men and women without such exposure. For cases with available frozen tissue, genetic analysis was performed for variants in APOE, MAPT, and TMEM106B. Immunohistochemistry revealed 21 of 66 former athletes had cortical tau pathology consistent with CTE. CTE pathology was not detected in 198 individuals without exposure to contact sports, including 33 individuals with documented single-incident TBI sustained from falls, motor vehicle accidents, domestic violence, or assaults. Among those exposed to contact sports, those with CTE pathology did not differ from those without CTE pathology with respect to noted clinicopathologic features. There were no significant differences in genetic variants for those with CTE pathology, but we observed a slight increase in MAPT H1 haplotype, and there tended to be fewer homozygous carriers of the protective TMEM106B rs3173615 minor allele in those with sports exposure and CTE pathology compared to those without CTE pathology. In conclusion, this study has identified a small, yet significant, subset of individuals with neurodegenerative disorders and concomitant CTE pathology. CTE pathology was only detected in individuals with documented participation in contact sports. Exposure to contact sports was the greatest risk factor for CTE pathology. Future studies addressing clinical correlates of CTE pathology are needed.

McGinley, A D; Master, C L; Zonfrillo, M R

Sports-Related Head Injuries in Adolescents: A Comprehensive Update Journal Article

In: Adolescent Medicine, vol. 26, no. 3, pp. 491–506, 2015.

BibTeX | Tags: Adolescent, Athletic Injuries, brain concussion, Brain Injuries, Brain Injury, Chronic, CONVALESCENCE, human, Humans, injury scale, Recovery of Function, sport injury, Trauma Severity Indices

McDevitt, J; Tierney, R T; Phillips, J; Gaughan, J P; Torg, J S; Krynetskiy, E

Association between GRIN2A promoter polymorphism and recovery from concussion Journal Article

In: Brain Injury, vol. 29, no. 13-14, pp. 1674–1681, 2015.

Abstract | Links | BibTeX | Tags: adult, Article, athlete, brain concussion, Brain Injury, calcium, capillary electrophoresis, CONVALESCENCE, DNA, Female, gene frequency, genetic association, genetic polymorphism, genetic variability, GENOTYPE, heterozygote, human, inheritance, major clinical study, Male, n methyl dextro aspartic acid receptor 2A, NR2A sub-unit, pedigree analysis, promoter region, sport injury, variable number of tandem repeat

@article{McDevitt2015,

title = {Association between GRIN2A promoter polymorphism and recovery from concussion},

author = {McDevitt, J and Tierney, R T and Phillips, J and Gaughan, J P and Torg, J S and Krynetskiy, E},

doi = {10.3109/02699052.2015.1075252},

year  = {2015},

date = {2015-01-01},

journal = {Brain Injury},

volume = {29},

number = {13-14},

pages = {1674--1681},

abstract = {Objective: To determine genetic variability within the N-methyl-D-aspartate receptor 2A sub-unit (GRIN2A) gene promoter and its association with concussion recovery time. The hypothesis tested was that there would be a difference in allele and/or genotype distribution between two groups of athletes with normal and prolonged recovery.Methods: DNA was extracted from saliva collected from a total of 87 athletes with a physician-diagnosed concussion. The (GT) variable number tandem repeats (VNTR) within the promoter region of GRIN2A was genotyped. The long (L) allele was an allele with ≥25 repeats and the short (S) allele was an allele with \<25 repeats in the GT tract. Participants recovery time was followed prospectively and was categorized as normal (≤60 days) or prolonged (\>60 days).Results: LL carriers were 6-times more likely to recover longer than 60 days following the concussive event (p = 0.0433) when compared to SS carriers. Additionally, L allele carriers were found more frequently in the prolonged recovery group (p = 0.048).Conclusion: Determining genetic influence on concussion recovery will aid in future development of genetic counselling. The clinical relevance of genotyping athletes could improve management of athletes who experience concussion injuries. © 2015 Taylor \& Francis Group, LLC.},

keywords = {adult, Article, athlete, brain concussion, Brain Injury, calcium, capillary electrophoresis, CONVALESCENCE, DNA, Female, gene frequency, genetic association, genetic polymorphism, genetic variability, GENOTYPE, heterozygote, human, inheritance, major clinical study, Male, n methyl dextro aspartic acid receptor 2A, NR2A sub-unit, pedigree analysis, promoter region, sport injury, variable number of tandem repeat},

pubstate = {published},

tppubtype = {article}

}

Patton, D A; McIntosh, A S; Kleiven, S

The biomechanical determinants of concussion: Finite element simulations to investigate tissue-level predictors of injury during sporting impacts to the unprotected head Journal Article

In: Journal of Applied Biomechanics, vol. 31, no. 4, pp. 264–268, 2015.

Abstract | Links | BibTeX | Tags: Article, Biomechanics, brain, Brain Injury, brain region, clinical article, Concussion, corpus callosum, Damage detection, evaluation study, finite element analysis, Finite element head models, Finite element method, Finite element simulations, football, gray matter, Head Injuries, head injury, human, Intra-cranial pressure, intracranial pressure, investigative procedures, Maximum principal strain, mesencephalon, Modeling, Models, Numerical reconstruction, Qualitative observations, Sport, sport injury, Sports, Strain and strain rates, Strain rate, Stress, thalamus, Tissue, tissue level

@article{Patton2015,

title = {The biomechanical determinants of concussion: Finite element simulations to investigate tissue-level predictors of injury during sporting impacts to the unprotected head},

author = {Patton, D A and McIntosh, A S and Kleiven, S},

doi = {10.1123/jab.2014-0223},

year  = {2015},

date = {2015-01-01},

journal = {Journal of Applied Biomechanics},

volume = {31},

number = {4},

pages = {264--268},

abstract = {Biomechanical studies of concussions have progressed from qualitative observations of head impacts to physical and numerical reconstructions, direct impact measurements, and finite element analyses. Supplementary to a previous study, which investigated maximum principal strain, the current study used a detailed finite element head model to simulate unhelmeted concussion and no-injury head impacts and evaluate the effectiveness of various tissue-level brain injury predictors: strain rate, product of strain and strain rate, cumulative strain damage measure, von Mises stress, and intracranial pressure. Von Mises stress was found to be the most effective predictor of concussion. It was also found that the thalamus and corpus callosum were brain regions with strong associations with concussion. Tentative tolerance limits for tissue-level predictors were proposed in an attempt to broaden the understanding of unhelmeted concussions. For the thalamus, tolerance limits were proposed for a 50% likelihood of concussion: 2.24 kPa, 24.0 s-1, and 2.49 s-1 for von Mises stress, strain rate, and the product of strain and strain rate, respectively. For the corpus callosum, tolerance limits were proposed for a 50% likelihood of concussion: 3.51 kPa, 25.1 s-1, and 2.76 s-1 for von Mises stress, strain rate, and the product of strain and strain rate, respectively. © 2015 Human Kinetics, Inc.},

keywords = {Article, Biomechanics, brain, Brain Injury, brain region, clinical article, Concussion, corpus callosum, Damage detection, evaluation study, finite element analysis, Finite element head models, Finite element method, Finite element simulations, football, gray matter, Head Injuries, head injury, human, Intra-cranial pressure, intracranial pressure, investigative procedures, Maximum principal strain, mesencephalon, Modeling, Models, Numerical reconstruction, Qualitative observations, Sport, sport injury, Sports, Strain and strain rates, Strain rate, Stress, thalamus, Tissue, tissue level},

pubstate = {published},

tppubtype = {article}

}

Andre, J B

Arterial spin labeling magnetic resonance perfusion for traumatic brain injury: Technical challenges and potentials Journal Article

In: Topics in Magnetic Resonance Imaging, vol. 24, no. 5, pp. 275–287, 2015.

Abstract | BibTeX | Tags: Arterial spin labeling, artery blood flow, artifact, brain, brain blood flow, brain circulation, Brain Injuries, Brain Injury, brain perfusion, Cerebrovascular Circulation, clinical classification, Concussion, echo planar imaging, gray matter, human, Humans, Magnetic Resonance Imaging, mild traumatic brain injury, neuroimaging, neuropsychological test, nuclear magnetic resonance imaging, pathology, positron emission tomography, priority journal, procedures, Review, single photon emission computer tomography, spin labeling, Spin Labels, Sport, Sports-related concussion, symptom, traumatic brain injury, white matter

@article{Andre2015,

title = {Arterial spin labeling magnetic resonance perfusion for traumatic brain injury: Technical challenges and potentials},

author = {Andre, J B},

year  = {2015},

date = {2015-01-01},

journal = {Topics in Magnetic Resonance Imaging},

volume = {24},

number = {5},

pages = {275--287},

abstract = {Traumatic brain injury (TBI), including concussion, is a public health concern, as it affects over 1.7 million persons in the United States per year. Yet, the diagnosis of TBI, particularly mild TBI (mTBI), can be controversial, as neuroimaging findings can be sparse on conventional magnetic resonance and computed tomography examinations, and when present, often poorly correlate with clinical signs and symptoms. Furthermore, the discussion of TBI, concussion, and head impact exposure is immediately complicated by the many differing opinions of what constitutes each, their respective severities, and how the underlying biomechanics of the inciting head impact might alter the distribution, severity, and prognosis of the underlying brain injury. Advanced imaging methodologies hold promise in improving the sensitivity and detectability of associated imaging biomarkers that might better correlate with patient outcome and prognostication, allowing for improved triage and therapeutic guidance in the setting of TBI, particularly in mTBI. This work will examine the defining symptom complex associated with mTBI and explore changes in cerebral blood flow measured by arterial spin labeling, as a potential imaging biomarker for TBI, and briefly correlate these observations with findings identified by single photon emission computed tomography and positron emission tomography imaging.. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.},

keywords = {Arterial spin labeling, artery blood flow, artifact, brain, brain blood flow, brain circulation, Brain Injuries, Brain Injury, brain perfusion, Cerebrovascular Circulation, clinical classification, Concussion, echo planar imaging, gray matter, human, Humans, Magnetic Resonance Imaging, mild traumatic brain injury, neuroimaging, neuropsychological test, nuclear magnetic resonance imaging, pathology, positron emission tomography, priority journal, procedures, Review, single photon emission computer tomography, spin labeling, Spin Labels, Sport, Sports-related concussion, symptom, traumatic brain injury, white matter},

pubstate = {published},

tppubtype = {article}

}

2014

Levin, B; Bhardwaj, A

Chronic traumatic encephalopathy: A critical appraisal Journal Article

In: Neurocritical Care, vol. 20, no. 2, pp. 334–344, 2014.

Abstract | Links | BibTeX | Tags: accident, alcohol consumption, amnesia, amyloid plaque, animal, Animals, Athletic Injuries, autopsy, behavior change, Brain Injury, Chronic, Chronic traumatic encephalopathy, Chronic Traumatic Encephalopathy Dementia, complication, Diffusion Tensor Imaging, disease course, Encephalopathy, functional magnetic resonance imaging, histopathology, human, Humans, longitudinal study, Male, Neurodegenerative, Neurodegenerative Diseases, nonhuman, NUCLEAR magnetic resonance spectroscopy, Parkinsonism, pathogenesis, pathology, Pathophysiology, Prevalence, priority journal, Pugilistic, Review, risk factor, Risk Factors, sport injury, suicide, Systematic Review, traumatic brain injury, violence

@article{Levin2014,

title = {Chronic traumatic encephalopathy: A critical appraisal},

author = {Levin, B and Bhardwaj, A},

url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84896549537\&partnerID=40\&md5=138104db42f7ca99527a78bb9c821f59},

doi = {10.1007/s12028-013-9931-1},

year  = {2014},

date = {2014-01-01},

journal = {Neurocritical Care},

volume = {20},

number = {2},

pages = {334--344},

abstract = {Chronic traumatic encephalopathy (CTE) formerly known as dementia pugilistica is a long-term neurodegenerative disorder associated with repeated subconcussive head injuries in high-contact sports. We reviewed the existing literature on CTE and examined epidemiological trends, risk factors, and its temporal progression, and proposed the underlying pathophysiological mechanisms that may provide unique insights to clinicians with an in-depth understanding of the disease to aid in the diagnosis and prevention, and provide future perspectives for research via search of Medline and Cochrane databases as well as manual review of bibliographies from selected articles and monographs. The prevalence of CTE in recent years is on the rise and almost exclusively affects men, with pathologic signs characterized by progressive memory loss, behavioral changes, and violent tendencies with some patients demonstrating Parkinsonian-like symptoms and signs. Many patients with CTE die following suicide, accident, or complications of drug or alcohol use. Postmortem pathologic analysis is characterized by neurofibrillary tangles and A$beta$ plaques in 50 % of cases. Currently, there are no ante-mortem diagnostic criteria, but modern imaging techniques such as functional magnetic resonance (MR) imaging, MR spectroscopy, and diffusion tension imaging hold promise for delineating the future diagnostic criteria. Further long-term longitudinal studies are warranted to investigate risk factors that will enhance understanding of the disease progression and its pathogenesis. © 2013 Springer Science+Business Media.},

keywords = {accident, alcohol consumption, amnesia, amyloid plaque, animal, Animals, Athletic Injuries, autopsy, behavior change, Brain Injury, Chronic, Chronic traumatic encephalopathy, Chronic Traumatic Encephalopathy Dementia, complication, Diffusion Tensor Imaging, disease course, Encephalopathy, functional magnetic resonance imaging, histopathology, human, Humans, longitudinal study, Male, Neurodegenerative, Neurodegenerative Diseases, nonhuman, NUCLEAR magnetic resonance spectroscopy, Parkinsonism, pathogenesis, pathology, Pathophysiology, Prevalence, priority journal, Pugilistic, Review, risk factor, Risk Factors, sport injury, suicide, Systematic Review, traumatic brain injury, violence},

pubstate = {published},

tppubtype = {article}

}

Andrikopoulos, J; Moines, D; Montenigro, P H; Stern, R A

Clinical presentation of chronic traumatic encephalopathy Journal Article

In: Neurology, vol. 83, no. 21, pp. 1991–1993, 2014.

Links | BibTeX | Tags: behavior, Behavioral Symptoms, Brain Injury, Chronic, Chronic Traumatic Encephalopathy alcohol abuse, clinical feature, Cognition Disorders, cognitive defect, etiology, human, Humans, Male, mood, Note, priority journal, prisoner of war, psychosis, traumatic brain injury

Andrikopoulos, J

Correspondence regarding chronic traumatic encephalopathy in athletes: Progressive tauopathy following repetitive concussion. J Neuropathol Exp Neurol 2009;68: 709-35 Journal Article

In: Journal of Neuropathology and Experimental Neurology, vol. 73, no. 4, pp. 375, 2014.

