Ellis, M J; Mutch, W A C; Ryner, L N; Graham, M R; Dufault, B; Gregson, B; Hall, T; Bunge, M; Essig, M; Fisher, J A; Duffin, J; Mikulis, D J
Brain magnetic resonance imaging CO2 stress testing in adolescent postconcussion syndrome Journal Article
In: Journal of Neurosurgery, vol. 125, no. 3, pp. 648–660, 2016.
Abstract | Links | BibTeX | Tags: Adolescent, Blood oxygen level-dependent imaging, Magnetic Resonance Imaging, postconcussion syndrome, Sports-related concussion, Trauma
@article{Ellis2016a,
title = {Brain magnetic resonance imaging CO2 stress testing in adolescent postconcussion syndrome},
author = {Ellis, M J and Mutch, W A C and Ryner, L N and Graham, M R and Dufault, B and Gregson, B and Hall, T and Bunge, M and Essig, M and Fisher, J A and Duffin, J and Mikulis, D J},
doi = {10.3171/2015.6.JNS15972},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurosurgery},
volume = {125},
number = {3},
pages = {648--660},
abstract = {OBJECTIVE: A Neuroimaging Assessment tool to visualize global and regional impairments in cerebral blood flow (CBF) and cerebrovascular responsiveness in individual patients with concussion remains elusive. Here the authors summarize the safety, feasibility, and results of brain CO2 stress testing in adolescents with postconcussion syndrome (PCS) and healthy controls. METHODS: This study was approved by the Biomedical Research Ethics Board at the University of Manitoba. Fifteen adolescents with PCS and 17 healthy control subjects underwent anatomical MRI, pseudo-continuous arterial spin labeling MRI, and brain stress testing using controlled CO2 challenge and blood oxygen level-dependent (BOLD) MRI. Post hoc processing was performed using statistical parametric mapping to determine voxel-by-voxel regional resting CBF and cerebrovascular responsiveness of the brain to the CO2 stimulus (increase in BOLD signal) or the inverse (decrease in BOLD signal). Receiver operating characteristic (ROC) curves were generated to compare voxel counts categorized by control (0) or PCS (1). RESULTS: Studies were well tolerated without any serious adverse events. Anatomical MRI was normal in all study participants. No differences in CO2 stimuli were seen between the 2 participant groups. No group differences in global mean CBF were detected between PCS patients and healthy controls. Patient-specific differences in mean regional CBF and CO2 BOLD responsiveness were observed in all PCS patients. The ROC curve analysis for brain regions manifesting a voxel response greater than and less than the control atlas (that is, abnormal voxel counts) produced an area under the curve of 0.87 (p \< 0.0001) and 0.80 (p = 0.0003), respectively, consistent with a clinically useful predictive model. CONCLUSIONS: Adolescent PCS is associated with patient-specific abnormalities in regional mean CBF and BOLD cerebrovascular responsiveness that occur in the setting of normal global resting CBF. Future prospective studies are warranted to examine the utility of brain MRI CO2 stress testing in the longitudinal assessment of acute sports-related concussion and PCS. © AANS, 2016.},
keywords = {Adolescent, Blood oxygen level-dependent imaging, Magnetic Resonance Imaging, postconcussion syndrome, Sports-related concussion, Trauma},
pubstate = {published},
tppubtype = {article}
}
Kania, K; Shaikh, K A; White, I K; Ackerman, L L
Follow-up issues in children with mild traumatic brain injuries Journal Article
In: Journal of Neurosurgery: Pediatrics, vol. 18, no. 2, pp. 224–230, 2016.
