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KRK  
#1 Posted : Thursday, October 17, 2019 8:37:24 AM(UTC)
krk comment....let's not rush guys
Brain Injury After Concussion May Linger
— Some effects persist a year after college athletes return to play

by Judy George, Senior Staff Writer, MedPage Today October 16, 2019

https://www.medpagetoday...NL_Daily_DHE_TopCatTestB

Concussion recovery patterns varied for different aspects of brain physiology, with some effects persisting a year after college athletes returned to play, a longitudinal imaging study showed.

Brain activity and communication between brain regions appeared normal 1 year after athletes received medical clearance to return to play, but cerebral blood flow and white matter diffusivity showed persistent effects, reported Tom Schweizer, PhD, of St. Michael's Hospital in Toronto, Canada, and colleagues in Neurology.

"Brain recovery after concussion may be a more complex and longer-lasting process than we originally thought," said co-author Nathan Churchill, PhD, also of St. Michael's Hospital.

"There is growing concern for the long-term health risks associated with concussion. However, we still know relatively little about how the brain recovers from concussion over the long-term, which is needed to understand the potential cause of these health concerns," he told MedPage Today.

"At the moment, safe return-to-play is largely based on the resolution of symptoms, but this is an indirect measure of brain recovery," he continued. At medical clearance, "concussed athletes showed differences in brain structure and function compared to uninjured athletes, suggesting incomplete recovery. More importantly, 1 year later, some aspects of the brain looked normal, but others still showed signs of ongoing recovery."

These findings are consistent with smaller studies that have used various imaging and electrical measurement tools to assess post-concussion effects, said Robert Cantu, MD, of the Boston University Chronic Traumatic Encephalopathy (CTE) Center, who was not involved in the study.

"When someone is symptomatically completely cleared of all post-concussion symptoms and is neurologically normal on examination -- when I, as a clinician in my office, determine the eye-tracking is normal, the cognition is normal, the balance is normal, the symptom checklist is back to baseline -- I'm going to send that individual through a return-to-play protocol and allow them to return to play," Cantu said in an interview with MedPage Today.

"At that point, there are still a wide number of studies that are not yet back to normal," he continued. "It's unnerving because we worry that we're possibly not being conservative enough in terms of when we send people back based just on the neurologic exam and the symptom checklist."

But many of these measurement tools -- such as evoked potentials, diffusion tensor MRI, and functional MRI -- are not recognized by the American Board of Radiology, Cantu added. "They are not clinical tools that a doctor in his office will order up and use as a stop-go criteria."

In their study, Schweizer and colleagues looked at college athletes who played volleyball, hockey, soccer, football, rugby, basketball, lacrosse, and water polo. They followed 24 athletes with concussion and 122 without; men and women were represented equally in both groups.

All athletes completed baseline assessments with the Sport Concussion Assessment Tool 3 (SCAT3). Athletes without concussion were scanned at the start of their competitive season. Concussed athletes had functional MRI, arterial spin labeling, and diffusion tensor imaging at three time points: an average of 4 days after injury, at return-to-play, and 1 year after return-to-play. No athlete acquired a new concussion during the study.

Compared with healthy athletes, concussed players had significantly reduced cerebral blood flow 1 year later, an average decrease of 10.03 mL/100g/m (95% CI -13.38 to -7.08). At the 1 year point, concussed athletes also showed possible signs of white matter tissue swelling, but no significant effects on global functional connectivity or white matter fractional anisotropy. MRI findings were tied to clinical measures, including acute symptom severity and time to return-to-play.

"By the end of the study, the concussed athletes were determined to be fully recovered based on clinical assessment, and had otherwise fully returned to normal work and school activities," Churchill said. "This is important, as it suggests that there are long-lasting brain changes even with full clinical recovery. It also raises new questions about when -- if ever -- the brain returns to 'normal,' and whether the long-lasting brain changes we see are related to worse outcomes if the athletes sustain another concussion before recovery is completed."