Links | BibTeX | Tags: Athletic Injuries, Brain Injury, Chronic, Chronic Traumatic Encephalopathy athlete, clinical feature, Closed, dysarthria, Female, Head Injuries, human, Humans, letter, Male, Parkinson disease, priority journal, pyramidal tract, Tauopathies, tauopathy, traumatic brain injury

Solomon, G S; Sills, A

Chronic traumatic encephalopathy and the availability cascade Journal Article

In: The Physician and sportsmedicine, vol. 42, no. 3, pp. 26–31, 2014.

Abstract | Links | BibTeX | Tags: 20th Century, Athletic Injuries, Bias (Epidemiology), brain, Brain Injury, Chronic, Chronic Traumatic Encephalopathy autopsy, HISTORY, human, Humans, pathology, public opinion, sport injury, statistical bias

Ling, H; Kara, E; Revesz, T; Lees, A J; Plant, G T; Martino, D; Houlden, H; Hardy, J; Holton, J L

Concomitant progressive supranuclear palsy and chronic traumatic encephalopathy in a boxer Journal Article

In: Acta neuropathologica communications, vol. 2, pp. 24, 2014.

Abstract | Links | BibTeX | Tags: aged, Brain Injury, case report, Chronic, Chronic Traumatic Encephalopathy GRN protein, complication, genetics, huma, human, Humans, Intercellular Signaling Peptides and Proteins, LRRK2 protein, Male, MAPT protein, pathology, Progressive, progressive supranuclear palsy, protein serine threonine kinase, Protein-Serine-Threonine Kinases, signal peptide, Supranuclear Palsy, tau protein, tau Proteins

2011

Omalu, B; Hammers, J L; Bailes, J; Hamilton, R L; Kamboh, M I; Webster, G; Fitzsimmons, R P

Chronic traumatic encephalopathy in an Iraqi war veteran with posttraumatic stress disorder who committed suicide Journal Article

In: Neurosurgical Focus, vol. 31, no. 5, pp. E3, 2011.

Abstract | BibTeX | Tags: *Blast Injuries/pa [Pathology], *Blast Injuries/pp [Physiopathology], *Brain Injury, *Combat Disorders/pp [Physiopathology], *Suicide/px [Psychology], 2003-2011, adult, Blast Injuries/co [Complications], Brain Injury, Chronic/co [Complications], Chronic/pa [Pathology], Chronic/pp [Physiopathology], Combat Disorders/px [Psychology], Humans, Iraq War, Male, Post-Traumatic/pp [Physiopatholo, Post-Traumatic/px [Psychology], Stress Disorders, Suicide/pc [Prevention & Control]

@article{Omalu2011,

title = {Chronic traumatic encephalopathy in an Iraqi war veteran with posttraumatic stress disorder who committed suicide},

author = {Omalu, B and Hammers, J L and Bailes, J and Hamilton, R L and Kamboh, M I and Webster, G and Fitzsimmons, R P},

year  = {2011},

date = {2011-01-01},

journal = {Neurosurgical Focus},

volume = {31},

number = {5},

pages = {E3},

abstract = {Following his discovery of chronic traumatic encephalopathy (CTE) in football players in 2002, Dr. Bennet Omalu hypothesized that posttraumatic stress disorder (PTSD) in military veterans may belong to the CTE spectrum of diseases. The CTE surveillance at the Brain Injury Research Institute was therefore expanded to include deceased military veterans diagnosed with PTSD. The authors report the case of a 27-year-old United States Marine Corps (USMC) Iraqi war veteran, an amphibious assault vehicle crewman, who committed suicide by hanging after two deployments to Fallujah and Ramadi. He experienced combat and was exposed to mortar blasts and improvised explosive device blasts less than 50 m away. Following his second deployment he developed a progressive history of cognitive impairment, impaired memory, behavioral and mood disorders, and alcohol abuse. Neuropsychiatric assessment revealed a diagnosis of PTSD with hyperarousal (irritability and insomnia) and numbing. He committed suicide approximately 8 months after his honorable discharge from the USMC. His brain at autopsy appeared grossly unremarkable except for congestive brain swelling. There was no atrophy or remote focal traumatic brain injury such as contusional necrosis or hemorrhage. Histochemical and immunohistochemical brain tissue analysis revealed CTE changes comprising multifocal, neocortical, and subcortical neurofibrillary tangles and neuritic threads (ranging from none, to sparse, to frequent) with the skip phenomenon, accentuated in the depths of sulci and in the frontal cortex. The subcortical white matter showed mild rarefaction, sparse perivascular and neuropil infiltration by histiocytes, and mild fibrillary astrogliosis. Apolipoprotein E genotype was 3/4. The authors report this case as a sentinel case of CTE in an Iraqi war veteran diagnosed with PTSD to possibly stimulate new lines of thought and research in the possible pathoetiology and pathogenesis of PTSD in military veterans as part of the CTE spectrum of diseases, and as chronic sequelae and outcomes of repetitive traumatic brain injuries.},

keywords = {*Blast Injuries/pa [Pathology], *Blast Injuries/pp [Physiopathology], *Brain Injury, *Combat Disorders/pp [Physiopathology], *Suicide/px [Psychology], 2003-2011, adult, Blast Injuries/co [Complications], Brain Injury, Chronic/co [Complications], Chronic/pa [Pathology], Chronic/pp [Physiopathology], Combat Disorders/px [Psychology], Humans, Iraq War, Male, Post-Traumatic/pp [Physiopatholo, Post-Traumatic/px [Psychology], Stress Disorders, Suicide/pc [Prevention \&amp; Control]},

pubstate = {published},

tppubtype = {article}

}

Following his discovery of chronic traumatic encephalopathy (CTE) in football players in 2002, Dr. Bennet Omalu hypothesized that posttraumatic stress disorder (PTSD) in military veterans may belong to the CTE spectrum of diseases. The CTE surveillance at the Brain Injury Research Institute was therefore expanded to include deceased military veterans diagnosed with PTSD. The authors report the case of a 27-year-old United States Marine Corps (USMC) Iraqi war veteran, an amphibious assault vehicle crewman, who committed suicide by hanging after two deployments to Fallujah and Ramadi. He experienced combat and was exposed to mortar blasts and improvised explosive device blasts less than 50 m away. Following his second deployment he developed a progressive history of cognitive impairment, impaired memory, behavioral and mood disorders, and alcohol abuse. Neuropsychiatric assessment revealed a diagnosis of PTSD with hyperarousal (irritability and insomnia) and numbing. He committed suicide approximately 8 months after his honorable discharge from the USMC. His brain at autopsy appeared grossly unremarkable except for congestive brain swelling. There was no atrophy or remote focal traumatic brain injury such as contusional necrosis or hemorrhage. Histochemical and immunohistochemical brain tissue analysis revealed CTE changes comprising multifocal, neocortical, and subcortical neurofibrillary tangles and neuritic threads (ranging from none, to sparse, to frequent) with the skip phenomenon, accentuated in the depths of sulci and in the frontal cortex. The subcortical white matter showed mild rarefaction, sparse perivascular and neuropil infiltration by histiocytes, and mild fibrillary astrogliosis. Apolipoprotein E genotype was 3/4. The authors report this case as a sentinel case of CTE in an Iraqi war veteran diagnosed with PTSD to possibly stimulate new lines of thought and research in the possible pathoetiology and pathogenesis of PTSD in military veterans as part of the CTE spectrum of diseases, and as chronic sequelae and outcomes of repetitive traumatic brain injuries.

Reference Search

32 entries « ‹ 1 of 2 › »

Asken, B M; Snyder, A R; Smith, M S; Zaremski, J L; Bauer, R M

Concussion-like symptom reporting in non-concussed adolescent athletes Journal Article

In: Clinical Neuropsychologist, vol. 31, no. 1, pp. 138–153, 2017.

Abstract | Links | BibTeX

@article{Asken2017,

title = {Concussion-like symptom reporting in non-concussed adolescent athletes},

author = {Asken, B M and Snyder, A R and Smith, M S and Zaremski, J L and Bauer, R M},

doi = {10.1080/13854046.2016.1246672},

year  = {2017},

date = {2017-01-01},

journal = {Clinical Neuropsychologist},

volume = {31},

number = {1},

pages = {138--153},

abstract = {Objective: The primary goals of this study were (1) to report rates of concussion-like symptoms in healthy adolescent student athletes assessed using the Sport Concussion Assessment Tool, 3rd edition (SCAT3) at baseline, (2) to examine rates of psychiatric diagnoses in this population, and (3) to evaluate effects of baseline symptoms on SCAT3 cognitive and balance performance. Methods: 349 adolescent student athletes (245 male) were administered the SCAT3 during pre-participation physical examinations. We described the prevalence rate of student athletes meeting criteria for International Classification of Diseases, 10th revision, post-concussional syndrome (ICD-10 PCS) diagnosis at baseline, and evaluated associations between symptom reporting and demographic/medical history factors using chi-square tests. Rates of self-reported psychiatric diagnosis were compared to general population estimates with one-sample binomial tests. We also compared SCAT3 cognitive and balance performance between adolescents with and without baseline ICD-10 PCS symptoms. Results: Overall, 20.3% of participants met ICD-10 PCS criteria at baseline. Rates were similar across sexes and age groups. We found no statistical association with medical history factors. The proportion of student athletes reporting a history of psychiatric diagnosis (5.2%) was significantly lower than general population estimates (14.0%; p \<.001), and this effect was consistent across sexes and age groups. SCAT3 cognitive and balance performance did not differ based on baseline symptom reporting. Conclusions: Healthy adolescent student athletes frequently report concussion-like symptoms at baseline. Clinicians should factor pre-injury symptomatology and medical history into concussion management when determining symptom etiology throughout the course of recovery. © 2016 Informa UK Limited, trading as Taylor \& Francis Group.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

Mihalik, J P; Lynall, R C; Wasserman, E B; Guskiewicz, K M; Marshall, S W

Evaluating the "threshold Theory": Can Head Impact Indicators Help? Journal Article

In: Medicine & Science in Sports & Exercise, vol. 49, no. 2, pp. 247–253, 2017.

Abstract | Links | BibTeX

Klein, T A; Graves, J M

A Comparison of Psychiatric and Nonpsychiatric Nurse Practitioner Knowledge and Management Recommendations Regarding Adolescent Mild Traumatic Brain Injury Journal Article

In: Journal of the American Psychiatric Nurses Association, vol. 23, no. 1, pp. 37–49, 2017.

Abstract | Links | BibTeX

@article{Klein2017,

title = {A Comparison of Psychiatric and Nonpsychiatric Nurse Practitioner Knowledge and Management Recommendations Regarding Adolescent Mild Traumatic Brain Injury},

author = {Klein, T A and Graves, J M},

doi = {10.1177/1078390316668992},

year  = {2017},

date = {2017-01-01},

journal = {Journal of the American Psychiatric Nurses Association},

volume = {23},

number = {1},

pages = {37--49},

abstract = {BACKGROUND: Nurse practitioners (NPs) are statutorily authorized to provide assessment and cognitive recommendations for concussion in most states. Their scope of practice includes assessment and management of concussion sequalae including anxiety, insomnia, and depression, as well as return to school and activity guidance. OBJECTIVES: Analysis of symptom-based diagnosis of mild traumatic brain injury (TBI) in adolescents, including return to school and school workload recommendations comparing psychiatric and nonpsychiatric NPs. DESIGN: Cross-sectional Web-based survey with embedded videos using standardized actors and scripts randomized for patient sex and sport. A total of 4,849 NPs licensed in Oregon or Washington were invited by e-mail to view and respond to this study, with a response rate of 23%. RESULTS: Psychiatric mental health nurse practitioners (PMHNPs) were 44% less likely than family NPs to report using standardized concussion tools. 17% had completed continuing education on mild TBI compared to 54.5% of family NPs. Seven PMHNPs provided additional feedback related to discomfort in completing the survey due to lack of comfort or experience. Return to school recommendations and reduced workload advice did not significantly differ by NP type. CONCLUSION: PMHNPs may support individualized assessment through concussion evaluation, use of standardized tools, and differential consideration of TBI for mental health symptoms. More research is required related to the role and contribution of cognitive rest to full recovery. © 2016, © The Author(s) 2016.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

Cobb, B R; Zadnik, A M; Rowson, S

Comparative analysis of helmeted impact response of Hybrid III and National Operating Committee on Standards for Athletic Equipment headforms Journal Article

In: Proceedings of the Institution of Mechanical Engineers, Part P: Journal of Sports Engineering and Technology, vol. 230, no. 1, pp. 50–60, 2016.

Abstract | Links | BibTeX

@article{Cobb2016,

title = {Comparative analysis of helmeted impact response of Hybrid III and National Operating Committee on Standards for Athletic Equipment headforms},

author = {Cobb, B R and Zadnik, A M and Rowson, S},

doi = {10.1177/1754337115599133},

year  = {2016},

date = {2016-01-01},

journal = {Proceedings of the Institution of Mechanical Engineers, Part P: Journal of Sports Engineering and Technology},

volume = {230},

number = {1},

pages = {50--60},

abstract = {As advanced helmet testing methodologies are developed, the effect headform selection may have on the biomechanical impact response must be considered. This study sought to assess response differences between two of the most commonly used headforms, the Hybrid III and National Operating Committee on Standards for Athletic Equipment headforms, through a series of helmeted impact tests. A total of 180 pendulum impact tests were conducted with three impactor velocities and six impact locations. Test condition-specific significant differences were found between the two headforms for peak linear and angular accelerations ($alpha$ = 0.05), although differences tended to be small. On average, the National Operating Committee on Standards for Athletic Equipment headform experienced higher peak linear (3.7 ± 7.8%) and angular (12.0 ± 21.6%) accelerations, with some of the largest differences associated with impacts to the facemask. Without the facemask impacts, the average differences in linear (1.8 ± 6.0%) and angular (9.6 ± 15.9%) acceleration would be lower. No significant differences were found in coefficient of variation values for linear (Hybrid III: 2.6 ± 2.3%, National Operating Committee on Standards for Athletic Equipment: 2.0 ± 1.4%) or angular (Hybrid III: 4.9 ± 4.0%; National Operating Committee on Standards for Athletic Equipment: 5.2 ± 5.8%) acceleration. These data have application toward development and validation of future helmet evaluation protocols and standards. © IMechE 2015.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

Puvenna, V; Engeler, M; Banjara, M; Brennan, C; Schreiber, P; Dadas, A; Bahrami, A; Solanki, J; Bandyopadhyay, A; Morris, J K; Bernick, C; Ghosh, C; Rapp, E; Bazarian, J J; Janigro, D

Is phosphorylated tau unique to chronic traumatic encephalopathy? Phosphorylated tau in epileptic brain and chronic traumatic encephalopathy Journal Article

In: Brain Research, vol. 1630, pp. 225–240, 2016.

