4
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: not found
      • Article: not found

      Prevalence of Abnormal Magnetic Resonance Imaging Findings in Children with Persistent Symptoms after Pediatric Sports-Related Concussion

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          A subset of patients experience persistent symptoms after pediatric concussion, and magnetic resonance imaging (MRI) is commonly used to evaluate for pathology. The utility of this practice is unclear. We conducted a retrospective cohort study to describe the MRI findings in children with concussion. A registry of all patients seen at our institution from January 2010 through March 2016 with pediatric sports-related concussion was cross-referenced with a database of radiographic studies. Radiology reports were reviewed for abnormal findings. Patients with abnormal CTs or MRI scans ordered for reasons other than concussion were excluded. Among 3,338 children identified with concussion, 427 underwent MRI. Only two (0.5%) had findings compatible with traumatic injury, consisting in both of microhemorrhage. Sixty-one patients (14.3%) had abnormal findings unrelated to trauma, including 24 nonspecific T2 changes, 15 pineal cysts, eight Chiari I malformations, and five arachnoid cysts. One child underwent craniotomy for a cerebellar hemangioblastoma after presenting with ataxia; another had cortical dysplasia resected after seizure. The two patients with microhemorrhage each had three prior concussions, significantly more than patients whose scans were normal (median: 1) or abnormal without injury (median: 1.5; P = 0.048). MRI rarely revealed intracranial injuries in children after concussion, and the clinical relevance of these uncommon findings remains unclear. Abnormalities unrelated to trauma are usually benign. However, MRI should be thoughtfully considered in children who present with concerning or atypical symptoms.

          Related collections

          Most cited references26

          • Record: found
          • Abstract: found
          • Article: not found

          Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED.

          Approximately one-third of children experiencing acute concussion experience ongoing somatic, cognitive, and psychological or behavioral symptoms, referred to as persistent postconcussion symptoms (PPCS). However, validated and pragmatic tools enabling clinicians to identify patients at risk for PPCS do not exist.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            American Academy of Pediatrics. Clinical report--sport-related concussion in children and adolescents.

            Sport-related concussion is a "hot topic" in the media and in medicine. It is a common injury that is likely underreported by pediatric and adolescent athletes. Football has the highest incidence of concussion, but girls have higher concussion rates than boys do in similar sports. A clear understanding of the definition, signs, and symptoms of concussion is necessary to recognize it and rule out more severe intracranial injury. Concussion can cause symptoms that interfere with school, social and family relationships, and participation in sports. Recognition and education are paramount, because although proper equipment, sport technique, and adherence to rules of the sport may decrease the incidence or severity of concussions, nothing has been shown to prevent them. Appropriate management is essential for reducing the risk of long-term symptoms and complications. Cognitive and physical rest is the mainstay of management after diagnosis, and neuropsychological testing is a helpful tool in the management of concussion. Return to sport should be accomplished by using a progressive exercise program while evaluating for any return of signs or symptoms. This report serves as a basis for understanding the diagnosis and management of concussion in children and adolescent athletes.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Diffusion tensor imaging of acute mild traumatic brain injury in adolescents.

              Despite normal CT imaging and neurologic functioning, many individuals report postconcussion symptoms following mild traumatic brain injury (MTBI). This dissociation has been enigmatic for clinicians and investigators. Diffusion tensor imaging tractography of the corpus callosum was performed in 10 adolescents (14 to 19 years of age) with MTBI 1 to 6 days postinjury with Glasgow Coma Scale score of 15 and negative CT, and 10 age- and gender-equivalent uninjured controls. Subjects were administered the Rivermead Post Concussion Symptoms Questionnaire and the Brief Symptom Inventory to assess self-reported cognitive, affective, and somatic symptoms. The MTBI group demonstrated increased fractional anisotropy and decreased apparent diffusion coefficient and radial diffusivity, and more intense postconcussion symptoms and emotional distress compared to the control group. Increased fractional anisotropy and decreased radial diffusivity were correlated with severity of postconcussion symptoms in the MTBI group, but not in the control group. In adolescents with mild traumatic brain injury (MTBI) with Glasgow Coma Scale score of 15 and negative CT, diffusion tensor imaging (DTI) performed within 6 days postinjury showed increased fractional anisotropy and decreased diffusivity suggestive of cytotoxic edema. Advanced MRI-based DTI methods may enhance our understanding of the neuropathology of TBI, including MTBI. Additionally, DTI may prove more sensitive than conventional imaging methods in detecting subtle, but clinically meaningful, changes following MTBI and may be critical in refining MTBI diagnosis, prognosis, and management.
                Bookmark

                Author and article information

                Journal
                Journal of Neurotrauma
                Journal of Neurotrauma
                Mary Ann Liebert Inc
                0897-7151
                1557-9042
                October 2017
                October 2017
                : 34
                : 19
                : 2706-2712
                Affiliations
                [1 ]Harborview Injury Prevention Research Center, Harborview Medical Center, University of Washington, Seattle, Washington.
                [2 ]Department of Neurological Surgery, University of Washington, and Seattle Children's Hospital, Seattle, Washington.
                [3 ]Radiology Clinical Research Imaging Core, Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington.
                [4 ]Department of Radiology, Seattle Children's Hospital, University of Washington, and Seattle Children's Hospital, Seattle, Washington.
                [5 ]Department of Anesthesia & Pain Medicine, Harborview Medical Center, University of Washington, Seattle, Washington.
                [6 ]Department of Pediatrics, Seattle Children's Hospital, University of Washington, and Seattle Children's Hospital, Seattle, Washington.
                Article
                10.1089/neu.2017.4970
                5824661
                28490224
                5c6385aa-d5b8-4665-8967-ae65f260c0f9
                © 2017

                http://www.liebertpub.com/nv/resources-tools/text-and-data-mining-policy/121/

                History

                Comments

                Comment on this article