This study had several limitations, the authors noted. Exertion and subconcussive impacts after return-to-play may have influenced results. In addition, athletes with concussion had MRIs only after injury, and not at baseline.
Cheesey  
#2 Posted : Thursday, October 17, 2019 9:41:17 AM(UTC)
I’ve had several concussions in my life growing up. None were from playing football. I can’t help but wonder if it had something to do with my Ménière’s disease and the migraines I suffer from now. That and the short term memory loss I also have.
Porforis  
#3 Posted : Thursday, October 17, 2019 11:43:48 AM(UTC)
Had one mild to moderate concussion and while it's hard to tell long-term, it's very likely and my personal opinion that I lost like 5% of my mental sharpness long-term from that. Luckily no other long term symptoms thusfar but seriously people, protect your heads.
KRK  
#4 Posted : Thursday, October 17, 2019 12:43:09 PM(UTC)
This one is near and dear to me.....set the wayback machine to 1975....Butler Bowl, Indianapolis

I was playing tight end and in the wedge on kickoff return. I was the guy who was supposed to catch crappy/short kicks, but most of the time block. I am about 6'3" and weighed, at the time 245.

This LB came down for Butler and was hauling ass. As I was taught to do, I lead with my head and hit him right in crown of his head. He went down, and I was out on my feet...literally.

They walked me over to the bench and just sat my ass down to view the rest of the game. The next thing I remembered, I was on the bus on the way home in incredible pain. My GPA went from 3.3 to 1.5.

Thank God, I had coaches who cared more about the players than the wins. The shut me down for the balance of the year. The first day of contact my Junior year, I got another one...I was done.

Porforis pointed out
Quote:
it's very likely and my personal opinion that I lost like 5% of my mental sharpness long-term from that.
I believe I did as well, at a minimum, for the near term. Learning helps repair the brain so I try to learn (re-learn) languages, do cross-words, and each good fats (avacados, nuts, red meat) as the brain is >60% fat.
Porforis  
#5 Posted : Thursday, October 17, 2019 1:17:31 PM(UTC)
I don't know whether I had too many cognitive problems in the short term - mainly because the physical symptoms for like 4-6 months were killer. For like 2 months, I couldn't focus on anything for longer than an hour or so without an increasingly bad headache and a form of profound fatigue I have not experienced before or since that would not go away without an extended time of lying down and doing nothing. It gradually got less and less severe after that, and after about 10 months I was more or less able to do whatever I could before the concussion for as long as I needed to.

Sadly, when I got my concussion I was 3 weeks from ending my previous job, I really needed to maintain a good relationship with the company, and we were (as usual) getting completely throttled, so 50+ hour weeks immediately after the concussion definitely didn't help. Working 10-12 hour days when you only physically can handle a couple hours a work at a time max without a 30+ minute break sure wasn't fun to try to swing. Under other circumstances, and even if this happened again under the same circumstances, I definitely would have gotten evaluated and taken as much time off to rest my brain as possible, consequences be damned. It definitely didn't help my recovery and I paid for it.

On the plus side, it had the unintended side effect of seriously helping me with a nervous overthinking problem of mine. Hard to constantly think about every possible way a situation could go automatically when your brain physically can't handle it for months.
KRK  
#6 Posted : Thursday, October 17, 2019 2:14:56 PM(UTC)
Porforis, you are my brain damaged brother!!!

How ironic as we still two of the brightest bulbs on the site LOL

How smart must we have been BEFORE it happened.
Cheesey  
#7 Posted : Thursday, October 17, 2019 8:05:10 PM(UTC)
What about me???
I feel so left out!
Porforis  
#8 Posted : Friday, October 18, 2019 11:37:58 AM(UTC)
Cheesey said: Go to Quoted Post
What about me???
I feel so left out!


I mean, you're kind of our brain damaged genius weird uncle.
Cheesey  
#9 Posted : Friday, October 18, 2019 3:14:44 PM(UTC)
Porforis said: Go to Quoted Post
I mean, you're kind of our brain damaged genius weird uncle.