Abstract | BibTeX

@article{Puvenna2016,

title = {Is phosphorylated tau unique to chronic traumatic encephalopathy? Phosphorylated tau in epileptic brain and chronic traumatic encephalopathy},

author = {Puvenna, V and Engeler, M and Banjara, M and Brennan, C and Schreiber, P and Dadas, A and Bahrami, A and Solanki, J and Bandyopadhyay, A and Morris, J K and Bernick, C and Ghosh, C and Rapp, E and Bazarian, J J and Janigro, D},

year  = {2016},

date = {2016-01-01},

journal = {Brain Research},

volume = {1630},

pages = {225--240},

abstract = {Repetitive traumatic brain injury (rTBI) is one of the major risk factors for the abnormal deposition of phosphorylated tau (PT) in the brain and chronic traumatic encephalopathy (CTE). CTE and temporal lobe epilepsy (TLE) affect the limbic system, but no comparative studies on PT distribution in TLE and CTE are available. It is also unclear whether PT pathology results from repeated head hits (rTBI). These gaps prevent a thorough understanding of the pathogenesis and clinical significance of PT, limiting our ability to develop preventative and therapeutic interventions. We quantified PT in TLE and CTE to unveil whether a history of rTBI is a prerequisite for PT accumulation in the brain. Six postmortem CTE (mean 73.3 years) and age matched control samples were compared to 19 surgically resected TLE brain specimens (4 months-58 years; mean 27.6 years). No history of TBI was present in TLE or control; all CTE patients had a history of rTBI. TLE and CTE brain displayed increased levels of PT as revealed by immunohistochemistry. No age-dependent changes were noted, as PT was present as early as 4 months after birth. In TLE and CTE, cortical neurons, perivascular regions around penetrating pial vessels and meninges were immunopositive for PT; white matter tracts also displayed robust expression of extracellular PT organized in bundles parallel to venules. Microscopically, there were extensive tau-immunoreactive neuronal, astrocytic and degenerating neurites throughout the brain. In CTE perivascular tangles were most prominent. Overall, significant differences in staining intensities were found between CTE and control (P\<0.01) but not between CTE and TLE (P=0.08). pS199 tau analysis showed that CTE had the most high molecular weight tangle-associated tau, whereas epileptic brain contained low molecular weight tau. Tau deposition may not be specific to rTBI since TLE recapitulated most of the pathological features of CTE. Copyright © 2015 Elsevier B.V. All rights reserved.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

Lucke-Wold, B P; Turner, R C; Logsdon, A F; Nguyen, L; Bailes, J E; Lee, J M; Robson, M J; Omalu, B I; Huber, J D; Rosen, C L

Endoplasmic reticulum stress implicated in chronic traumatic encephalopathy Journal Article

In: Journal of Neurosurgery, vol. 124, no. 3, pp. 687–702, 2016.

Abstract | BibTeX

@article{Lucke-Wold2016,

title = {Endoplasmic reticulum stress implicated in chronic traumatic encephalopathy},

author = {Lucke-Wold, B P and Turner, R C and Logsdon, A F and Nguyen, L and Bailes, J E and Lee, J M and Robson, M J and Omalu, B I and Huber, J D and Rosen, C L},

year  = {2016},

date = {2016-01-01},

journal = {Journal of Neurosurgery},

volume = {124},

number = {3},

pages = {687--702},

abstract = {OBJECTIVE: Chronic traumatic encephalopathy is a progressive neurodegenerative disease characterized by neurofibrillary tau tangles following repetitive neurotrauma. The underlying mechanism linking traumatic brain injury to chronic traumatic encephalopathy has not been elucidated. The authors investigate the role of endoplasmic reticulum stress as a link between acute neurotrauma and chronic neurodegeneration. METHODS: The authors used pharmacological, biochemical, and behavioral tools to assess the role of endoplasmic reticulum stress in linking acute repetitive traumatic brain injury to the development of chronic neurodegeneration. Data from the authors' clinically relevant and validated rodent blast model were compared with those obtained from postmortem human chronic traumatic encephalopathy specimens from a National Football League player and World Wrestling Entertainment wrestler. RESULTS: The results demonstrated strong correlation of endoplasmic reticulum stress activation with subsequent tau hyperphosphorylation. Various endoplasmic reticulum stress markers were increased in human chronic traumatic encephalopathy specimens, and the endoplasmic reticulum stress response was associated with an increase in the tau kinase, glycogen synthase kinase-3beta. Docosahexaenoic acid, an endoplasmic reticulum stress inhibitor, improved cognitive performance in the rat model 3 weeks after repetitive blast exposure. The data showed that docosahexaenoic acid administration substantially reduced tau hyperphosphorylation (t = 4.111, p \< 0.05), improved cognition (t = 6.532, p \< 0.001), and inhibited C/EBP homology protein activation (t = 5.631, p \< 0.01). Additionally the data showed, for the first time, that endoplasmic reticulum stress is involved in the pathophysiology of chronic traumatic encephalopathy. CONCLUSIONS: Docosahexaenoic acid therefore warrants further investigation as a potential therapeutic agent for the prevention of chronic traumatic encephalopathy.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

Kroshus, E; Gillard, D; Haarbauer‐Krupa, J; Goldman, R E; Bickham, D S

Talking with young children about concussions: An exploratory study Journal Article

In: Child: Care, Health and Development, 2016, ISBN: 0305-1862 1365-2214.

Abstract | Links | BibTeX

Mez, J; Solomon, T M; Daneshvar, D H; Stein, T D; McKee, A C

Pathologically Confirmed Chronic Traumatic Encephalopathy in a 25-Year-Old Former College Football Player Journal Article

In: JAMA Neurology, vol. 73, no. 3, pp. 353–355, 2016.

BibTeX

Aomura, S; Zhang, Y; Nakadate, H; Koyama, T; Nishimura, A

Brain injury risk estimation of collegiate football player based on game video of concussion suspected accident Journal Article

In: Journal of Biomechanical Science and Engineering, vol. 11, no. 4, 2016.

Abstract | Links | BibTeX

@article{Aomura2016,

title = {Brain injury risk estimation of collegiate football player based on game video of concussion suspected accident},

author = {Aomura, S and Zhang, Y and Nakadate, H and Koyama, T and Nishimura, A},

doi = {10.1299/jbse.16-00393},

year  = {2016},

date = {2016-01-01},

journal = {Journal of Biomechanical Science and Engineering},

volume = {11},

number = {4},

abstract = {The collision accident in collegiate football game was simulated based on the game video and the concussive impact on the head was analyzed. First, the collision motion of players was reproduced based on the video by using motion analysis, and the translational and rotational velocities, relative position and contact location of the struck and the striking players' heads just before the collision were calculated. Then the data obtained were input to two helmeted finite element (FE) human head models as the initial condition, and the brain injury risk was evaluated by using the impact analysis. The FE helmet model was validated by a drop test of the helmet in which the head impactor was embedded. In the present study, two concussion suspected accident cases were analyzed; then the concussion was evaluated by ten mechanical parameters generated inside the skull caused by the collision. The injury risk evaluated by multi parameters belonged to the dangerous range that may cause concussion and was consistent with the diagnosis of the medical team doctor. The brain injury risk can be successfully estimated by the reconstructed simulation of the game video and FE analysis. To our knowledge, this study is the first attempt in Japan to estimate the brain injury risk systematically by a combination of game video analysis which is originally introduced for the players' health care and FE analysis by helmeted human head model. In the future, brain injury risk caused by an accident can be evaluated with higher accuracy by analyzing more accident cases. © 2016 The Japan Society of Mechanical Engineers.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

10.

O'Kane, J W

Is Heading in Youth Soccer Dangerous Play? Journal Article

In: Physician & Sportsmedicine, vol. 44, no. 2, pp. 190–194, 2016.

Abstract | BibTeX

@article{OKane2016,

title = {Is Heading in Youth Soccer Dangerous Play?},

author = {O'Kane, J W},

year  = {2016},

date = {2016-01-01},

journal = {Physician \& Sportsmedicine},

volume = {44},

number = {2},

pages = {190--194},

abstract = {BACKGROUND: Soccer is among the most popular youth sports with over 3 million youth players registered in the U.S. Soccer is unique in that players intentionally use their head to strike the ball, leading to concerns that heading could cause acute or chronic brain injury, especially in the immature brains of children. METHODS: Pub Med search without date restriction was conducted in November 2014 and August 2015 using the terms soccer and concussion, heading and concussion, and youth soccer and concussion. 310 articles were identified and reviewed for applicable content specifically relating to youth athletes, heading, and/or acute or chronic brain injury from soccer. RESULTS: Soccer is a low-risk sport for catastrophic head injury, but concussions are relatively common and heading often plays a role. At all levels of play, concussions are more likely to occur in the act of heading than with other facets of the game. While concussion from heading the ball without other contact to the head appears rare in adult players, some data suggests children are more susceptible to concussion from heading primarily in game situations. Contributing factors include biomechanical forces, less developed technique, and the immature brain's susceptibility to injury. CONCLUSIONS: There is no evidence that heading in youth soccer causes any permanent brain injury and there is limited evidence that heading in youth soccer can cause concussion. A reasonable approach based on U.S. Youth Soccer recommendations is to teach heading after age 10 in controlled settings, and heading in games should be delayed until skill acquisition and physical maturity allow the youth player to head correctly with confidence.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

11.

Keener, A B

Tackling the brain: Clues emerge about the pathology of sports-related brain trauma Journal Article

In: Nature Medicine, vol. 22, no. 4, pp. 326–329, 2016.

Links | BibTeX

12.

Ojo, J O; Mouzon, B C; Crawford, F

Repetitive head trauma, chronic traumatic encephalopathy and tau: Challenges in translating from mice to men Journal Article

In: Experimental Neurology, vol. 275, pp. 389–404, 2016.

Abstract | Links | BibTeX

@article{Ojo2016,

title = {Repetitive head trauma, chronic traumatic encephalopathy and tau: Challenges in translating from mice to men},

author = {Ojo, J O and Mouzon, B C and Crawford, F},

doi = {10.1016/j.expneurol.2015.06.003},

year  = {2016},

date = {2016-01-01},

journal = {Experimental Neurology},

volume = {275},

pages = {389--404},

abstract = {Chronic traumatic encephalopathy (CTE) is a neurological and psychiatric condition marked by preferential perivascular foci of neurofibrillary and glial tangles (composed of hyperphosphorylated-tau proteins) in the depths of the sulci. Recent retrospective case series published over the last decade on athletes and military personnel have added considerably to our clinical and histopathological knowledge of CTE. This has marked a vital turning point in the traumatic brain injury (TBI) field, raising public awareness of the potential long-term effects of mild and moderate repetitive TBI, which has been recognized as one of the major risk factors associated with CTE. Although these human studies have been informative, their retrospective design carries certain inherent limitations that should be cautiously interpreted. In particular, the current overriding issue in the CTE literature remains confusing in regard to appropriate definitions of terminology, variability in individual pathologies and the potential case selection bias in autopsy based studies. There are currently no epidemiological or prospective studies on CTE. Controlled preclinical studies in animals therefore provide an alternative means for specifically interrogating aspects of CTE pathogenesis. In this article, we review the current literature and discuss difficulties and challenges of developing in-vivo TBI experimental paradigms to explore the link between repetitive head trauma and tau-dependent changes. We provide our current opinion list of recommended features to consider for successfully modeling CTE in animals to better understand the pathobiology and develop therapeutics and diagnostics, and critical factors, which might influence outcome. We finally discuss the possible directions of future experimental research in the repetitive TBI/CTE field. © 2015 Elsevier Inc..},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

13.

Buckley, T A; Vallabhajosula, S; Oldham, J R; Munkasy, B A; Evans, K M; Krazeise, D A; Ketcham, C J; Hall, E E

Evidence of a conservative gait strategy in athletes with a history of concussions Journal Article

In: Journal of Sport and Health Science, vol. 5, no. 4, pp. 417–423, 2016.

Abstract | Links | BibTeX

@article{Buckley2016a,

title = {Evidence of a conservative gait strategy in athletes with a history of concussions},

author = {Buckley, T A and Vallabhajosula, S and Oldham, J R and Munkasy, B A and Evans, K M and Krazeise, D A and Ketcham, C J and Hall, E E},

doi = {10.1016/j.jshs.2015.03.010},

year  = {2016},

date = {2016-01-01},

journal = {Journal of Sport and Health Science},

volume = {5},

number = {4},

pages = {417--423},

abstract = {Background A history of 3 or more concussions is frequently associated with numerous short- and long-term neuropathologies. Impairments in postural control are a known acute consequence of concussion; however, limited evidence exists on the effects of multiple concussions on gait. The purpose of this study was to assess gait stepping characteristics in collegiate aged student-athletes based on concussion history. Methods There were 63 participants divided into 3 even groups based on concussion history: ≥3 concussions, 1\textendash2 concussions, and 0 concussion. All participants completed 10 trials of gait on a 4.9 m instrumented walkway. The dependent variables of interest included both gait stepping characteristics (step velocity, length, and width, double support time, and the percentage of the gait cycle in stance) and coefficient of variability (CoV) measures (step length, time, and width). The gait stepping characteristics were compared first with a MANOVA with follow-up 1-way ANOVAs and Tukey post hoc tests as appropriate. The CoV measures were compared with 1-way ANOVAs and Tukey post hoc tests. Results There were main effects for group for step velocity, length, width, and double support time. Overall, the 0 concussion group displayed typical healthy young gait parameters and performed significantly better than either concussion group. The 0 concussion group had a significantly greater step length CoV, but there were no differences in the step time or width CoV. Conclusion This finding provides evidence of subtle impairments in postural control during gait among individuals with prior history of concussion which could be an early indicator of future neurological deficiencies. The limited difference in the variability measures is consistent with prior static stance studies and could suggest the individuals constrain their motor systems to reduce variability. Taken together, these findings suggest a conservative gait strategy which is adopted by individuals with a history of concussions. © 2016},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

14.

Steiger, B

Meet Bennet Omalu, Md: The Physician Leader Whose Research Inspired the Movie Concussion Journal Article

In: Physician Leadership Journal, vol. 3, no. 2, pp. 8–10, 2016.

Abstract | BibTeX

15.

Terwilliger, V K; Pratson, L; Vaughan, C G; Gioia, G A

Additional Post-Concussion Impact Exposure May Affect Recovery in Adolescent Athletes Journal Article

In: Journal of Neurotrauma, vol. 33, no. 8, pp. 761–765, 2016.

