Cerebral blood flow in children and adolescents several years after concussion

ABSTRACT

Objectives: The long-term effects of concussion in youth remain poorly understood. The objective of this study was to determine the association between history of concussion and cerebral blood flow (CBF) in youth.

Methods: A total of 53 children and adolescents with a history of concussion (n = 37) or orthopaedic injury (OI; n = 16) were considered. Measures included pseudo-continuous arterial spin labelling magnetic resonance imaging to quantify CBF, post-concussion symptoms, psychological symptoms, and cognitive testing.

Results: Participants (mean age: 14.4 years, 95% CI = 13.8–15.4, range = 8–19) were on average 2.7 years (95% CI = 2.2–3.1) post-injury. Youth with a history of concussion had higher parent-reported physical, cognitive, anxiety, and depression symptoms than children with OI, but the groups did not differ on self-reported symptoms (post-concussive or psychological) or cognitive testing. Global CBF did not differ between groups. Regional CBF analyses suggested that youth with a history of concussion had hypoperfusion in posterior and inferior regions and hyperperfusion in anterior/frontal/temporal regions as compared to those with OI. However, neither global nor regional CBF were significantly associated with demographics, pre-injury functioning, number of concussions, time since injury, post-concussive symptoms, psychological symptoms, or cognitive abilities.

Conclusions: Youth with a history of concussion demonstrate differences in regional CBF (not global CBF), but without clear clinical expression.

KEYWORDS:

• Children
• closed head injury
• concussion
• MRI
• neuroimaging

Acknowledgements

The authors thank the members of the NEURO-detect study team (Helen Carlson PhD, Michael Esser MD PhD, Kathryn Schneider PhD PT, Catherine Lebel PhD, Signe Bray PhD, and Ashley Harris PhD). Thanks to Lonna Mitchell BA and Kalina Slepicka BA for scoring protocols and (alphabetically) Amy Bobyn, Dominique Bonneville BA (Hons), Shauna Bulman, Christianne Laliberté-Durish MSc, Shelby MacPhail, Maya Sohn, and Cole Sugden for assistance with data entry/checking. Thanks to Brenda Turley BA (Hons), Carolyn Emery PhD PT, and Kathryn Schneider PhD PT for assisting with recruitment. Recruitment of some orthopaedic control participants was done using the Healthy Infants and Children Clinical Research Program database (HICCUP; http://www.ucalgary.ca/paediatrics_hiccup). Thanks to Elodie Boudes PhD, Aneesh Khetani BSc, and the Child and Adolescent Imaging Research (CAIR) technicians for assistance with the MRI. Thank you to the families who participated in this study and generously donated their time to research.

Disclosure Statement

R. Marc Lebel is an employee of GE Healthcare. Brian Brooks receives royalties for the sales of the Pediatric Forensic Neuropsychology textbook (2012, Oxford University Press) and three paediatric neuropsychological tests [Child and Adolescent Memory Profile (ChAMP, Sherman and Brooks, 2015, PAR Inc.), Memory Validity Profile (MVP, Sherman and Brooks, 2015, PAR Inc.), and Multidimensional Everyday Memory Ratings for Youth (MEMRY, Sherman and Brooks, 2017, PAR Inc.)]. He has previously received in-kind support (free test credits) from the publisher of the computerized cognitive test (CNS Vital Signs, Chapel Hill, North Carolina) used in this study. Keith Yeates receives royalties for book sales from Guilford Press and Cambridge University Press and occasionally serves as a paid expert in forensic cases. None of the authors nor their family members have a financial interest in any measures used in this study.

Additional information

Funding

This study was funded by the Shaikh Family Research Award, an endowment held by the Alberta Children’s Hospital Foundation and granted to Brian Brooks by the Alberta Children’s Hospital Research Institute. Additional support for the study was provided from the Ronald and Irene Ward Chair in Pediatric Brain Injury (awarded to Keith Yeates). Brian Brooks acknowledges salary funding from the Canadian Institutes for Health Research (CIHR) Embedded Clinician Researcher Salary Award. Vickie Plourde acknowledges fellowship funding from the Alberta Children’s Hospital Research Institute (University of Calgary), the Integrated Concussion Research Program (University of Calgary), and Alberta Innovates-Health Solutions. Trevor Low acknowledges summer studentship funding from the Alberta Children’s Hospital Research Institute (University of Calgary), the Integrated Concussion Research Program (University of Calgary), and Alberta Innovates-Health Solutions. Keith Yeates acknowledges funding from the Ronald and Irene Ward Chair in Pediatric Brain Injury.