Abstract | Links | BibTeX | Tags: Acute Concussion Evaluation, Concussion, head injury, Patient Outcome Assessment, Trauma, traumatic brain injury
@article{Kania2016,
title = {Follow-up issues in children with mild traumatic brain injuries},
author = {Kania, K and Shaikh, K A and White, I K and Ackerman, L L},
doi = {10.3171/2016.1.PEDS15511},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurosurgery: Pediatrics},
volume = {18},
number = {2},
pages = {224--230},
abstract = {OBJECTIVE: Concerns about mild traumatic brain injury (mTBI) have increased in recent years, and neurosurgical consultation is often requested for patients with radiographic abnormalities or clinical findings suspicious for mTBI. However, to the authors' knowledge, no study has used the Acute Concussion Evaluation (ACE) tool to systematically evaluate the evolution of symptoms in patients with mTBI during neurosurgical follow-up. The goal in this study was to evaluate symptom progression in pediatric patients referred for neurosurgical consultation by using the ACE, as endorsed by the Centers for Disease Control and Prevention. METHODS: The authors performed a retrospective review of records of consecutive pediatric patients who had presented to the emergency department, were diagnosed with possible mTBI, and were referred for neurosurgical consultation. Outpatient follow-up for these patients included serial assessment using the ACE. Data collected included the mechanisms of the patients' injuries, symptoms, follow-up duration, and premorbid conditions that might potentially contribute to protracted recovery. RESULTS: Of 91 patients identified with mTBI, 58 met the inclusion criteria, and 33 of these had sufficient follow-up data to be included in the study. Mechanisms of injury included sports injury (15 patients), isolated falls (10), and motor vehicle collisions (8). Ages ranged from 5 to 17 years (mean age 11.6 years), and 29 of the 33 patients were male. Six patients had preinjury developmental and/or psychiatric diagnoses such as attention deficit hyperactivity disorder. Seventeen had negative findings on head CT scans. The first follow-up evaluation occurred at a mean of 30 days after injury. The mean number of symptoms reported on the ACE inventory at first follow-up were 3.2; 12 patients were symptom free. Patients with positive head CT findings required longer follow-up: these patients needed 14.59 weeks, versus 7.87 weeks of follow-up in patients with negative findings on head CT scans (p \< 0.05). CONCLUSIONS: The data suggest that patients with mTBI, particularly those with developmental and/or psychiatric comorbidities and concurrent cerebral or extracranial injury, often report symptoms for several weeks after their initial injury. Serial ACE assessment permits systematic identification of patients who are experiencing continued symptoms, leading to appropriate patient management and referral. ©AANS, 2016.},
keywords = {Acute Concussion Evaluation, Concussion, head injury, Patient Outcome Assessment, Trauma, traumatic brain injury},
pubstate = {published},
tppubtype = {article}
}
Chiroban, O; Perju-Dumbravă, L
Postmortem evaluation of chronic traumatic encephalopathy Journal Article
In: Romanian Journal of Legal Medicine, vol. 24, no. 4, pp. 266–272, 2016.
Abstract | Links | BibTeX | Tags: Chronic traumatic encephalopathy, Forensic pathology, NEURODEGENERATION, Trauma
@article{Chiroban2016,
title = {Postmortem evaluation of chronic traumatic encephalopathy},
author = {Chiroban, O and Perju-Dumbrav\u{a}, L},
doi = {10.4323/rjlm.2016.266},
year = {2016},
date = {2016-01-01},
journal = {Romanian Journal of Legal Medicine},
volume = {24},
number = {4},
pages = {266--272},
abstract = {Chronic traumatic encephalopathy (CTE) is the modern concept naming the neurodegenerative processes occurring in patients with positive medical history of repeated brain trauma and progressive dementia. Morphologically, CTE is classified as being a distinct member of the tauopathies family, with different distribution of tau-positive neurofibrillary tangles (NFTs) and low to none beta-amyloid deposits, contrasting the most famous member of the family: Alzheimer’s disease (AD). As opposed to other of its kind, the neurofibrillary tangles (NFTs) are spread in the form of irregular, perivascular, patchy disseminations throughout frontal and temporal cortex, especially in the superficial cerebral layers, leaning for sulcal depths. The previously mentioned characteristics constitute the hallmark signature of CTE. Although the connection between repeated concussions and CTE has been recently proposed, the startup path is still a mysterious topic. It remains, up to a point, common to all tauopathies, yet overpasses all genders, sex and age. Initially, considered a professional disease in boxing, scientific overviews link CTE to military service, sports and even daily activities. It is a consensus that a moderate traumatic event sustained during life-spam was correlated with 2.3 fold increase in the risk of developing dementia, while severe concussion augments up 4 times the chances. By the same token, considering the broad population with potential exposure to repetitive insults, CTE represents an important public health issue. The main purpose of this scientific article is to highlight the neuropathological features encountered and discuss the limitations of proper diagnostic. © 2016 Romanian Society of Legal Medicine.},
keywords = {Chronic traumatic encephalopathy, Forensic pathology, NEURODEGENERATION, Trauma},
pubstate = {published},
tppubtype = {article}
}
Ellis, M J; Cordingley, D; Vis, S; Reimer, K; Leiter, J; Russell, K
Vestibulo-ocular dysfunction in pediatric sports-related concussion Journal Article
In: Journal of Neurosurgery: Pediatrics, vol. 16, no. 3, pp. 248–255, 2015.