Abstract | Links | BibTeX

@article{Terwilliger2016,

title = {Additional Post-Concussion Impact Exposure May Affect Recovery in Adolescent Athletes},

author = {Terwilliger, V K and Pratson, L and Vaughan, C G and Gioia, G A},

doi = {10.1089/neu.2015.4082},

year  = {2016},

date = {2016-01-01},

journal = {Journal of Neurotrauma},

volume = {33},

number = {8},

pages = {761--765},

abstract = {Repeat concussion has been associated with risk for prolonged and pronounced clinical recovery in athletes. In this study of adolescent athletes, we examined whether an additional head impact within 24 h of a sports-related concussion (SRC) is associated with higher symptom burden and prolonged clinical recovery compared with a single-injury group. Forty-two student-athletes (52% male, mean age = 14.9 years) diagnosed with an SRC in a concussion clinic were selected for this study: (1) 21 athletes who sustained an additional significant head impact within 24 h of the initial injury (additional-impact group); (2) 21 single-injury athletes, age and gender matched, who sustained only one discrete concussive blow to the head (single-injury group). Groups did not differ on initial injury characteristics or pre-injury risk factors. The effect of injury status (single-vs. additional-impact) was examined on athlete-and parent-reported symptom burden (at first clinic visit) and length of recovery (LOR). Higher symptom burden was reported by the athletes and parents in the additional-impact group at the time of first visit. The additional-impact group also had a significantly longer LOR compared with the single-injury group. These findings provide preliminary, hypothesis-generating evidence for the importance of immediate removal from play following an SRC to protect athletes from re-injury, which may worsen symptoms and prolong recovery. The retrospective study design from a specialized clinical sample points to the need for future prospective studies of the relationship between single-and additional-impact injuries on symptom burden and LOR. © 2016 Mary Ann Liebert, Inc.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

16.

Iverson, G L

Suicide and Chronic Traumatic Encephalopathy Journal Article

In: Journal of Neuropsychiatry & Clinical Neurosciences, vol. 28, no. 1, pp. 9–16, 2016.

Abstract | BibTeX

17.

Morgan, C D; Zuckerman, S L; King, L E; Beaird, S E; Sills, A K; Solomon, G S

Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging Journal Article

In: Child's Nervous System, vol. 31, no. 12, pp. 2305–2309, 2015.

Abstract | Links | BibTeX

@article{Morgan2015,

title = {Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging},

author = {Morgan, C D and Zuckerman, S L and King, L E and Beaird, S E and Sills, A K and Solomon, G S},

doi = {10.1007/s00381-015-2916-y},

year  = {2015},

date = {2015-01-01},

journal = {Child's Nervous System},

volume = {31},

number = {12},

pages = {2305--2309},

abstract = {Purpose: Approximately 90% of concussions are transient, with symptoms resolving within 10\textendash14 days. However, a minority of patients remain symptomatic several months post-injury, a condition known as post-concussion syndrome (PCS). The treatment of these patients can be challenging. The goal of our study was to assess the utility and cost-effectiveness of neurologic imaging two or more weeks post-injury in a cohort of youth with PCS. Methods: We conducted a retrospective study of 52 pediatric patients with persistent post-concussion symptoms after 3 months. We collected demographics and neuroimaging results obtained greater than 2 weeks post-concussion. Neuroimaging ordered in the first 2 weeks post-concussion was excluded, except to determine the rate of re-imaging. Descriptive statistics and corresponding cost data were collected. Results: Of 52 patients with PCS, 23/52 (44 %) had neuroimaging at least 2 weeks after the initial injury, for a total of 32 diagnostic studies. In summary, 1/19 MRIs (5.3 %), 1/8 CTs (13 %), and 0/5 x-rays (0 %) yielded significant positive findings, none of which altered clinical management. Chronic phase neuroimaging estimated costs from these 52 pediatric patients totaled $129,025. We estimate the cost to identify a single positive finding was $21,000 for head CT and $104,500 for brain MRI. Conclusions: In this cohort of pediatric PCS patients, brain imaging in the chronic phase (defined as more than 2 weeks after concussion) was pursued in almost half the study sample, had low diagnostic yield, and had poor cost-effectiveness. Based on these results, outpatient management of pediatric patients with long-term post-concussive symptoms should rarely include repeat neuroimaging beyond the acute phase. © 2015, Springer-Verlag Berlin Heidelberg.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

18.

Ice Hockey Summit II: zero tolerance for head hits and fighting.[Erratum appears in Clin J Sport Med. 2015 Jul;25(4):379] Journal Article

In: Clinical Journal of Sport Medicine, vol. 25, no. 2, pp. 78–87, 2015.

Abstract | BibTeX

@article{Smith2015a,

title = {Ice Hockey Summit II: zero tolerance for head hits and fighting.[Erratum appears in Clin J Sport Med. 2015 Jul;25(4):379]},

author = {Smith, A M and Stuart, M J and Dodick, D W and Roberts, W O and Alford, P W and Ashare, A B and Aubrey, M and Benson, B W and Burke, C J and Dick, R and Eickhoff, C and Emery, C A and Flashman, L A and Gaz, D and Giza, C C and Greenwald, R M and Herring, S and Hoshizaki, T B and Hudziak, J J and {Huston 3rd}, J and Krause, D and LaVoi, N and Leaf, M and Leddy, J J and MacPherson, A and McKee, A C and Mihalik, J P and Moessner, A M and Montelpare, W J and Putukian, M and Schneider, K J and Szalkowski, R and Tabrum, M and Whitehead, J and Wiese-Bjornstal, D M},

year  = {2015},

date = {2015-01-01},

journal = {Clinical Journal of Sport Medicine},

volume = {25},

number = {2},

pages = {78--87},

abstract = {OBJECTIVE: To present currently known basic science and on-ice influences of sport-related concussion (SRC) in hockey, building on the Ice Hockey Summit I action plan (2011) to reduce SRC. METHODS: The prior summit proceedings included an action plan intended to reduce SRC. As such, the proceedings from Summit I served as a point of departure, for the science and discussion held during Summit II (Mayo Clinic, Rochester MN, October 2013). Summit II focused on (1) Basic Science of Concussions in Ice Hockey: Taking Science Forward; (2) Acute and Chronic Concussion Care: Making a Difference; (3) Preventing Concussions via Behavior, Rules, Education and Measuring Effectiveness; (4) Updates in Equipment: their Relationship to Industry Standards; and (5) Policies and Plans at State, National and Federal Levels to reduce SRC. Action strategies derived from the presentations and discussion described in these sectors were subsequently voted on for purposes of prioritization. The following proceedings include knowledge and research shared by invited faculty, many of whom are health care providers and clinical investigators. RESULTS: The Summit II evidence-based action plan emphasizes the rapidly evolving scientific content of hockey SRC. It includes the most highly prioritized strategies voted on for implementation to decrease concussion. CONCLUSIONS: The highest priority action items identified from the Summit includes the following: (1) eliminate head hits from all levels of ice hockey, (2) change body-checking policies, and (3) eliminate fighting in all amateur and professional hockey.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

19.

Beta-amyloid deposition in chronic traumatic encephalopathy Journal Article

In: Acta Neuropathologica, vol. 130, no. 1, pp. 21–34, 2015.

Abstract | BibTeX

@article{Stein2015b,

title = {Beta-amyloid deposition in chronic traumatic encephalopathy},

author = {Stein, T D and Montenigro, P H and Alvarez, V E and Xia, W and Crary, J F and Tripodis, Y and Daneshvar, D H and Mez, J and Solomon, T and Meng, G and Kubilus, C A and Cormier, K A and Meng, S and Babcock, K and Kiernan, P and Murphy, L and Nowinski, C J and Martin, B and Dixon, D and Stern, R A and Cantu, R C and Kowall, N W and McKee, A C},

year  = {2015},

date = {2015-01-01},

journal = {Acta Neuropathologica},

volume = {130},

number = {1},

pages = {21--34},

abstract = {Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with repetitive mild traumatic brain injury. It is defined pathologically by the abnormal accumulation of tau in a unique pattern that is distinct from other tauopathies, including Alzheimer's disease (AD). Although trauma has been suggested to increase amyloid beta peptide (Abeta) levels, the extent of Abeta deposition in CTE has not been thoroughly characterized. We studied a heterogeneous cohort of deceased athletes and military veterans with neuropathologically diagnosed CTE (n = 114, mean age at death = 60) to test the hypothesis that Abeta deposition is altered in CTE and associated with more severe pathology and worse clinical outcomes. We found that Abeta deposition, either as diffuse or neuritic plaques, was present in 52 % of CTE subjects. Moreover, Abeta deposition in CTE occurred at an accelerated rate and with altered dynamics in CTE compared to a normal aging population (OR = 3.8, p \< 0.001). We also found a clear pathological and clinical dichotomy between those CTE cases with Abeta plaques and those without. Abeta deposition was significantly associated with the presence of the APOE epsilon4 allele (p = 0.035), older age at symptom onset (p \< 0.001), and older age at death (p \< 0.001). In addition, when controlling for age, neuritic plaques were significantly associated with increased CTE tauopathy stage (beta = 2.43},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

20.

Meehan 3rd, W; Mannix, R; Zafonte, R; Pascual-Leone, A

Chronic traumatic encephalopathy and athletes Journal Article

In: Neurology, vol. 85, no. 17, pp. 1504–1511, 2015.

Abstract | BibTeX

@article{Meehan3rd2015a,

title = {Chronic traumatic encephalopathy and athletes},

author = {{Meehan 3rd}, W and Mannix, R and Zafonte, R and Pascual-Leone, A},

year  = {2015},

date = {2015-01-01},

journal = {Neurology},

volume = {85},

number = {17},

pages = {1504--1511},

abstract = {Recent case reports have described athletes previously exposed to repetitive head trauma while participating in contact sports who later in life developed mood disorders, headaches, cognitive difficulties, suicidal ideation, difficulties with speech, and aggressive behavior. Postmortem discoveries show that some of these athletes have pathologic findings that are collectively termed chronic traumatic encephalopathy (CTE). Current hypotheses suggest that concussions or perhaps blows to the head that do not cause the signs and symptoms necessary for making the diagnosis of concussion, so-called subconcussive blows, cause both the clinical and pathologic findings. There are, however, some athletes who participate in contact sports who do not develop the findings ascribed to CTE. Furthermore, there are people who have headaches, mood disorders, cognitive difficulties, suicidal ideation, and other clinical problems who have neither been exposed to repeated head trauma nor possessed the pathologic postmortem findings of those currently diagnosed with CTE. The current lack of prospective data and properly designed case-control studies limits the current understanding of CTE, leading to debate about the causes of the neuropathologic findings and the clinical observations. Given the potential for referral and recall bias in available studies, it remains unclear whether or not the pathologic findings made postmortem cause the presumed neurobehavioral sequela and whether the presumed risk factors, such as sports activity, cerebral concussions, and subconcussive blows, are solely causative of the clinical signs and symptoms. This article discusses the current evidence and the associated limitations. Copyright © 2015 American Academy of Neurology.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

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2017

Asken, B M; Snyder, A R; Smith, M S; Zaremski, J L; Bauer, R M

Concussion-like symptom reporting in non-concussed adolescent athletes Journal Article

In: Clinical Neuropsychologist, vol. 31, no. 1, pp. 138–153, 2017.

Abstract | Links | BibTeX | Tags: Adolescent, biopsychosocial, Brain Injury, high school, Sport-related concussion

@article{Asken2017,

title = {Concussion-like symptom reporting in non-concussed adolescent athletes},

author = {Asken, B M and Snyder, A R and Smith, M S and Zaremski, J L and Bauer, R M},

doi = {10.1080/13854046.2016.1246672},

year  = {2017},

date = {2017-01-01},

journal = {Clinical Neuropsychologist},

volume = {31},

number = {1},

pages = {138--153},

abstract = {Objective: The primary goals of this study were (1) to report rates of concussion-like symptoms in healthy adolescent student athletes assessed using the Sport Concussion Assessment Tool, 3rd edition (SCAT3) at baseline, (2) to examine rates of psychiatric diagnoses in this population, and (3) to evaluate effects of baseline symptoms on SCAT3 cognitive and balance performance. Methods: 349 adolescent student athletes (245 male) were administered the SCAT3 during pre-participation physical examinations. We described the prevalence rate of student athletes meeting criteria for International Classification of Diseases, 10th revision, post-concussional syndrome (ICD-10 PCS) diagnosis at baseline, and evaluated associations between symptom reporting and demographic/medical history factors using chi-square tests. Rates of self-reported psychiatric diagnosis were compared to general population estimates with one-sample binomial tests. We also compared SCAT3 cognitive and balance performance between adolescents with and without baseline ICD-10 PCS symptoms. Results: Overall, 20.3% of participants met ICD-10 PCS criteria at baseline. Rates were similar across sexes and age groups. We found no statistical association with medical history factors. The proportion of student athletes reporting a history of psychiatric diagnosis (5.2%) was significantly lower than general population estimates (14.0%; p \<.001), and this effect was consistent across sexes and age groups. SCAT3 cognitive and balance performance did not differ based on baseline symptom reporting. Conclusions: Healthy adolescent student athletes frequently report concussion-like symptoms at baseline. Clinicians should factor pre-injury symptomatology and medical history into concussion management when determining symptom etiology throughout the course of recovery. © 2016 Informa UK Limited, trading as Taylor \& Francis Group.},

keywords = {Adolescent, biopsychosocial, Brain Injury, high school, Sport-related concussion},

pubstate = {published},

tppubtype = {article}

}

Mihalik, J P; Lynall, R C; Wasserman, E B; Guskiewicz, K M; Marshall, S W

Evaluating the "threshold Theory": Can Head Impact Indicators Help? Journal Article

In: Medicine & Science in Sports & Exercise, vol. 49, no. 2, pp. 247–253, 2017.

Abstract | Links | BibTeX | Tags: Biomechanics, Brain Injury, Concussion, sport injury

Klein, T A; Graves, J M

A Comparison of Psychiatric and Nonpsychiatric Nurse Practitioner Knowledge and Management Recommendations Regarding Adolescent Mild Traumatic Brain Injury Journal Article

In: Journal of the American Psychiatric Nurses Association, vol. 23, no. 1, pp. 37–49, 2017.

