title: Cerebral Perfusion Changes in Post-Concussion Syndrome: A Prospective Controlled Cohort Study.
abstract: The biology of post-concussive symptoms is unclear. Symptoms are often increased during activities, and have been linked to decreased cerebrovascular reactivity and perfusion. The aim of this study was to examine cerebral blood flow (CBF) in children with different clinical recovery patterns following mild traumatic brain injury (mTBI). This was a prospective controlled cohort study of children with mTBI (ages 8 to 18 years) who were symptomatic with post-concussive symptoms at one month post-injury (symptomatic, n = 27) and children who had recovered quickly (asymptomatic, n = 24). Pseudo continuous arterial spin labeling magnetic resonance imaging (MRI) was used to quantify CBF. The mTBI groups were imaged at 40 days post-injury. Global and regional CBF were compared with healthy controls of similar age and sex but without a history of mTBI (n = 21). Seventy-two participants (mean age: 14.1 years) underwent neuroimaging. Significant differences in CBF were found: global CBF was higher in the symptomatic group and lower in the asymptomatic group compared with controls, (F(2,69) 9.734; p < 0.001). Post-injury symptom score could be predicted by pre-injury symptoms and CBF in presence of mTBI (adjusted R2= 0.424; p < 0.001). Altered patterns of cerebral perfusion are seen following mTBI and are associated with the recovery trajectory. Symptomatic children have higher CBF. Children who "recovered" quickly, have decreased CBF suggesting that clinical recovery precedes the cerebral recovery. Further longitudinal studies are required to determine if these perfusion patterns continue to change over time.
authors.affiliation: 1 Department of Pediatrics, University of Calgary , Calgary, Alberta, Canada .|2 Department of Clinical Neurosciences, University of Calgary , Calgary, Alberta, Canada .|3 Alberta Children's Hospital Research Institute , Calgary, Alberta, Canada .
authors.forename: Karen M
authors.initials: KM
authors.lastname: Barlow
authors.affiliation: 4 Health Sciences, University of Calgary , Calgary, Alberta, Canada .
authors.forename: Lorenzo D
authors.initials: LD
authors.lastname: Marcil
authors.affiliation: 1 Department of Pediatrics, University of Calgary , Calgary, Alberta, Canada .|3 Alberta Children's Hospital Research Institute , Calgary, Alberta, Canada .|5 Department of Community Health Sciences, University of Calgary , Calgary, Alberta, Canada .
authors.forename: Deborah
authors.initials: D
authors.lastname: Dewey
authors.affiliation: 3 Alberta Children's Hospital Research Institute , Calgary, Alberta, Canada .|6 Alberta Children's Hospital , Calgary, Alberta, Canada .
authors.forename: Helen L
authors.initials: HL
authors.lastname: Carlson
authors.affiliation: 1 Department of Pediatrics, University of Calgary , Calgary, Alberta, Canada .|3 Alberta Children's Hospital Research Institute , Calgary, Alberta, Canada .|7 Strategic Clinical Network for Addictions and Mental Health, Alberta Health Services , Edmonton, Alberta, Canada .|8 Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute , Calgary, Alberta, Canada .|9 Department of Psychiatry, University of Calgary , Calgary, Alberta, Canada .
authors.forename: Frank P
authors.initials: FP
authors.lastname: MacMaster
authors.affiliation: 1 Department of Pediatrics, University of Calgary , Calgary, Alberta, Canada .|2 Department of Clinical Neurosciences, University of Calgary , Calgary, Alberta, Canada .|3 Alberta Children's Hospital Research Institute , Calgary, Alberta, Canada .|6 Alberta Children's Hospital , Calgary, Alberta, Canada .|13 Department of Psychology, University of Calgary , Calgary, Alberta, Canada .
authors.forename: Brian L
authors.initials: BL
authors.lastname: Brooks
authors.affiliation: 3 Alberta Children's Hospital Research Institute , Calgary, Alberta, Canada .|10 Department of Radiology, University of Calgary , Calgary, Alberta, Canada .|11 Biomedical Engineering, University of Calgary , Calgary, Alberta, Canada .|12 GE Healthcare , Calgary, Alberta, Canada .
authors.forename: R Marc
authors.initials: RM
authors.lastname: Lebel
mesh_terms: D000293:Adolescent; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D038223:Post-Concussion Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013113:Spin Labels
chemical_list: D013113:Spin Labels
keywords: arterial spin labeling; cerebral blood flow; pediatric brain injury; recovery; traumatic brain injury