Abstract | Links | BibTeX | Tags: Adolescent, amnesia, Article, Athletic Injuries, Baseball, BASKETBALL, blurred vision, brain concussion, CANADA, Child, childhood disease, cohort analysis, complication, Concussion, consultation, controlled study, disease duration, Dizziness, Female, follow up, football, Hockey, human, Humans, interdisciplinary communication, major clinical study, Male, Manitoba, migraine, neuroimaging, neuropsychological test, Neuropsychological Tests, ODDS ratio, Pathophysiology, Pediatric, Physical Examination, physiotherapy, Post-Concussion Syndrome, postconcussion syndrome, Prevalence, priority journal, Reflex, Retrospective Studies, retrospective study, return to sport, saccadic eye movement, skating, skiing, Soccer, sport injury, sport related concussion, Sports-related concussion, Trauma, vestibular physiotherapy, Vestibular therapy, vestibulo ocular dysfunction, Vestibulo-Ocular, Vestibulo-ocular dysfunction, vestibuloocular reflex, VOLLEYBALL, Young Adult, youth sport
@article{Ellis2015,
title = {Vestibulo-ocular dysfunction in pediatric sports-related concussion},
author = {Ellis, M J and Cordingley, D and Vis, S and Reimer, K and Leiter, J and Russell, K},
doi = {10.3171/2015.1.PEDS14524},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neurosurgery: Pediatrics},
volume = {16},
number = {3},
pages = {248--255},
abstract = {Object The objective of this study was 2-fold: 1) to examine the prevalence of vestibulo-ocular dysfunction (VOD) among children and adolescents with acute sports-related concussion (SRC) and postconcussion syndrome (PCS) who were referred to a multidisciplinary pediatric concussion program; and 2) to determine if VOD is associated with the development of PCS in this cohort. Methods The authors conducted a retrospective review of all patients with acute SRC (presenting 30 days or less postinjury) and PCS (3 or more symptoms for at least 1 month) referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Initial assessment included clinical history, physical examination, and Post-Concussion Symptom Scale assessment. Patients were also assessed for VOD, which was defined as more than one subjective vestibular and oculomotor complaint (dizziness, blurred vision, and so on) and more than one objective physical examination finding (abnormal smooth pursuits, saccades, vestibulo-ocular reflex, and so on). This study was approved by the local institutional ethics review board. Results A total of 101 patients (mean age 14.2 years, SD 2.3 years; 63 male and 38 female patients) participated, including 77 (76.2%) with acute SRC and 24 (23.8%) with PCS. Twenty-two of the 77 patients (28.6%) with acute SRC and 15 of the 24 (62.5%) with PCS met the clinical criteria for VOD. The median duration of symptoms was 40 days (interquartile range [IQR] 28.5-54 days) for patients with acute SRC who had VOD compared with 21 days (IQR 13-32 days) for those without VOD (p = 0.0001). There was a statistically significant increase in the adjusted odds of developing PCS among patients with acute SRC who had VOD compared with those without VOD (adjusted OR 4.10; 95% CI 1.04-16.16). Conclusions Evidence of VOD was detected in a significant proportion of children and adolescents with acute SRC and PCS who were referred to a multidisciplinary pediatric concussion program. This clinical feature was a significant risk factor for the subsequent development of PCS in this pediatric acute SRC cohort. © AANS, 2015.},
keywords = {Adolescent, amnesia, Article, Athletic Injuries, Baseball, BASKETBALL, blurred vision, brain concussion, CANADA, Child, childhood disease, cohort analysis, complication, Concussion, consultation, controlled study, disease duration, Dizziness, Female, follow up, football, Hockey, human, Humans, interdisciplinary communication, major clinical study, Male, Manitoba, migraine, neuroimaging, neuropsychological test, Neuropsychological Tests, ODDS ratio, Pathophysiology, Pediatric, Physical Examination, physiotherapy, Post-Concussion Syndrome, postconcussion syndrome, Prevalence, priority journal, Reflex, Retrospective Studies, retrospective study, return to sport, saccadic eye movement, skating, skiing, Soccer, sport injury, sport related concussion, Sports-related concussion, Trauma, vestibular physiotherapy, Vestibular therapy, vestibulo ocular dysfunction, Vestibulo-Ocular, Vestibulo-ocular dysfunction, vestibuloocular reflex, VOLLEYBALL, Young Adult, youth sport},
pubstate = {published},
tppubtype = {article}
}
Ellis, M J; Mutch, W A C; Ryner, L N; Graham, M R; Dufault, B; Gregson, B; Hall, T; Bunge, M; Essig, M; Fisher, J A; Duffin, J; Mikulis, D J
Brain magnetic resonance imaging CO2 stress testing in adolescent postconcussion syndrome Journal Article
In: Journal of Neurosurgery, vol. 125, no. 3, pp. 648–660, 2016.