Abstract | Links | BibTeX | Tags: adolescents/adolescence, Brain Injury, Concussion, nurse practitioner

@article{Klein2017,

title = {A Comparison of Psychiatric and Nonpsychiatric Nurse Practitioner Knowledge and Management Recommendations Regarding Adolescent Mild Traumatic Brain Injury},

author = {Klein, T A and Graves, J M},

doi = {10.1177/1078390316668992},

year  = {2017},

date = {2017-01-01},

journal = {Journal of the American Psychiatric Nurses Association},

volume = {23},

number = {1},

pages = {37--49},

abstract = {BACKGROUND: Nurse practitioners (NPs) are statutorily authorized to provide assessment and cognitive recommendations for concussion in most states. Their scope of practice includes assessment and management of concussion sequalae including anxiety, insomnia, and depression, as well as return to school and activity guidance. OBJECTIVES: Analysis of symptom-based diagnosis of mild traumatic brain injury (TBI) in adolescents, including return to school and school workload recommendations comparing psychiatric and nonpsychiatric NPs. DESIGN: Cross-sectional Web-based survey with embedded videos using standardized actors and scripts randomized for patient sex and sport. A total of 4,849 NPs licensed in Oregon or Washington were invited by e-mail to view and respond to this study, with a response rate of 23%. RESULTS: Psychiatric mental health nurse practitioners (PMHNPs) were 44% less likely than family NPs to report using standardized concussion tools. 17% had completed continuing education on mild TBI compared to 54.5% of family NPs. Seven PMHNPs provided additional feedback related to discomfort in completing the survey due to lack of comfort or experience. Return to school recommendations and reduced workload advice did not significantly differ by NP type. CONCLUSION: PMHNPs may support individualized assessment through concussion evaluation, use of standardized tools, and differential consideration of TBI for mental health symptoms. More research is required related to the role and contribution of cognitive rest to full recovery. © 2016, © The Author(s) 2016.},

keywords = {adolescents/adolescence, Brain Injury, Concussion, nurse practitioner},

pubstate = {published},

tppubtype = {article}

}

2016

Cobb, B R; Zadnik, A M; Rowson, S

Comparative analysis of helmeted impact response of Hybrid III and National Operating Committee on Standards for Athletic Equipment headforms Journal Article

In: Proceedings of the Institution of Mechanical Engineers, Part P: Journal of Sports Engineering and Technology, vol. 230, no. 1, pp. 50–60, 2016.

@article{Cobb2016,

title = {Comparative analysis of helmeted impact response of Hybrid III and National Operating Committee on Standards for Athletic Equipment headforms},

author = {Cobb, B R and Zadnik, A M and Rowson, S},

doi = {10.1177/1754337115599133},

year  = {2016},

date = {2016-01-01},

journal = {Proceedings of the Institution of Mechanical Engineers, Part P: Journal of Sports Engineering and Technology},

volume = {230},

number = {1},

pages = {50--60},

abstract = {As advanced helmet testing methodologies are developed, the effect headform selection may have on the biomechanical impact response must be considered. This study sought to assess response differences between two of the most commonly used headforms, the Hybrid III and National Operating Committee on Standards for Athletic Equipment headforms, through a series of helmeted impact tests. A total of 180 pendulum impact tests were conducted with three impactor velocities and six impact locations. Test condition-specific significant differences were found between the two headforms for peak linear and angular accelerations ($alpha$ = 0.05), although differences tended to be small. On average, the National Operating Committee on Standards for Athletic Equipment headform experienced higher peak linear (3.7 ± 7.8%) and angular (12.0 ± 21.6%) accelerations, with some of the largest differences associated with impacts to the facemask. Without the facemask impacts, the average differences in linear (1.8 ± 6.0%) and angular (9.6 ± 15.9%) acceleration would be lower. No significant differences were found in coefficient of variation values for linear (Hybrid III: 2.6 ± 2.3%, National Operating Committee on Standards for Athletic Equipment: 2.0 ± 1.4%) or angular (Hybrid III: 4.9 ± 4.0%; National Operating Committee on Standards for Athletic Equipment: 5.2 ± 5.8%) acceleration. These data have application toward development and validation of future helmet evaluation protocols and standards. © IMechE 2015.},

keywords = {Acceleration, Accident prevention, Angular acceleration, Biomechanics, Brain Injury, Coefficient of variation values, Comparative analysis, Concussion, Equipment, Evaluation protocol, helmet testing, Linear acceleration, Linear accelerations, Rotational acceleration, Safety devices, Sporting goods, standards},

pubstate = {published},

tppubtype = {article}

}

Puvenna, V; Engeler, M; Banjara, M; Brennan, C; Schreiber, P; Dadas, A; Bahrami, A; Solanki, J; Bandyopadhyay, A; Morris, J K; Bernick, C; Ghosh, C; Rapp, E; Bazarian, J J; Janigro, D

Is phosphorylated tau unique to chronic traumatic encephalopathy? Phosphorylated tau in epileptic brain and chronic traumatic encephalopathy Journal Article

In: Brain Research, vol. 1630, pp. 225–240, 2016.

@article{Puvenna2016,

title = {Is phosphorylated tau unique to chronic traumatic encephalopathy? Phosphorylated tau in epileptic brain and chronic traumatic encephalopathy},

author = {Puvenna, V and Engeler, M and Banjara, M and Brennan, C and Schreiber, P and Dadas, A and Bahrami, A and Solanki, J and Bandyopadhyay, A and Morris, J K and Bernick, C and Ghosh, C and Rapp, E and Bazarian, J J and Janigro, D},

year  = {2016},

date = {2016-01-01},

journal = {Brain Research},

volume = {1630},

pages = {225--240},

abstract = {Repetitive traumatic brain injury (rTBI) is one of the major risk factors for the abnormal deposition of phosphorylated tau (PT) in the brain and chronic traumatic encephalopathy (CTE). CTE and temporal lobe epilepsy (TLE) affect the limbic system, but no comparative studies on PT distribution in TLE and CTE are available. It is also unclear whether PT pathology results from repeated head hits (rTBI). These gaps prevent a thorough understanding of the pathogenesis and clinical significance of PT, limiting our ability to develop preventative and therapeutic interventions. We quantified PT in TLE and CTE to unveil whether a history of rTBI is a prerequisite for PT accumulation in the brain. Six postmortem CTE (mean 73.3 years) and age matched control samples were compared to 19 surgically resected TLE brain specimens (4 months-58 years; mean 27.6 years). No history of TBI was present in TLE or control; all CTE patients had a history of rTBI. TLE and CTE brain displayed increased levels of PT as revealed by immunohistochemistry. No age-dependent changes were noted, as PT was present as early as 4 months after birth. In TLE and CTE, cortical neurons, perivascular regions around penetrating pial vessels and meninges were immunopositive for PT; white matter tracts also displayed robust expression of extracellular PT organized in bundles parallel to venules. Microscopically, there were extensive tau-immunoreactive neuronal, astrocytic and degenerating neurites throughout the brain. In CTE perivascular tangles were most prominent. Overall, significant differences in staining intensities were found between CTE and control (P\<0.01) but not between CTE and TLE (P=0.08). pS199 tau analysis showed that CTE had the most high molecular weight tangle-associated tau, whereas epileptic brain contained low molecular weight tau. Tau deposition may not be specific to rTBI since TLE recapitulated most of the pathological features of CTE. Copyright © 2015 Elsevier B.V. All rights reserved.},

keywords = {*Brain Injury, *Brain/me [Metabolism], *Epilepsy/me [Metabolism], *tau Proteins/me [Metabolism], 0 (MAPT protein, 0 (tau Proteins), 80 and over, Adolescent, adult, aged, Brain Injury, Brain/pa [Pathology], Brain/su [Surgery], Child, Chronic/me [Metabolism], Chronic/pa [Pathology], ENZYME-linked immunosorbent assay, Epilepsy/pa [Pathology], Epilepsy/su [Surgery], Female, human), Humans, immunohistochemistry, Infant, Male, middle aged, Phosphorylation, Preschool, Young Adult},

pubstate = {published},

tppubtype = {article}

}

Lucke-Wold, B P; Turner, R C; Logsdon, A F; Nguyen, L; Bailes, J E; Lee, J M; Robson, M J; Omalu, B I; Huber, J D; Rosen, C L

Endoplasmic reticulum stress implicated in chronic traumatic encephalopathy Journal Article

In: Journal of Neurosurgery, vol. 124, no. 3, pp. 687–702, 2016.

@article{Lucke-Wold2016,

title = {Endoplasmic reticulum stress implicated in chronic traumatic encephalopathy},

author = {Lucke-Wold, B P and Turner, R C and Logsdon, A F and Nguyen, L and Bailes, J E and Lee, J M and Robson, M J and Omalu, B I and Huber, J D and Rosen, C L},

year  = {2016},

date = {2016-01-01},

journal = {Journal of Neurosurgery},

volume = {124},

number = {3},

pages = {687--702},

abstract = {OBJECTIVE: Chronic traumatic encephalopathy is a progressive neurodegenerative disease characterized by neurofibrillary tau tangles following repetitive neurotrauma. The underlying mechanism linking traumatic brain injury to chronic traumatic encephalopathy has not been elucidated. The authors investigate the role of endoplasmic reticulum stress as a link between acute neurotrauma and chronic neurodegeneration. METHODS: The authors used pharmacological, biochemical, and behavioral tools to assess the role of endoplasmic reticulum stress in linking acute repetitive traumatic brain injury to the development of chronic neurodegeneration. Data from the authors' clinically relevant and validated rodent blast model were compared with those obtained from postmortem human chronic traumatic encephalopathy specimens from a National Football League player and World Wrestling Entertainment wrestler. RESULTS: The results demonstrated strong correlation of endoplasmic reticulum stress activation with subsequent tau hyperphosphorylation. Various endoplasmic reticulum stress markers were increased in human chronic traumatic encephalopathy specimens, and the endoplasmic reticulum stress response was associated with an increase in the tau kinase, glycogen synthase kinase-3beta. Docosahexaenoic acid, an endoplasmic reticulum stress inhibitor, improved cognitive performance in the rat model 3 weeks after repetitive blast exposure. The data showed that docosahexaenoic acid administration substantially reduced tau hyperphosphorylation (t = 4.111, p \< 0.05), improved cognition (t = 6.532, p \< 0.001), and inhibited C/EBP homology protein activation (t = 5.631, p \< 0.01). Additionally the data showed, for the first time, that endoplasmic reticulum stress is involved in the pathophysiology of chronic traumatic encephalopathy. CONCLUSIONS: Docosahexaenoic acid therefore warrants further investigation as a potential therapeutic agent for the prevention of chronic traumatic encephalopathy.},

keywords = {*Blast Injuries/px [Psychology], *Brain Injury, *Endoplasmic Reticulum Stress/ph [Physiology], *Football/in [Injuries], *Wrestling/in [Injuries], adult, animal, Animals, Blast Injuries/et [Etiology], Blast Injuries/pa [Pathology], Brain Injury, Chronic/et [Etiology], Chronic/pa [Pathology], Chronic/px [Psychology], Disease Models, Humans, Male, Rats, Sprague-Dawley},

pubstate = {published},

tppubtype = {article}

}

Kroshus, E; Gillard, D; Haarbauer‐Krupa, J; Goldman, R E; Bickham, D S

Talking with young children about concussions: An exploratory study Journal Article

In: Child: Care, Health and Development, 2016, ISBN: 0305-1862 1365-2214.

Abstract | Links | BibTeX | Tags: 2016, Brain Injury, children, Concussion, No terms assigned, Parents, Sport

@article{Kroshus2016b,

title = {Talking with young children about concussions: An exploratory study},

author = {Kroshus, E and Gillard, D and Haarbauer‐Krupa, J and Goldman, R E and Bickham, D S},

doi = {10.1111/cch.12433},

isbn = {0305-1862

1365-2214},

year  = {2016},

date = {2016-01-01},

journal = {Child: Care, Health and Development},

publisher = {Wiley-Blackwell Publishing Ltd.},

address = {United Kingdom},

abstract = {Background Concussion education for children early in their participation in organized sport may help shape lasting attitudes about concussion safety. However, existing programming and research focus on older ages. Methods Qualitative interviews about concussions were conducted with twenty children between the ages of six and eight. Structural, descriptive and pattern coding were used to organize the transcribed interviews and identify emergent themes. Results Eighteen of the participants indicated that they had heard of the word concussion, with 12 describing the injury as related to the brain or head. The most frequently described mechanisms of injury were impacts to the head or falls, and symptoms tended to be somatic, such as generalized pain. The most frequently endorsed strategy to avoid sustaining a concussion was to ‘follow the rules.’ Multiple participants referenced parents as an informal source of information about concussions. Conclusions While most participants demonstrated some awareness about concussions, there were clear knowledge gaps that can be addressed with developmentally appropriate concussion education programming. Consistent with their developmental stage, interventions targeted at children in this age range may be most successful if they use basic logic, concrete ideas, provide rules to be followed and engage parents in dissemination. (PsycINFO Database Record (c) 2016 APA, all rights reserved)},

keywords = {2016, Brain Injury, children, Concussion, No terms assigned, Parents, Sport},

pubstate = {published},

tppubtype = {article}

}

Mez, J; Solomon, T M; Daneshvar, D H; Stein, T D; McKee, A C

Pathologically Confirmed Chronic Traumatic Encephalopathy in a 25-Year-Old Former College Football Player Journal Article

In: JAMA Neurology, vol. 73, no. 3, pp. 353–355, 2016.

Aomura, S; Zhang, Y; Nakadate, H; Koyama, T; Nishimura, A

Brain injury risk estimation of collegiate football player based on game video of concussion suspected accident Journal Article

In: Journal of Biomechanical Science and Engineering, vol. 11, no. 4, 2016.

@article{Aomura2016,

title = {Brain injury risk estimation of collegiate football player based on game video of concussion suspected accident},

author = {Aomura, S and Zhang, Y and Nakadate, H and Koyama, T and Nishimura, A},

doi = {10.1299/jbse.16-00393},

year  = {2016},

date = {2016-01-01},

journal = {Journal of Biomechanical Science and Engineering},

volume = {11},

number = {4},

abstract = {The collision accident in collegiate football game was simulated based on the game video and the concussive impact on the head was analyzed. First, the collision motion of players was reproduced based on the video by using motion analysis, and the translational and rotational velocities, relative position and contact location of the struck and the striking players' heads just before the collision were calculated. Then the data obtained were input to two helmeted finite element (FE) human head models as the initial condition, and the brain injury risk was evaluated by using the impact analysis. The FE helmet model was validated by a drop test of the helmet in which the head impactor was embedded. In the present study, two concussion suspected accident cases were analyzed; then the concussion was evaluated by ten mechanical parameters generated inside the skull caused by the collision. The injury risk evaluated by multi parameters belonged to the dangerous range that may cause concussion and was consistent with the diagnosis of the medical team doctor. The brain injury risk can be successfully estimated by the reconstructed simulation of the game video and FE analysis. To our knowledge, this study is the first attempt in Japan to estimate the brain injury risk systematically by a combination of game video analysis which is originally introduced for the players' health care and FE analysis by helmeted human head model. In the future, brain injury risk caused by an accident can be evaluated with higher accuracy by analyzing more accident cases. © 2016 The Japan Society of Mechanical Engineers.},

keywords = {Accidents, Brain Injury, Brain injury risk estimation, Collision accidents, DIAGNOSIS, FEM, Finite element method, FOOTBALL players, Game video, Game videos, Health risks, Initial conditions, Mechanical parameters, Motion analysis, Relative positions, RISK assessment, Risk perception, Rotational velocity, Sports, Sports-related concussion},

pubstate = {published},

tppubtype = {article}

}

O'Kane, J W

Is Heading in Youth Soccer Dangerous Play? Journal Article

In: Physician & Sportsmedicine, vol. 44, no. 2, pp. 190–194, 2016.