I take that as a compliment!!!LOL
Cheesey  
#10 Posted : Friday, October 18, 2019 3:15:31 PM(UTC)
Hey!!!
When was THIS thread started!?!?
KRK  
#11 Posted : Friday, October 18, 2019 10:43:13 PM(UTC)
Last Tuesday or Wednesday....but this week for sure

I am post-concussed, so I don't remember.
Cheesey  
#12 Posted : Saturday, October 19, 2019 9:32:08 AM(UTC)
KRK said: Go to Quoted Post
Last Tuesday or Wednesday....but this week for sure

I am post-concussed, so I don't remember.


You got concussed by a POST?
Hope it wasn’t one of mine that did it!LOL

I know this is a serious thread, but as Popeye would say, “I yam what I yam”....in my case, CHEESEY.
KRK  
#13 Posted : Thursday, October 24, 2019 5:30:15 AM(UTC)
MRI Confirms Persistent Concussion Effects in Athletes 1 Year After Resuming Play
-Brain recovery lagged behind clinical recovery, increasing risk for long-term consequences
by Zeena Nackerdien PhD, CME Writer, MedPage Today October 23, 2019
Study Authors: Nathan W. Churchill, Michael G. Hutchison, et al.

Target Audience and Goal Statement: Neurologists, sports medicine doctors, psychologists, radiologists, emergency department physicians, family physicians

The goal of this observational study was to test the hypothesis that concussion-related brain alterations seen at symptomatic injury and medical clearance to return to play in college athletes will have dissipated by 1 year after return to play.

Question Addressed: Would effects from concussion persist at 1 year after a college athlete was medically cleared to return to play?

Study Synopsis and Perspective:
Acute trauma to the brain, such as the impact of a sports injury, a car accident, or a fall, could result in a concussion. Brain injuries may occur in a coup-countercoup fashion, in which the brain bumps into the interior of the skull, where it is hit, as well as on the opposite side, resulting in damaging bruises at two sites in the brain. Biomechanical injury to neurons in the brain are thought to contribute to post-concussive vulnerability.

Action Points
  • Imaging markers of brain injury were still seen on MRI when concussed athletes were cleared to return to play, and evidence of brain injury persisted for 12 months after return to play, in this observational study of college athletes.
  • Realize that the diagnosis of concussion and determination of return to play are currently based on symptom status and brief evaluations of cognition and balance, but these assessments only indirectly reflect the underlying brain injury.


Competitive sports and recreational activities account for as many as 3.8 million concussions in the U.S. each year, with half of these transient brain injuries going unreported. About 1 million athletes have reported having two or more concussions. Recurrent concussion is associated with a higher risk of post-concussion syndrome -- a complex disorder in which various symptoms (such as headaches and dizziness) last for weeks and sometimes months after the injury.

However, the diagnosis of a concussion is currently based on symptom status and brief evaluations of cognition and balance. Similarly, a return to play is determined mainly by symptom resolution of a graded exercise protocol.

In a new study published in Neurology, Tom Schweizer, PhD, of St. Michael's Hospital in Toronto, Canada, and colleagues used longitudinal MRI to investigate brain recovery after a concussion. They reported that different aspects of brain physiology showed different patterns of recovery over time, with only a subset of MRI parameters showing non-significant concussion effects at 1 year after return to play. Moreover, the effects of concussion on the brain also vary as a function of clinical measures, including acute symptom severity and time to return to play, for all examined MRI parameters, they noted.

A total of 24 college athletes with concussion (mean age 20, 54% women) and 122 without concussion (mean age 20.3, 49% women) were enrolled in this observational study. Athletes were recruited via a sports medicine clinic at a single institution. The included athletes who played volleyball, hockey, soccer, football, rugby, basketball, lacrosse, and water polo.

All athletes completed baseline assessments with the Sport Concussion Assessment Tool 3 (SCAT3). Three MRI scans were performed: the first scan was performed about 4 days, on average, after the injury; the second one was performed when the athlete received clearance to return to play; and the final scan was performed 1 year after the return to play. Athletes who did not have concussions also underwent MRIs at the start of their respective seasons. Key effects of concussion on MRI parameters were evaluated at post-injury time points.