@article{Ellis2016a,
title = {Brain magnetic resonance imaging CO2 stress testing in adolescent postconcussion syndrome},
author = {Ellis, M J and Mutch, W A C and Ryner, L N and Graham, M R and Dufault, B and Gregson, B and Hall, T and Bunge, M and Essig, M and Fisher, J A and Duffin, J and Mikulis, D J},
doi = {10.3171/2015.6.JNS15972},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurosurgery},
volume = {125},
number = {3},
pages = {648--660},
abstract = {OBJECTIVE: A Neuroimaging Assessment tool to visualize global and regional impairments in cerebral blood flow (CBF) and cerebrovascular responsiveness in individual patients with concussion remains elusive. Here the authors summarize the safety, feasibility, and results of brain CO2 stress testing in adolescents with postconcussion syndrome (PCS) and healthy controls. METHODS: This study was approved by the Biomedical Research Ethics Board at the University of Manitoba. Fifteen adolescents with PCS and 17 healthy control subjects underwent anatomical MRI, pseudo-continuous arterial spin labeling MRI, and brain stress testing using controlled CO2 challenge and blood oxygen level-dependent (BOLD) MRI. Post hoc processing was performed using statistical parametric mapping to determine voxel-by-voxel regional resting CBF and cerebrovascular responsiveness of the brain to the CO2 stimulus (increase in BOLD signal) or the inverse (decrease in BOLD signal). Receiver operating characteristic (ROC) curves were generated to compare voxel counts categorized by control (0) or PCS (1). RESULTS: Studies were well tolerated without any serious adverse events. Anatomical MRI was normal in all study participants. No differences in CO2 stimuli were seen between the 2 participant groups. No group differences in global mean CBF were detected between PCS patients and healthy controls. Patient-specific differences in mean regional CBF and CO2 BOLD responsiveness were observed in all PCS patients. The ROC curve analysis for brain regions manifesting a voxel response greater than and less than the control atlas (that is, abnormal voxel counts) produced an area under the curve of 0.87 (p \< 0.0001) and 0.80 (p = 0.0003), respectively, consistent with a clinically useful predictive model. CONCLUSIONS: Adolescent PCS is associated with patient-specific abnormalities in regional mean CBF and BOLD cerebrovascular responsiveness that occur in the setting of normal global resting CBF. Future prospective studies are warranted to examine the utility of brain MRI CO2 stress testing in the longitudinal assessment of acute sports-related concussion and PCS. © AANS, 2016.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Kania, K; Shaikh, K A; White, I K; Ackerman, L L
Follow-up issues in children with mild traumatic brain injuries Journal Article
In: Journal of Neurosurgery: Pediatrics, vol. 18, no. 2, pp. 224–230, 2016.
@article{Kania2016,
title = {Follow-up issues in children with mild traumatic brain injuries},
author = {Kania, K and Shaikh, K A and White, I K and Ackerman, L L},
doi = {10.3171/2016.1.PEDS15511},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurosurgery: Pediatrics},
volume = {18},
number = {2},
pages = {224--230},
abstract = {OBJECTIVE: Concerns about mild traumatic brain injury (mTBI) have increased in recent years, and neurosurgical consultation is often requested for patients with radiographic abnormalities or clinical findings suspicious for mTBI. However, to the authors' knowledge, no study has used the Acute Concussion Evaluation (ACE) tool to systematically evaluate the evolution of symptoms in patients with mTBI during neurosurgical follow-up. The goal in this study was to evaluate symptom progression in pediatric patients referred for neurosurgical consultation by using the ACE, as endorsed by the Centers for Disease Control and Prevention. METHODS: The authors performed a retrospective review of records of consecutive pediatric patients who had presented to the emergency department, were diagnosed with possible mTBI, and were referred for neurosurgical consultation. Outpatient follow-up for these patients included serial assessment using the ACE. Data collected included the mechanisms of the patients' injuries, symptoms, follow-up duration, and premorbid conditions that might potentially contribute to protracted recovery. RESULTS: Of 91 patients identified with mTBI, 58 met the inclusion criteria, and 33 of these had sufficient follow-up data to be included in the study. Mechanisms of injury included sports injury (15 patients), isolated falls (10), and motor vehicle collisions (8). Ages ranged from 5 to 17 years (mean age 11.6 years), and 29 of the 33 patients were male. Six patients had preinjury developmental and/or psychiatric diagnoses such as attention deficit hyperactivity disorder. Seventeen had negative findings on head CT scans. The first follow-up evaluation occurred at a mean of 30 days after injury. The mean number of symptoms reported on the ACE inventory at first follow-up were 3.2; 12 patients were symptom free. Patients with positive head CT findings required longer follow-up: these patients needed 14.59 weeks, versus 7.87 weeks of follow-up in patients with negative findings on head CT scans (p \< 0.05). CONCLUSIONS: The data suggest that patients with mTBI, particularly those with developmental and/or psychiatric comorbidities and concurrent cerebral or extracranial injury, often report symptoms for several weeks after their initial injury. Serial ACE assessment permits systematic identification of patients who are experiencing continued symptoms, leading to appropriate patient management and referral. ©AANS, 2016.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Chiroban, O; Perju-Dumbravă, L
Postmortem evaluation of chronic traumatic encephalopathy Journal Article
In: Romanian Journal of Legal Medicine, vol. 24, no. 4, pp. 266–272, 2016.