@article{OKane2016,

title = {Is Heading in Youth Soccer Dangerous Play?},

author = {O'Kane, J W},

year  = {2016},

date = {2016-01-01},

journal = {Physician \& Sportsmedicine},

volume = {44},

number = {2},

pages = {190--194},

abstract = {BACKGROUND: Soccer is among the most popular youth sports with over 3 million youth players registered in the U.S. Soccer is unique in that players intentionally use their head to strike the ball, leading to concerns that heading could cause acute or chronic brain injury, especially in the immature brains of children. METHODS: Pub Med search without date restriction was conducted in November 2014 and August 2015 using the terms soccer and concussion, heading and concussion, and youth soccer and concussion. 310 articles were identified and reviewed for applicable content specifically relating to youth athletes, heading, and/or acute or chronic brain injury from soccer. RESULTS: Soccer is a low-risk sport for catastrophic head injury, but concussions are relatively common and heading often plays a role. At all levels of play, concussions are more likely to occur in the act of heading than with other facets of the game. While concussion from heading the ball without other contact to the head appears rare in adult players, some data suggests children are more susceptible to concussion from heading primarily in game situations. Contributing factors include biomechanical forces, less developed technique, and the immature brain's susceptibility to injury. CONCLUSIONS: There is no evidence that heading in youth soccer causes any permanent brain injury and there is limited evidence that heading in youth soccer can cause concussion. A reasonable approach based on U.S. Youth Soccer recommendations is to teach heading after age 10 in controlled settings, and heading in games should be delayed until skill acquisition and physical maturity allow the youth player to head correctly with confidence.},

keywords = {*Brain Injuries/et [Etiology], *Brain Injury, *Soccer/in [Injuries], Adolescent, Brain Concussion/et [Etiology], Brain Concussion/pc [Prevention \&amp; Control], Brain Injuries/pc [Prevention \&amp; Control], Brain Injury, Child, Chronic/et [Etiology], Chronic/pc [Prevention \&amp; Control], Humans, Risk Factors, UNITED States},

pubstate = {published},

tppubtype = {article}

}

Keener, A B

Tackling the brain: Clues emerge about the pathology of sports-related brain trauma Journal Article

In: Nature Medicine, vol. 22, no. 4, pp. 326–329, 2016.

Ojo, J O; Mouzon, B C; Crawford, F

Repetitive head trauma, chronic traumatic encephalopathy and tau: Challenges in translating from mice to men Journal Article

In: Experimental Neurology, vol. 275, pp. 389–404, 2016.

@article{Ojo2016,

title = {Repetitive head trauma, chronic traumatic encephalopathy and tau: Challenges in translating from mice to men},

author = {Ojo, J O and Mouzon, B C and Crawford, F},

doi = {10.1016/j.expneurol.2015.06.003},

year  = {2016},

date = {2016-01-01},

journal = {Experimental Neurology},

volume = {275},

pages = {389--404},

abstract = {Chronic traumatic encephalopathy (CTE) is a neurological and psychiatric condition marked by preferential perivascular foci of neurofibrillary and glial tangles (composed of hyperphosphorylated-tau proteins) in the depths of the sulci. Recent retrospective case series published over the last decade on athletes and military personnel have added considerably to our clinical and histopathological knowledge of CTE. This has marked a vital turning point in the traumatic brain injury (TBI) field, raising public awareness of the potential long-term effects of mild and moderate repetitive TBI, which has been recognized as one of the major risk factors associated with CTE. Although these human studies have been informative, their retrospective design carries certain inherent limitations that should be cautiously interpreted. In particular, the current overriding issue in the CTE literature remains confusing in regard to appropriate definitions of terminology, variability in individual pathologies and the potential case selection bias in autopsy based studies. There are currently no epidemiological or prospective studies on CTE. Controlled preclinical studies in animals therefore provide an alternative means for specifically interrogating aspects of CTE pathogenesis. In this article, we review the current literature and discuss difficulties and challenges of developing in-vivo TBI experimental paradigms to explore the link between repetitive head trauma and tau-dependent changes. We provide our current opinion list of recommended features to consider for successfully modeling CTE in animals to better understand the pathobiology and develop therapeutics and diagnostics, and critical factors, which might influence outcome. We finally discuss the possible directions of future experimental research in the repetitive TBI/CTE field. © 2015 Elsevier Inc..},

keywords = {amyloid beta protein, animal, Animal models, Animals, Astroglial tangles, Brain Injury, cell activation, Chronic, complication, Concussion, Craniocerebral Trauma, CTE, diffuse axonal injury, disease duration, disease model, Disease Models, genetic predisposition, gliosis, head injury, hippocampus, human, Humans, lifestyle modification, lithium, metabolism, Mice, microglia, minocycline, mouse, nervous system inflammation, Neurobehaviour, Neurofibrillary tangles, neuropathology, nonhuman, pathogenesis, pathology, priority journal, procedures, protein aggregation, protein analysis, protein blood level, protein cleavage, Repetitive TBI, Review, sex difference, stress activated protein kinase inhibitor, Systematic Review, Tau, tau protein, tau Proteins, Transgenic mice, Translational Medical Research, translational research, traumatic brain injury, trends},

pubstate = {published},

tppubtype = {article}

}

Buckley, T A; Vallabhajosula, S; Oldham, J R; Munkasy, B A; Evans, K M; Krazeise, D A; Ketcham, C J; Hall, E E

Evidence of a conservative gait strategy in athletes with a history of concussions Journal Article

In: Journal of Sport and Health Science, vol. 5, no. 4, pp. 417–423, 2016.

Abstract | Links | BibTeX | Tags: Balance, Brain Injury, Gait performance, Locomotion, Mild traumatic, postural control, postural stability, Variability

@article{Buckley2016a,

title = {Evidence of a conservative gait strategy in athletes with a history of concussions},

author = {Buckley, T A and Vallabhajosula, S and Oldham, J R and Munkasy, B A and Evans, K M and Krazeise, D A and Ketcham, C J and Hall, E E},

doi = {10.1016/j.jshs.2015.03.010},

year  = {2016},

date = {2016-01-01},

journal = {Journal of Sport and Health Science},

volume = {5},

number = {4},

pages = {417--423},

abstract = {Background A history of 3 or more concussions is frequently associated with numerous short- and long-term neuropathologies. Impairments in postural control are a known acute consequence of concussion; however, limited evidence exists on the effects of multiple concussions on gait. The purpose of this study was to assess gait stepping characteristics in collegiate aged student-athletes based on concussion history. Methods There were 63 participants divided into 3 even groups based on concussion history: ≥3 concussions, 1\textendash2 concussions, and 0 concussion. All participants completed 10 trials of gait on a 4.9 m instrumented walkway. The dependent variables of interest included both gait stepping characteristics (step velocity, length, and width, double support time, and the percentage of the gait cycle in stance) and coefficient of variability (CoV) measures (step length, time, and width). The gait stepping characteristics were compared first with a MANOVA with follow-up 1-way ANOVAs and Tukey post hoc tests as appropriate. The CoV measures were compared with 1-way ANOVAs and Tukey post hoc tests. Results There were main effects for group for step velocity, length, width, and double support time. Overall, the 0 concussion group displayed typical healthy young gait parameters and performed significantly better than either concussion group. The 0 concussion group had a significantly greater step length CoV, but there were no differences in the step time or width CoV. Conclusion This finding provides evidence of subtle impairments in postural control during gait among individuals with prior history of concussion which could be an early indicator of future neurological deficiencies. The limited difference in the variability measures is consistent with prior static stance studies and could suggest the individuals constrain their motor systems to reduce variability. Taken together, these findings suggest a conservative gait strategy which is adopted by individuals with a history of concussions. © 2016},

keywords = {Balance, Brain Injury, Gait performance, Locomotion, Mild traumatic, postural control, postural stability, Variability},

pubstate = {published},

tppubtype = {article}

}

Steiger, B

Meet Bennet Omalu, Md: The Physician Leader Whose Research Inspired the Movie Concussion Journal Article

In: Physician Leadership Journal, vol. 3, no. 2, pp. 8–10, 2016.

Terwilliger, V K; Pratson, L; Vaughan, C G; Gioia, G A

Additional Post-Concussion Impact Exposure May Affect Recovery in Adolescent Athletes Journal Article

In: Journal of Neurotrauma, vol. 33, no. 8, pp. 761–765, 2016.

@article{Terwilliger2016,

title = {Additional Post-Concussion Impact Exposure May Affect Recovery in Adolescent Athletes},

author = {Terwilliger, V K and Pratson, L and Vaughan, C G and Gioia, G A},

doi = {10.1089/neu.2015.4082},

year  = {2016},

date = {2016-01-01},

journal = {Journal of Neurotrauma},

volume = {33},

number = {8},

pages = {761--765},

abstract = {Repeat concussion has been associated with risk for prolonged and pronounced clinical recovery in athletes. In this study of adolescent athletes, we examined whether an additional head impact within 24 h of a sports-related concussion (SRC) is associated with higher symptom burden and prolonged clinical recovery compared with a single-injury group. Forty-two student-athletes (52% male, mean age = 14.9 years) diagnosed with an SRC in a concussion clinic were selected for this study: (1) 21 athletes who sustained an additional significant head impact within 24 h of the initial injury (additional-impact group); (2) 21 single-injury athletes, age and gender matched, who sustained only one discrete concussive blow to the head (single-injury group). Groups did not differ on initial injury characteristics or pre-injury risk factors. The effect of injury status (single-vs. additional-impact) was examined on athlete-and parent-reported symptom burden (at first clinic visit) and length of recovery (LOR). Higher symptom burden was reported by the athletes and parents in the additional-impact group at the time of first visit. The additional-impact group also had a significantly longer LOR compared with the single-injury group. These findings provide preliminary, hypothesis-generating evidence for the importance of immediate removal from play following an SRC to protect athletes from re-injury, which may worsen symptoms and prolong recovery. The retrospective study design from a specialized clinical sample points to the need for future prospective studies of the relationship between single-and additional-impact injuries on symptom burden and LOR. © 2016 Mary Ann Liebert, Inc.},

keywords = {Adolescent, Article, athlete, Athletes, brain concussion, Brain Injury, clinical article, Concussion, controlled study, CONVALESCENCE, Female, human, Male, mTBI, Parent, postconcussion syndrome, retrospective study, risk factor, sport injury},

pubstate = {published},

tppubtype = {article}

}

Iverson, G L

Suicide and Chronic Traumatic Encephalopathy Journal Article

In: Journal of Neuropsychiatry & Clinical Neurosciences, vol. 28, no. 1, pp. 9–16, 2016.

2015

Morgan, C D; Zuckerman, S L; King, L E; Beaird, S E; Sills, A K; Solomon, G S

Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging Journal Article

In: Child's Nervous System, vol. 31, no. 12, pp. 2305–2309, 2015.

@article{Morgan2015,

title = {Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging},

author = {Morgan, C D and Zuckerman, S L and King, L E and Beaird, S E and Sills, A K and Solomon, G S},

doi = {10.1007/s00381-015-2916-y},

year  = {2015},

date = {2015-01-01},

journal = {Child's Nervous System},

volume = {31},

number = {12},

pages = {2305--2309},

abstract = {Purpose: Approximately 90% of concussions are transient, with symptoms resolving within 10\textendash14 days. However, a minority of patients remain symptomatic several months post-injury, a condition known as post-concussion syndrome (PCS). The treatment of these patients can be challenging. The goal of our study was to assess the utility and cost-effectiveness of neurologic imaging two or more weeks post-injury in a cohort of youth with PCS. Methods: We conducted a retrospective study of 52 pediatric patients with persistent post-concussion symptoms after 3 months. We collected demographics and neuroimaging results obtained greater than 2 weeks post-concussion. Neuroimaging ordered in the first 2 weeks post-concussion was excluded, except to determine the rate of re-imaging. Descriptive statistics and corresponding cost data were collected. Results: Of 52 patients with PCS, 23/52 (44 %) had neuroimaging at least 2 weeks after the initial injury, for a total of 32 diagnostic studies. In summary, 1/19 MRIs (5.3 %), 1/8 CTs (13 %), and 0/5 x-rays (0 %) yielded significant positive findings, none of which altered clinical management. Chronic phase neuroimaging estimated costs from these 52 pediatric patients totaled $129,025. We estimate the cost to identify a single positive finding was $21,000 for head CT and $104,500 for brain MRI. Conclusions: In this cohort of pediatric PCS patients, brain imaging in the chronic phase (defined as more than 2 weeks after concussion) was pursued in almost half the study sample, had low diagnostic yield, and had poor cost-effectiveness. Based on these results, outpatient management of pediatric patients with long-term post-concussive symptoms should rarely include repeat neuroimaging beyond the acute phase. © 2015, Springer-Verlag Berlin Heidelberg.},

keywords = {Adolescent, arachnoid cyst, Article, brain, Brain Injury, Child, Computed tomography (CT) neuroimaging, computer assisted tomography, Computer-Assisted, Concussion, cost effectiveness analysis, cost utility analysis, DECISION making, diagnostic value, DSM-IV, Female, human, Humans, image processing, Magnetic Resonance Imaging, Magnetic resonance imaging (MRI), major clinical study, Male, mild traumatic brain injury, neuroimaging, neurosurgery, nuclear magnetic resonance, nuclear magnetic resonance imaging, pathology, Post-Concussion Syndrome, postconcussion syndrome, Preschool, preschool child, priority journal, Radiography, Retrospective Studies, retrospective study, Sports, STATISTICS, Tomography, traumatic brain injury, X ray, X-Ray Computed},

pubstate = {published},

tppubtype = {article}

}

Ice Hockey Summit II: zero tolerance for head hits and fighting.[Erratum appears in Clin J Sport Med. 2015 Jul;25(4):379] Journal Article

In: Clinical Journal of Sport Medicine, vol. 25, no. 2, pp. 78–87, 2015.