Imaging markers of brain injury were still seen when concussed athletes were cleared to return to play, and evidence of brain injury persisted for 12 months after return to play. Significant reductions in cerebral blood flow of 10 mL/100g/m were observed in concussed versus healthy athletes. Using an imaging approach that maps how water molecules move in the white matter of the brain, the researchers showed that the brains of concussed athletes exhibited possible evidence of tissue swelling 1 year after return to play.

Prior sports concussions studies have identified both focal increases and decreases in brain connectivity. But in the current study, measurements of the patterns of resting brain activity in the organ's gray matter and measurements of the lines of communication in the brain's white matter showed a return to normal 1 year after a return to play.

"Brain recovery after concussion may be a more complex and longer-lasting process than we originally thought," said co-author Nathan Churchill, PhD, also of St. Michael's Hospital.

"There is growing concern for the long-term health risks associated with concussion. However, we still know relatively little about how the brain recovers from concussion over the long-term, which is needed to understand the potential cause of these health concerns," he told MedPage Today.

This study had several limitations, the authors noted. Exertion and subconcussive impacts after return to play may have influenced results. In addition, athletes with concussion had MRIs only after injury, and not at baseline.
Source Reference: Neurology 2019; DOI: 10.1212/WNL.0000000000008523

Study Highlights and Explanation of Findings:
Based on one of the longest follow-up studies of brain recovery in university-level athletes to date, researchers found that the brains of concussed athletes still continued to show signs of injury 1 year after receiving full medical clearance.

"This research is striking because the length of time of the follow-up is unprecedented," said Churchill in a press release.

"At the moment, safe return-to-play is largely based on the resolution of symptoms, but this is an indirect measure of brain recovery," Churchill told MedPage Today. At medical clearance, "concussed athletes showed differences in brain structure and function compared to uninjured athletes, suggesting incomplete recovery. More importantly, 1 year later, some aspects of the brain looked normal, but others still showed signs of ongoing recovery."

"At return to play, face-value indications of the injury -- such as cognitive impairment and symptoms -- appear to have cleared," said Schweizer in the press release. "However, our findings show early and long-term brain changes in response to the concussion. This suggests a potential risk for long-term consequences, given the evidence of worse outcomes if a second concussion occurs before recovery is complete."

These findings are consistent with smaller studies that have used various imaging and electrical measurement tools to assess post-concussion effects, said Robert Cantu, MD, of the Boston University Chronic Traumatic Encephalopathy (CTE) Center, who was not involved in the study.
"When someone is symptomatically completely cleared of all post-concussion symptoms and is neurologically normal on examination -- when I, as a clinician in my office, determine the eye-tracking is normal, the cognition is normal, the balance is normal, the symptom checklist is back to baseline -- I'm going to send that individual through a return-to-play protocol and allow them to return to play," Cantu said in an interview with MedPage Today.

"At that point, there are still a wide number of studies that are not yet back to normal," he continued. "It's unnerving because we worry that we're possibly not being conservative enough in terms of when we send people back based just on the neurologic exam and the symptom checklist."

But many of these measurement tools -- such as evoked potentials, diffusion tensor MRI, and functional MRI -- are not recognized by the American Board of Radiology, Cantu added. "They are not clinical tools that a doctor in his office will order up and use as stop-go criteria."

"By the end of the study, the concussed athletes were determined to be fully recovered based on clinical assessment, and had otherwise fully returned to normal work and school activities," Churchill said. "This is important, as it suggests that there are long-lasting brain changes even with full clinical recovery. It also raises new questions about when -- if ever -- the brain returns to 'normal,' and whether the long-lasting brain changes we see are related to worse outcomes if the athletes sustain another concussion before recovery is completed."

Reviewed by Henry A. Solomon, MD, FACP, FACC Clinical Associate Professor, Weill Cornell Medical College
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