@article{Chiroban2016,
title = {Postmortem evaluation of chronic traumatic encephalopathy},
author = {Chiroban, O and Perju-Dumbrav\u{a}, L},
doi = {10.4323/rjlm.2016.266},
year = {2016},
date = {2016-01-01},
journal = {Romanian Journal of Legal Medicine},
volume = {24},
number = {4},
pages = {266--272},
abstract = {Chronic traumatic encephalopathy (CTE) is the modern concept naming the neurodegenerative processes occurring in patients with positive medical history of repeated brain trauma and progressive dementia. Morphologically, CTE is classified as being a distinct member of the tauopathies family, with different distribution of tau-positive neurofibrillary tangles (NFTs) and low to none beta-amyloid deposits, contrasting the most famous member of the family: Alzheimer’s disease (AD). As opposed to other of its kind, the neurofibrillary tangles (NFTs) are spread in the form of irregular, perivascular, patchy disseminations throughout frontal and temporal cortex, especially in the superficial cerebral layers, leaning for sulcal depths. The previously mentioned characteristics constitute the hallmark signature of CTE. Although the connection between repeated concussions and CTE has been recently proposed, the startup path is still a mysterious topic. It remains, up to a point, common to all tauopathies, yet overpasses all genders, sex and age. Initially, considered a professional disease in boxing, scientific overviews link CTE to military service, sports and even daily activities. It is a consensus that a moderate traumatic event sustained during life-spam was correlated with 2.3 fold increase in the risk of developing dementia, while severe concussion augments up 4 times the chances. By the same token, considering the broad population with potential exposure to repetitive insults, CTE represents an important public health issue. The main purpose of this scientific article is to highlight the neuropathological features encountered and discuss the limitations of proper diagnostic. © 2016 Romanian Society of Legal Medicine.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Ellis, M J; Cordingley, D; Vis, S; Reimer, K; Leiter, J; Russell, K
Vestibulo-ocular dysfunction in pediatric sports-related concussion Journal Article
In: Journal of Neurosurgery: Pediatrics, vol. 16, no. 3, pp. 248–255, 2015.
@article{Ellis2015,
title = {Vestibulo-ocular dysfunction in pediatric sports-related concussion},
author = {Ellis, M J and Cordingley, D and Vis, S and Reimer, K and Leiter, J and Russell, K},
doi = {10.3171/2015.1.PEDS14524},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neurosurgery: Pediatrics},
volume = {16},
number = {3},
pages = {248--255},
abstract = {Object The objective of this study was 2-fold: 1) to examine the prevalence of vestibulo-ocular dysfunction (VOD) among children and adolescents with acute sports-related concussion (SRC) and postconcussion syndrome (PCS) who were referred to a multidisciplinary pediatric concussion program; and 2) to determine if VOD is associated with the development of PCS in this cohort. Methods The authors conducted a retrospective review of all patients with acute SRC (presenting 30 days or less postinjury) and PCS (3 or more symptoms for at least 1 month) referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Initial assessment included clinical history, physical examination, and Post-Concussion Symptom Scale assessment. Patients were also assessed for VOD, which was defined as more than one subjective vestibular and oculomotor complaint (dizziness, blurred vision, and so on) and more than one objective physical examination finding (abnormal smooth pursuits, saccades, vestibulo-ocular reflex, and so on). This study was approved by the local institutional ethics review board. Results A total of 101 patients (mean age 14.2 years, SD 2.3 years; 63 male and 38 female patients) participated, including 77 (76.2%) with acute SRC and 24 (23.8%) with PCS. Twenty-two of the 77 patients (28.6%) with acute SRC and 15 of the 24 (62.5%) with PCS met the clinical criteria for VOD. The median duration of symptoms was 40 days (interquartile range [IQR] 28.5-54 days) for patients with acute SRC who had VOD compared with 21 days (IQR 13-32 days) for those without VOD (p = 0.0001). There was a statistically significant increase in the adjusted odds of developing PCS among patients with acute SRC who had VOD compared with those without VOD (adjusted OR 4.10; 95% CI 1.04-16.16). Conclusions Evidence of VOD was detected in a significant proportion of children and adolescents with acute SRC and PCS who were referred to a multidisciplinary pediatric concussion program. This clinical feature was a significant risk factor for the subsequent development of PCS in this pediatric acute SRC cohort. © AANS, 2015.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Ellis, M J; Mutch, W A C; Ryner, L N; Graham, M R; Dufault, B; Gregson, B; Hall, T; Bunge, M; Essig, M; Fisher, J A; Duffin, J; Mikulis, D J
Brain magnetic resonance imaging CO2 stress testing in adolescent postconcussion syndrome Journal Article
In: Journal of Neurosurgery, vol. 125, no. 3, pp. 648–660, 2016.