@article{Smith2015a,

title = {Ice Hockey Summit II: zero tolerance for head hits and fighting.[Erratum appears in Clin J Sport Med. 2015 Jul;25(4):379]},

author = {Smith, A M and Stuart, M J and Dodick, D W and Roberts, W O and Alford, P W and Ashare, A B and Aubrey, M and Benson, B W and Burke, C J and Dick, R and Eickhoff, C and Emery, C A and Flashman, L A and Gaz, D and Giza, C C and Greenwald, R M and Herring, S and Hoshizaki, T B and Hudziak, J J and {Huston 3rd}, J and Krause, D and LaVoi, N and Leaf, M and Leddy, J J and MacPherson, A and McKee, A C and Mihalik, J P and Moessner, A M and Montelpare, W J and Putukian, M and Schneider, K J and Szalkowski, R and Tabrum, M and Whitehead, J and Wiese-Bjornstal, D M},

year  = {2015},

date = {2015-01-01},

journal = {Clinical Journal of Sport Medicine},

volume = {25},

number = {2},

pages = {78--87},

abstract = {OBJECTIVE: To present currently known basic science and on-ice influences of sport-related concussion (SRC) in hockey, building on the Ice Hockey Summit I action plan (2011) to reduce SRC. METHODS: The prior summit proceedings included an action plan intended to reduce SRC. As such, the proceedings from Summit I served as a point of departure, for the science and discussion held during Summit II (Mayo Clinic, Rochester MN, October 2013). Summit II focused on (1) Basic Science of Concussions in Ice Hockey: Taking Science Forward; (2) Acute and Chronic Concussion Care: Making a Difference; (3) Preventing Concussions via Behavior, Rules, Education and Measuring Effectiveness; (4) Updates in Equipment: their Relationship to Industry Standards; and (5) Policies and Plans at State, National and Federal Levels to reduce SRC. Action strategies derived from the presentations and discussion described in these sectors were subsequently voted on for purposes of prioritization. The following proceedings include knowledge and research shared by invited faculty, many of whom are health care providers and clinical investigators. RESULTS: The Summit II evidence-based action plan emphasizes the rapidly evolving scientific content of hockey SRC. It includes the most highly prioritized strategies voted on for implementation to decrease concussion. CONCLUSIONS: The highest priority action items identified from the Summit includes the following: (1) eliminate head hits from all levels of ice hockey, (2) change body-checking policies, and (3) eliminate fighting in all amateur and professional hockey.},

keywords = {*Brain Concussion/pc [Prevention \&amp; Control], *Brain Injury, *Hockey/in [Injuries], *Violence/pc [Prevention \&amp; Control], Adolescent, adult, Brain Concussion/th [Therapy], Brain Injury, Child, Chronic/pc [Prevention \&amp; Control], Chronic/th [Therapy], Congresses as Topic, Evidence-Based Medicine, Head Protective Devices/st [Standards], Hockey/st [Standards], Humans, policy, Young Adult},

pubstate = {published},

tppubtype = {article}

}

Beta-amyloid deposition in chronic traumatic encephalopathy Journal Article

In: Acta Neuropathologica, vol. 130, no. 1, pp. 21–34, 2015.

@article{Stein2015b,

title = {Beta-amyloid deposition in chronic traumatic encephalopathy},

author = {Stein, T D and Montenigro, P H and Alvarez, V E and Xia, W and Crary, J F and Tripodis, Y and Daneshvar, D H and Mez, J and Solomon, T and Meng, G and Kubilus, C A and Cormier, K A and Meng, S and Babcock, K and Kiernan, P and Murphy, L and Nowinski, C J and Martin, B and Dixon, D and Stern, R A and Cantu, R C and Kowall, N W and McKee, A C},

year  = {2015},

date = {2015-01-01},

journal = {Acta Neuropathologica},

volume = {130},

number = {1},

pages = {21--34},

abstract = {Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with repetitive mild traumatic brain injury. It is defined pathologically by the abnormal accumulation of tau in a unique pattern that is distinct from other tauopathies, including Alzheimer's disease (AD). Although trauma has been suggested to increase amyloid beta peptide (Abeta) levels, the extent of Abeta deposition in CTE has not been thoroughly characterized. We studied a heterogeneous cohort of deceased athletes and military veterans with neuropathologically diagnosed CTE (n = 114, mean age at death = 60) to test the hypothesis that Abeta deposition is altered in CTE and associated with more severe pathology and worse clinical outcomes. We found that Abeta deposition, either as diffuse or neuritic plaques, was present in 52 % of CTE subjects. Moreover, Abeta deposition in CTE occurred at an accelerated rate and with altered dynamics in CTE compared to a normal aging population (OR = 3.8, p \< 0.001). We also found a clear pathological and clinical dichotomy between those CTE cases with Abeta plaques and those without. Abeta deposition was significantly associated with the presence of the APOE epsilon4 allele (p = 0.035), older age at symptom onset (p \< 0.001), and older age at death (p \< 0.001). In addition, when controlling for age, neuritic plaques were significantly associated with increased CTE tauopathy stage (beta = 2.43},

keywords = {*Amyloid beta-Peptides/me [Metabolism], *Brain Injury, *Brain/pa [Pathology], *Neurodegenerative Diseases/pa [Pathology], *tau Proteins/me [Metabolism], 0 (Amyloid beta-Peptides), 0 (Apolipoprotein E4), 0 (MAPT protein, 0 (tau Proteins), 80 and over, adult, Age Factors, aged, Amyloid/et [Etiology], Amyloid/me [Metabolism], Amyloid/pa [Pathology], Apolipoprotein E4/ge [Genetics], Athletes, Athletic Injuries/ep [Epidemiology], Athletic Injuries/ge [Genetics], Athletic Injuries/me [Metabolism], Athletic Injuries/pa [Pathology], Brain Injury, Brain/me [Metabolism], Chronic/ep [Epidemiology], Chronic/ge [Genetics], Chronic/me [Metabolism], Chronic/pa [Pathology], Cohort Studies, comorbidity, human), Humans, middle aged, Neurodegenerative Diseases/ep [Epidemiology], Neurodegenerative Diseases/ge [Genetics], Neurodegenerative Diseases/me [Metabolism], Plaque, SEVERITY of illness index, veterans, War-Related Injuries/ep [Epidemiology], War-Related Injuries/ge [Genetics], War-Related Injuries/me [Metabolism], War-Related Injuries/pa [Pathology]},

pubstate = {published},

tppubtype = {article}

}

Meehan 3rd, W; Mannix, R; Zafonte, R; Pascual-Leone, A

Chronic traumatic encephalopathy and athletes Journal Article

In: Neurology, vol. 85, no. 17, pp. 1504–1511, 2015.

@article{Meehan3rd2015a,

title = {Chronic traumatic encephalopathy and athletes},

author = {{Meehan 3rd}, W and Mannix, R and Zafonte, R and Pascual-Leone, A},

year  = {2015},

date = {2015-01-01},

journal = {Neurology},

volume = {85},

number = {17},

pages = {1504--1511},

abstract = {Recent case reports have described athletes previously exposed to repetitive head trauma while participating in contact sports who later in life developed mood disorders, headaches, cognitive difficulties, suicidal ideation, difficulties with speech, and aggressive behavior. Postmortem discoveries show that some of these athletes have pathologic findings that are collectively termed chronic traumatic encephalopathy (CTE). Current hypotheses suggest that concussions or perhaps blows to the head that do not cause the signs and symptoms necessary for making the diagnosis of concussion, so-called subconcussive blows, cause both the clinical and pathologic findings. There are, however, some athletes who participate in contact sports who do not develop the findings ascribed to CTE. Furthermore, there are people who have headaches, mood disorders, cognitive difficulties, suicidal ideation, and other clinical problems who have neither been exposed to repeated head trauma nor possessed the pathologic postmortem findings of those currently diagnosed with CTE. The current lack of prospective data and properly designed case-control studies limits the current understanding of CTE, leading to debate about the causes of the neuropathologic findings and the clinical observations. Given the potential for referral and recall bias in available studies, it remains unclear whether or not the pathologic findings made postmortem cause the presumed neurobehavioral sequela and whether the presumed risk factors, such as sports activity, cerebral concussions, and subconcussive blows, are solely causative of the clinical signs and symptoms. This article discusses the current evidence and the associated limitations. Copyright © 2015 American Academy of Neurology.},

keywords = {*Athletic Injuries/pa [Pathology], *Brain Concussion/pa [Pathology], *Brain Injury, *Brain/pa [Pathology], *Cognition Disorders/pa [Pathology], *Suicidal Ideation, Aggression/px [Psychology], Athletes, Athletic Injuries/co [Complications], Athletic Injuries/px [Psychology], Brain Concussion/co [Complications], Brain Concussion/px [Psychology], Brain Injury, Chronic/et [Etiology], Chronic/pa [Pathology], Chronic/px [Psychology], Cognition Disorders/et [Etiology], Cognition Disorders/px [Psychology], Headache/et [Etiology], Headache/pa [Pathology], Humans, Mood Disorders/et [Etiology], Mood Disorders/pa [Pathology], Mood Disorders/px [Psychology], Speech Disorders/et [Etiology], Speech Disorders/pa [Pathology], Speech Disorders/px [Psychology]},

pubstate = {published},

tppubtype = {article}

}

Faden, A I; Loane, D J

Chronic neurodegeneration after traumatic brain injury: Alzheimer disease, chronic traumatic encephalopathy, or persistent neuroinflammation? Journal Article

In: Neurotherapeutics, vol. 12, no. 1, pp. 143–150, 2015.

@article{Faden2015,

title = {Chronic neurodegeneration after traumatic brain injury: Alzheimer disease, chronic traumatic encephalopathy, or persistent neuroinflammation?},

author = {Faden, A I and Loane, D J},

year  = {2015},

date = {2015-01-01},

journal = {Neurotherapeutics},

volume = {12},

number = {1},

pages = {143--150},

abstract = {It has long been suggested that prior traumatic brain injury (TBI) increases the subsequent incidence of chronic neurodegenerative disorders, including Alzheimer disease, Parkinson disease, and amyotrophic lateral sclerosis. Among these, the association with Alzheimer disease has the strongest support. There is also a long-recognized association between repeated concussive insults and progressive cognitive decline or other neuropsychiatric abnormalities. The latter was first described in boxers as dementia pugilistica, and has received widespread recent attention in contact sports such as professional American football. The term chronic traumatic encephalopathy was coined to attempt to define a "specific" entity marked by neurobehavioral changes and the extensive deposition of phosphorylated tau protein. Nearly lost in the discussions of post-traumatic neurodegeneration after traumatic brain injury has been the role of sustained neuroinflammation, even though this association has been well established pathologically since the 1950s, and is strongly supported by subsequent preclinical and clinical studies. Manifested by extensive microglial and astroglial activation, such chronic traumatic brain inflammation may be the most important cause of post-traumatic neurodegeneration in terms of prevalence. Critically, emerging preclinical studies indicate that persistent neuroinflammation and associated neurodegeneration may be treatable long after the initiating insult(s).},

keywords = {*Alzheimer Disease/et [Etiology], *Brain Injuries/co [Complications], *Brain Injury, *Encephalitis/et [Etiology], *Nerve Degeneration/et [Etiology], Alzheimer Disease/pa [Pathology], Animals, Brain Injury, Chronic/et [Etiology], Chronic/pa [Pathology], Encephalitis/pa [Pathology], Humans, Nerve Degeneration/pa [Pathology]},

pubstate = {published},

tppubtype = {article}

}

Bieniek, K F; Ross, O A; Cormier, K A; Walton, R L; Soto-Ortolaza, A; Johnston, A E; DeSaro, P; Boylan, K B; Graff-Radford, N R; Wszolek, Z K; Rademakers, R; Boeve, B F; McKee, A C; Dickson, D W

Chronic traumatic encephalopathy pathology in a neurodegenerative disorders brain bank Journal Article

In: Acta Neuropathologica, vol. 130, no. 6, pp. 877–889, 2015.

@article{Bieniek2015,

title = {Chronic traumatic encephalopathy pathology in a neurodegenerative disorders brain bank},

author = {Bieniek, K F and Ross, O A and Cormier, K A and Walton, R L and Soto-Ortolaza, A and Johnston, A E and DeSaro, P and Boylan, K B and Graff-Radford, N R and Wszolek, Z K and Rademakers, R and Boeve, B F and McKee, A C and Dickson, D W},

year  = {2015},

date = {2015-01-01},

journal = {Acta Neuropathologica},

volume = {130},

number = {6},

pages = {877--889},

abstract = {Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disorder linked to repetitive traumatic brain injury (TBI) and characterized by deposition of hyperphosphorylated tau at the depths of sulci. We sought to determine the presence of CTE pathology in a brain bank for neurodegenerative disorders for individuals with and without a history of contact sports participation. Available medical records of 1721 men were reviewed for evidence of past history of injury or participation in contact sports. Subsequently, cerebral cortical samples were processed for tau immunohistochemistry in cases with a documented history of sports exposure as well as age- and disease-matched men and women without such exposure. For cases with available frozen tissue, genetic analysis was performed for variants in APOE, MAPT, and TMEM106B. Immunohistochemistry revealed 21 of 66 former athletes had cortical tau pathology consistent with CTE. CTE pathology was not detected in 198 individuals without exposure to contact sports, including 33 individuals with documented single-incident TBI sustained from falls, motor vehicle accidents, domestic violence, or assaults. Among those exposed to contact sports, those with CTE pathology did not differ from those without CTE pathology with respect to noted clinicopathologic features. There were no significant differences in genetic variants for those with CTE pathology, but we observed a slight increase in MAPT H1 haplotype, and there tended to be fewer homozygous carriers of the protective TMEM106B rs3173615 minor allele in those with sports exposure and CTE pathology compared to those without CTE pathology. In conclusion, this study has identified a small, yet significant, subset of individuals with neurodegenerative disorders and concomitant CTE pathology. CTE pathology was only detected in individuals with documented participation in contact sports. Exposure to contact sports was the greatest risk factor for CTE pathology. Future studies addressing clinical correlates of CTE pathology are needed.},

keywords = {*Brain Injury, *Brain/pa [Pathology], *Neurodegenerative Diseases/et [Etiology], *Neurodegenerative Diseases/pa [Pathology], 0 (Apolipoproteins E), 0 (MAPT protein, 0 (Membrane Proteins), 0 (Nerve Tissue Proteins), 0 (tau Proteins), 0 (TMEM106B protein, aged, Apolipoproteins E/ge [Genetics], Athletic Injuries/co [Complications], Athletic Injuries/ge [Genetics], Athletic Injuries/me [Metabolism], Athletic Injuries/pa [Pathology], Brain Injury, Brain/me [Metabolism], Chronic/et [Etiology], Chronic/ge [Genetics], Chronic/me [Metabolism], Chronic/pa [Pathology], Female, human), Humans, immunohistochemistry, Male, Membrane Proteins/ge [Genetics], Nerve Tissue Proteins/ge [Genetics], Neurodegenerative Diseases/ge [Genetics], Neurodegenerative Diseases/me [Metabolism], Retrospective Studies, tau Proteins/ge [Genetics], tau Proteins/me [Metabolism], Tissue Banks},

pubstate = {published},

tppubtype = {article}

}

McGinley, A D; Master, C L; Zonfrillo, M R

Sports-Related Head Injuries in Adolescents: A Comprehensive Update Journal Article

In: Adolescent Medicine, vol. 26, no. 3, pp. 491–506, 2015.