Abstract | Links | BibTeX | Tags: Adolescent, Blood oxygen level-dependent imaging, Magnetic Resonance Imaging, postconcussion syndrome, Sports-related concussion, Trauma
@article{Ellis2016a,
title = {Brain magnetic resonance imaging CO2 stress testing in adolescent postconcussion syndrome},
author = {Ellis, M J and Mutch, W A C and Ryner, L N and Graham, M R and Dufault, B and Gregson, B and Hall, T and Bunge, M and Essig, M and Fisher, J A and Duffin, J and Mikulis, D J},
doi = {10.3171/2015.6.JNS15972},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurosurgery},
volume = {125},
number = {3},
pages = {648--660},
abstract = {OBJECTIVE: A Neuroimaging Assessment tool to visualize global and regional impairments in cerebral blood flow (CBF) and cerebrovascular responsiveness in individual patients with concussion remains elusive. Here the authors summarize the safety, feasibility, and results of brain CO2 stress testing in adolescents with postconcussion syndrome (PCS) and healthy controls. METHODS: This study was approved by the Biomedical Research Ethics Board at the University of Manitoba. Fifteen adolescents with PCS and 17 healthy control subjects underwent anatomical MRI, pseudo-continuous arterial spin labeling MRI, and brain stress testing using controlled CO2 challenge and blood oxygen level-dependent (BOLD) MRI. Post hoc processing was performed using statistical parametric mapping to determine voxel-by-voxel regional resting CBF and cerebrovascular responsiveness of the brain to the CO2 stimulus (increase in BOLD signal) or the inverse (decrease in BOLD signal). Receiver operating characteristic (ROC) curves were generated to compare voxel counts categorized by control (0) or PCS (1). RESULTS: Studies were well tolerated without any serious adverse events. Anatomical MRI was normal in all study participants. No differences in CO2 stimuli were seen between the 2 participant groups. No group differences in global mean CBF were detected between PCS patients and healthy controls. Patient-specific differences in mean regional CBF and CO2 BOLD responsiveness were observed in all PCS patients. The ROC curve analysis for brain regions manifesting a voxel response greater than and less than the control atlas (that is, abnormal voxel counts) produced an area under the curve of 0.87 (p \< 0.0001) and 0.80 (p = 0.0003), respectively, consistent with a clinically useful predictive model. CONCLUSIONS: Adolescent PCS is associated with patient-specific abnormalities in regional mean CBF and BOLD cerebrovascular responsiveness that occur in the setting of normal global resting CBF. Future prospective studies are warranted to examine the utility of brain MRI CO2 stress testing in the longitudinal assessment of acute sports-related concussion and PCS. © AANS, 2016.},
keywords = {Adolescent, Blood oxygen level-dependent imaging, Magnetic Resonance Imaging, postconcussion syndrome, Sports-related concussion, Trauma},
pubstate = {published},
tppubtype = {article}
}
Kania, K; Shaikh, K A; White, I K; Ackerman, L L
Follow-up issues in children with mild traumatic brain injuries Journal Article
In: Journal of Neurosurgery: Pediatrics, vol. 18, no. 2, pp. 224–230, 2016.
Abstract | Links | BibTeX | Tags: Acute Concussion Evaluation, Concussion, head injury, Patient Outcome Assessment, Trauma, traumatic brain injury
@article{Kania2016,
title = {Follow-up issues in children with mild traumatic brain injuries},
author = {Kania, K and Shaikh, K A and White, I K and Ackerman, L L},
doi = {10.3171/2016.1.PEDS15511},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurosurgery: Pediatrics},
volume = {18},
number = {2},
pages = {224--230},
abstract = {OBJECTIVE: Concerns about mild traumatic brain injury (mTBI) have increased in recent years, and neurosurgical consultation is often requested for patients with radiographic abnormalities or clinical findings suspicious for mTBI. However, to the authors' knowledge, no study has used the Acute Concussion Evaluation (ACE) tool to systematically evaluate the evolution of symptoms in patients with mTBI during neurosurgical follow-up. The goal in this study was to evaluate symptom progression in pediatric patients referred for neurosurgical consultation by using the ACE, as endorsed by the Centers for Disease Control and Prevention. METHODS: The authors performed a retrospective review of records of consecutive pediatric patients who had presented to the emergency department, were diagnosed with possible mTBI, and were referred for neurosurgical consultation. Outpatient follow-up for these patients included serial assessment using the ACE. Data collected included the mechanisms of the patients' injuries, symptoms, follow-up duration, and premorbid conditions that might potentially contribute to protracted recovery. RESULTS: Of 91 patients identified with mTBI, 58 met the inclusion criteria, and 33 of these had sufficient follow-up data to be included in the study. Mechanisms of injury included sports injury (15 patients), isolated falls (10), and motor vehicle collisions (8). Ages ranged from 5 to 17 years (mean age 11.6 years), and 29 of the 33 patients were male. Six patients had preinjury developmental and/or psychiatric diagnoses such as attention deficit hyperactivity disorder. Seventeen had negative findings on head CT scans. The first follow-up evaluation occurred at a mean of 30 days after injury. The mean number of symptoms reported on the ACE inventory at first follow-up were 3.2; 12 patients were symptom free. Patients with positive head CT findings required longer follow-up: these patients needed 14.59 weeks, versus 7.87 weeks of follow-up in patients with negative findings on head CT scans (p \< 0.05). CONCLUSIONS: The data suggest that patients with mTBI, particularly those with developmental and/or psychiatric comorbidities and concurrent cerebral or extracranial injury, often report symptoms for several weeks after their initial injury. Serial ACE assessment permits systematic identification of patients who are experiencing continued symptoms, leading to appropriate patient management and referral. ©AANS, 2016.},
keywords = {Acute Concussion Evaluation, Concussion, head injury, Patient Outcome Assessment, Trauma, traumatic brain injury},
pubstate = {published},
tppubtype = {article}
}
Chiroban, O; Perju-Dumbravă, L
Postmortem evaluation of chronic traumatic encephalopathy Journal Article
In: Romanian Journal of Legal Medicine, vol. 24, no. 4, pp. 266–272, 2016.
Abstract | Links | BibTeX | Tags: Chronic traumatic encephalopathy, Forensic pathology, NEURODEGENERATION, Trauma
@article{Chiroban2016,
title = {Postmortem evaluation of chronic traumatic encephalopathy},
author = {Chiroban, O and Perju-Dumbrav\u{a}, L},
doi = {10.4323/rjlm.2016.266},
year = {2016},
date = {2016-01-01},
journal = {Romanian Journal of Legal Medicine},
volume = {24},
number = {4},
pages = {266--272},
abstract = {Chronic traumatic encephalopathy (CTE) is the modern concept naming the neurodegenerative processes occurring in patients with positive medical history of repeated brain trauma and progressive dementia. Morphologically, CTE is classified as being a distinct member of the tauopathies family, with different distribution of tau-positive neurofibrillary tangles (NFTs) and low to none beta-amyloid deposits, contrasting the most famous member of the family: Alzheimer’s disease (AD). As opposed to other of its kind, the neurofibrillary tangles (NFTs) are spread in the form of irregular, perivascular, patchy disseminations throughout frontal and temporal cortex, especially in the superficial cerebral layers, leaning for sulcal depths. The previously mentioned characteristics constitute the hallmark signature of CTE. Although the connection between repeated concussions and CTE has been recently proposed, the startup path is still a mysterious topic. It remains, up to a point, common to all tauopathies, yet overpasses all genders, sex and age. Initially, considered a professional disease in boxing, scientific overviews link CTE to military service, sports and even daily activities. It is a consensus that a moderate traumatic event sustained during life-spam was correlated with 2.3 fold increase in the risk of developing dementia, while severe concussion augments up 4 times the chances. By the same token, considering the broad population with potential exposure to repetitive insults, CTE represents an important public health issue. The main purpose of this scientific article is to highlight the neuropathological features encountered and discuss the limitations of proper diagnostic. © 2016 Romanian Society of Legal Medicine.},
keywords = {Chronic traumatic encephalopathy, Forensic pathology, NEURODEGENERATION, Trauma},
pubstate = {published},
tppubtype = {article}
}
Ellis, M J; Cordingley, D; Vis, S; Reimer, K; Leiter, J; Russell, K
Vestibulo-ocular dysfunction in pediatric sports-related concussion Journal Article
In: Journal of Neurosurgery: Pediatrics, vol. 16, no. 3, pp. 248–255, 2015.