McDevitt, J; Tierney, R T; Phillips, J; Gaughan, J P; Torg, J S; Krynetskiy, E

Association between GRIN2A promoter polymorphism and recovery from concussion Journal Article

In: Brain Injury, vol. 29, no. 13-14, pp. 1674–1681, 2015.

@article{McDevitt2015,

title = {Association between GRIN2A promoter polymorphism and recovery from concussion},

author = {McDevitt, J and Tierney, R T and Phillips, J and Gaughan, J P and Torg, J S and Krynetskiy, E},

doi = {10.3109/02699052.2015.1075252},

year  = {2015},

date = {2015-01-01},

journal = {Brain Injury},

volume = {29},

number = {13-14},

pages = {1674--1681},

abstract = {Objective: To determine genetic variability within the N-methyl-D-aspartate receptor 2A sub-unit (GRIN2A) gene promoter and its association with concussion recovery time. The hypothesis tested was that there would be a difference in allele and/or genotype distribution between two groups of athletes with normal and prolonged recovery.Methods: DNA was extracted from saliva collected from a total of 87 athletes with a physician-diagnosed concussion. The (GT) variable number tandem repeats (VNTR) within the promoter region of GRIN2A was genotyped. The long (L) allele was an allele with ≥25 repeats and the short (S) allele was an allele with \<25 repeats in the GT tract. Participants recovery time was followed prospectively and was categorized as normal (≤60 days) or prolonged (\>60 days).Results: LL carriers were 6-times more likely to recover longer than 60 days following the concussive event (p = 0.0433) when compared to SS carriers. Additionally, L allele carriers were found more frequently in the prolonged recovery group (p = 0.048).Conclusion: Determining genetic influence on concussion recovery will aid in future development of genetic counselling. The clinical relevance of genotyping athletes could improve management of athletes who experience concussion injuries. © 2015 Taylor \& Francis Group, LLC.},

keywords = {adult, Article, athlete, brain concussion, Brain Injury, calcium, capillary electrophoresis, CONVALESCENCE, DNA, Female, gene frequency, genetic association, genetic polymorphism, genetic variability, GENOTYPE, heterozygote, human, inheritance, major clinical study, Male, n methyl dextro aspartic acid receptor 2A, NR2A sub-unit, pedigree analysis, promoter region, sport injury, variable number of tandem repeat},

pubstate = {published},

tppubtype = {article}

}

Patton, D A; McIntosh, A S; Kleiven, S

The biomechanical determinants of concussion: Finite element simulations to investigate tissue-level predictors of injury during sporting impacts to the unprotected head Journal Article

In: Journal of Applied Biomechanics, vol. 31, no. 4, pp. 264–268, 2015.

@article{Patton2015,

title = {The biomechanical determinants of concussion: Finite element simulations to investigate tissue-level predictors of injury during sporting impacts to the unprotected head},

author = {Patton, D A and McIntosh, A S and Kleiven, S},

doi = {10.1123/jab.2014-0223},

year  = {2015},

date = {2015-01-01},

journal = {Journal of Applied Biomechanics},

volume = {31},

number = {4},

pages = {264--268},

abstract = {Biomechanical studies of concussions have progressed from qualitative observations of head impacts to physical and numerical reconstructions, direct impact measurements, and finite element analyses. Supplementary to a previous study, which investigated maximum principal strain, the current study used a detailed finite element head model to simulate unhelmeted concussion and no-injury head impacts and evaluate the effectiveness of various tissue-level brain injury predictors: strain rate, product of strain and strain rate, cumulative strain damage measure, von Mises stress, and intracranial pressure. Von Mises stress was found to be the most effective predictor of concussion. It was also found that the thalamus and corpus callosum were brain regions with strong associations with concussion. Tentative tolerance limits for tissue-level predictors were proposed in an attempt to broaden the understanding of unhelmeted concussions. For the thalamus, tolerance limits were proposed for a 50% likelihood of concussion: 2.24 kPa, 24.0 s-1, and 2.49 s-1 for von Mises stress, strain rate, and the product of strain and strain rate, respectively. For the corpus callosum, tolerance limits were proposed for a 50% likelihood of concussion: 3.51 kPa, 25.1 s-1, and 2.76 s-1 for von Mises stress, strain rate, and the product of strain and strain rate, respectively. © 2015 Human Kinetics, Inc.},

keywords = {Article, Biomechanics, brain, Brain Injury, brain region, clinical article, Concussion, corpus callosum, Damage detection, evaluation study, finite element analysis, Finite element head models, Finite element method, Finite element simulations, football, gray matter, Head Injuries, head injury, human, Intra-cranial pressure, intracranial pressure, investigative procedures, Maximum principal strain, mesencephalon, Modeling, Models, Numerical reconstruction, Qualitative observations, Sport, sport injury, Sports, Strain and strain rates, Strain rate, Stress, thalamus, Tissue, tissue level},

pubstate = {published},

tppubtype = {article}

}

Andre, J B

Arterial spin labeling magnetic resonance perfusion for traumatic brain injury: Technical challenges and potentials Journal Article

In: Topics in Magnetic Resonance Imaging, vol. 24, no. 5, pp. 275–287, 2015.

@article{Andre2015,

title = {Arterial spin labeling magnetic resonance perfusion for traumatic brain injury: Technical challenges and potentials},

author = {Andre, J B},

year  = {2015},

date = {2015-01-01},

journal = {Topics in Magnetic Resonance Imaging},

volume = {24},

number = {5},

pages = {275--287},

abstract = {Traumatic brain injury (TBI), including concussion, is a public health concern, as it affects over 1.7 million persons in the United States per year. Yet, the diagnosis of TBI, particularly mild TBI (mTBI), can be controversial, as neuroimaging findings can be sparse on conventional magnetic resonance and computed tomography examinations, and when present, often poorly correlate with clinical signs and symptoms. Furthermore, the discussion of TBI, concussion, and head impact exposure is immediately complicated by the many differing opinions of what constitutes each, their respective severities, and how the underlying biomechanics of the inciting head impact might alter the distribution, severity, and prognosis of the underlying brain injury. Advanced imaging methodologies hold promise in improving the sensitivity and detectability of associated imaging biomarkers that might better correlate with patient outcome and prognostication, allowing for improved triage and therapeutic guidance in the setting of TBI, particularly in mTBI. This work will examine the defining symptom complex associated with mTBI and explore changes in cerebral blood flow measured by arterial spin labeling, as a potential imaging biomarker for TBI, and briefly correlate these observations with findings identified by single photon emission computed tomography and positron emission tomography imaging.. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.},

keywords = {Arterial spin labeling, artery blood flow, artifact, brain, brain blood flow, brain circulation, Brain Injuries, Brain Injury, brain perfusion, Cerebrovascular Circulation, clinical classification, Concussion, echo planar imaging, gray matter, human, Humans, Magnetic Resonance Imaging, mild traumatic brain injury, neuroimaging, neuropsychological test, nuclear magnetic resonance imaging, pathology, positron emission tomography, priority journal, procedures, Review, single photon emission computer tomography, spin labeling, Spin Labels, Sport, Sports-related concussion, symptom, traumatic brain injury, white matter},

pubstate = {published},

tppubtype = {article}

}

2014

Levin, B; Bhardwaj, A

Chronic traumatic encephalopathy: A critical appraisal Journal Article

In: Neurocritical Care, vol. 20, no. 2, pp. 334–344, 2014.

@article{Levin2014,

title = {Chronic traumatic encephalopathy: A critical appraisal},

author = {Levin, B and Bhardwaj, A},

url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84896549537\&partnerID=40\&md5=138104db42f7ca99527a78bb9c821f59},

doi = {10.1007/s12028-013-9931-1},

year  = {2014},

date = {2014-01-01},

journal = {Neurocritical Care},

volume = {20},

number = {2},

pages = {334--344},

abstract = {Chronic traumatic encephalopathy (CTE) formerly known as dementia pugilistica is a long-term neurodegenerative disorder associated with repeated subconcussive head injuries in high-contact sports. We reviewed the existing literature on CTE and examined epidemiological trends, risk factors, and its temporal progression, and proposed the underlying pathophysiological mechanisms that may provide unique insights to clinicians with an in-depth understanding of the disease to aid in the diagnosis and prevention, and provide future perspectives for research via search of Medline and Cochrane databases as well as manual review of bibliographies from selected articles and monographs. The prevalence of CTE in recent years is on the rise and almost exclusively affects men, with pathologic signs characterized by progressive memory loss, behavioral changes, and violent tendencies with some patients demonstrating Parkinsonian-like symptoms and signs. Many patients with CTE die following suicide, accident, or complications of drug or alcohol use. Postmortem pathologic analysis is characterized by neurofibrillary tangles and A$beta$ plaques in 50 % of cases. Currently, there are no ante-mortem diagnostic criteria, but modern imaging techniques such as functional magnetic resonance (MR) imaging, MR spectroscopy, and diffusion tension imaging hold promise for delineating the future diagnostic criteria. Further long-term longitudinal studies are warranted to investigate risk factors that will enhance understanding of the disease progression and its pathogenesis. © 2013 Springer Science+Business Media.},

keywords = {accident, alcohol consumption, amnesia, amyloid plaque, animal, Animals, Athletic Injuries, autopsy, behavior change, Brain Injury, Chronic, Chronic traumatic encephalopathy, Chronic Traumatic Encephalopathy Dementia, complication, Diffusion Tensor Imaging, disease course, Encephalopathy, functional magnetic resonance imaging, histopathology, human, Humans, longitudinal study, Male, Neurodegenerative, Neurodegenerative Diseases, nonhuman, NUCLEAR magnetic resonance spectroscopy, Parkinsonism, pathogenesis, pathology, Pathophysiology, Prevalence, priority journal, Pugilistic, Review, risk factor, Risk Factors, sport injury, suicide, Systematic Review, traumatic brain injury, violence},

pubstate = {published},

tppubtype = {article}

}

Andrikopoulos, J; Moines, D; Montenigro, P H; Stern, R A

Clinical presentation of chronic traumatic encephalopathy Journal Article

In: Neurology, vol. 83, no. 21, pp. 1991–1993, 2014.

Andrikopoulos, J

Correspondence regarding chronic traumatic encephalopathy in athletes: Progressive tauopathy following repetitive concussion. J Neuropathol Exp Neurol 2009;68: 709-35 Journal Article

In: Journal of Neuropathology and Experimental Neurology, vol. 73, no. 4, pp. 375, 2014.

Solomon, G S; Sills, A

Chronic traumatic encephalopathy and the availability cascade Journal Article

In: The Physician and sportsmedicine, vol. 42, no. 3, pp. 26–31, 2014.

Ling, H; Kara, E; Revesz, T; Lees, A J; Plant, G T; Martino, D; Houlden, H; Hardy, J; Holton, J L

Concomitant progressive supranuclear palsy and chronic traumatic encephalopathy in a boxer Journal Article

In: Acta neuropathologica communications, vol. 2, pp. 24, 2014.

2011

Omalu, B; Hammers, J L; Bailes, J; Hamilton, R L; Kamboh, M I; Webster, G; Fitzsimmons, R P

Chronic traumatic encephalopathy in an Iraqi war veteran with posttraumatic stress disorder who committed suicide Journal Article

In: Neurosurgical Focus, vol. 31, no. 5, pp. E3, 2011.

@article{Omalu2011,

title = {Chronic traumatic encephalopathy in an Iraqi war veteran with posttraumatic stress disorder who committed suicide},

author = {Omalu, B and Hammers, J L and Bailes, J and Hamilton, R L and Kamboh, M I and Webster, G and Fitzsimmons, R P},

year  = {2011},

date = {2011-01-01},

journal = {Neurosurgical Focus},

volume = {31},

number = {5},

pages = {E3},

abstract = {Following his discovery of chronic traumatic encephalopathy (CTE) in football players in 2002, Dr. Bennet Omalu hypothesized that posttraumatic stress disorder (PTSD) in military veterans may belong to the CTE spectrum of diseases. The CTE surveillance at the Brain Injury Research Institute was therefore expanded to include deceased military veterans diagnosed with PTSD. The authors report the case of a 27-year-old United States Marine Corps (USMC) Iraqi war veteran, an amphibious assault vehicle crewman, who committed suicide by hanging after two deployments to Fallujah and Ramadi. He experienced combat and was exposed to mortar blasts and improvised explosive device blasts less than 50 m away. Following his second deployment he developed a progressive history of cognitive impairment, impaired memory, behavioral and mood disorders, and alcohol abuse. Neuropsychiatric assessment revealed a diagnosis of PTSD with hyperarousal (irritability and insomnia) and numbing. He committed suicide approximately 8 months after his honorable discharge from the USMC. His brain at autopsy appeared grossly unremarkable except for congestive brain swelling. There was no atrophy or remote focal traumatic brain injury such as contusional necrosis or hemorrhage. Histochemical and immunohistochemical brain tissue analysis revealed CTE changes comprising multifocal, neocortical, and subcortical neurofibrillary tangles and neuritic threads (ranging from none, to sparse, to frequent) with the skip phenomenon, accentuated in the depths of sulci and in the frontal cortex. The subcortical white matter showed mild rarefaction, sparse perivascular and neuropil infiltration by histiocytes, and mild fibrillary astrogliosis. Apolipoprotein E genotype was 3/4. The authors report this case as a sentinel case of CTE in an Iraqi war veteran diagnosed with PTSD to possibly stimulate new lines of thought and research in the possible pathoetiology and pathogenesis of PTSD in military veterans as part of the CTE spectrum of diseases, and as chronic sequelae and outcomes of repetitive traumatic brain injuries.},

keywords = {*Blast Injuries/pa [Pathology], *Blast Injuries/pp [Physiopathology], *Brain Injury, *Combat Disorders/pp [Physiopathology], *Suicide/px [Psychology], 2003-2011, adult, Blast Injuries/co [Complications], Brain Injury, Chronic/co [Complications], Chronic/pa [Pathology], Chronic/pp [Physiopathology], Combat Disorders/px [Psychology], Humans, Iraq War, Male, Post-Traumatic/pp [Physiopatholo, Post-Traumatic/px [Psychology], Stress Disorders, Suicide/pc [Prevention \&amp; Control]},

pubstate = {published},

tppubtype = {article}

}

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