Abstract | Links | BibTeX | Tags: Adolescent, amnesia, Article, Athletic Injuries, Baseball, BASKETBALL, blurred vision, brain concussion, CANADA, Child, childhood disease, cohort analysis, complication, Concussion, consultation, controlled study, disease duration, Dizziness, Female, follow up, football, Hockey, human, Humans, interdisciplinary communication, major clinical study, Male, Manitoba, migraine, neuroimaging, neuropsychological test, Neuropsychological Tests, ODDS ratio, Pathophysiology, Pediatric, Physical Examination, physiotherapy, Post-Concussion Syndrome, postconcussion syndrome, Prevalence, priority journal, Reflex, Retrospective Studies, retrospective study, return to sport, saccadic eye movement, skating, skiing, Soccer, sport injury, sport related concussion, Sports-related concussion, Trauma, vestibular physiotherapy, Vestibular therapy, vestibulo ocular dysfunction, Vestibulo-Ocular, Vestibulo-ocular dysfunction, vestibuloocular reflex, VOLLEYBALL, Young Adult, youth sport
@article{Ellis2015,
title = {Vestibulo-ocular dysfunction in pediatric sports-related concussion},
author = {Ellis, M J and Cordingley, D and Vis, S and Reimer, K and Leiter, J and Russell, K},
doi = {10.3171/2015.1.PEDS14524},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neurosurgery: Pediatrics},
volume = {16},
number = {3},
pages = {248--255},
abstract = {Object The objective of this study was 2-fold: 1) to examine the prevalence of vestibulo-ocular dysfunction (VOD) among children and adolescents with acute sports-related concussion (SRC) and postconcussion syndrome (PCS) who were referred to a multidisciplinary pediatric concussion program; and 2) to determine if VOD is associated with the development of PCS in this cohort. Methods The authors conducted a retrospective review of all patients with acute SRC (presenting 30 days or less postinjury) and PCS (3 or more symptoms for at least 1 month) referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Initial assessment included clinical history, physical examination, and Post-Concussion Symptom Scale assessment. Patients were also assessed for VOD, which was defined as more than one subjective vestibular and oculomotor complaint (dizziness, blurred vision, and so on) and more than one objective physical examination finding (abnormal smooth pursuits, saccades, vestibulo-ocular reflex, and so on). This study was approved by the local institutional ethics review board. Results A total of 101 patients (mean age 14.2 years, SD 2.3 years; 63 male and 38 female patients) participated, including 77 (76.2%) with acute SRC and 24 (23.8%) with PCS. Twenty-two of the 77 patients (28.6%) with acute SRC and 15 of the 24 (62.5%) with PCS met the clinical criteria for VOD. The median duration of symptoms was 40 days (interquartile range [IQR] 28.5-54 days) for patients with acute SRC who had VOD compared with 21 days (IQR 13-32 days) for those without VOD (p = 0.0001). There was a statistically significant increase in the adjusted odds of developing PCS among patients with acute SRC who had VOD compared with those without VOD (adjusted OR 4.10; 95% CI 1.04-16.16). Conclusions Evidence of VOD was detected in a significant proportion of children and adolescents with acute SRC and PCS who were referred to a multidisciplinary pediatric concussion program. This clinical feature was a significant risk factor for the subsequent development of PCS in this pediatric acute SRC cohort. © AANS, 2015.},
keywords = {Adolescent, amnesia, Article, Athletic Injuries, Baseball, BASKETBALL, blurred vision, brain concussion, CANADA, Child, childhood disease, cohort analysis, complication, Concussion, consultation, controlled study, disease duration, Dizziness, Female, follow up, football, Hockey, human, Humans, interdisciplinary communication, major clinical study, Male, Manitoba, migraine, neuroimaging, neuropsychological test, Neuropsychological Tests, ODDS ratio, Pathophysiology, Pediatric, Physical Examination, physiotherapy, Post-Concussion Syndrome, postconcussion syndrome, Prevalence, priority journal, Reflex, Retrospective Studies, retrospective study, return to sport, saccadic eye movement, skating, skiing, Soccer, sport injury, sport related concussion, Sports-related concussion, Trauma, vestibular physiotherapy, Vestibular therapy, vestibulo ocular dysfunction, Vestibulo-Ocular, Vestibulo-ocular dysfunction, vestibuloocular reflex, VOLLEYBALL, Young Adult, youth sport},
pubstate = {published},
tppubtype = {article}
}