1 Department of Neurological Surgery, University of Washington, Seattle, Washington.
2 Harborview Injury Prevention and Research Center, Seattle, Washington.
J Neurotrauma. 2019 Jan 15;36(2):264-274. doi: 10.1089/neu.2018.5629. Epub 2018 Aug 10.
This study longitudinally assessed 10- to 14-year-old patients with sports and recreational concussion (n = 22) who remained symptomatic 3 to 4weeks post-injury compared with typically developing controls (n = 24). Examination by multi-modal magnetic resonance imaging (MRI) and multi-domain clinical outcome measures was completed at 1-month and 6-months post-injury. Concussion patients showed evidence of improvement by 6-month follow-up in domains of cognitive function, whereas measures of psychological health were less resolved with patients exhibiting sustained symptoms of depression, behavior impairment, and concussion symptoms. Quantitative neuroimaging measures identified measures indicative of chronic injury with regional reductions observed by both volumetric segmentation and white matter fractional anisotropy (FA) from diffusion tensor imaging (DTI). Volumetric reductions (p < 0.01) were observed in the middle anterior and posterior portions of the corpus callosum, and right caudal anterior cingulate cortex of patients, although none held after strict correction. Examination of the FA data identified significant reductions in the left middle frontal gyrus white matter (p = 0.0003). Linear regression analysis on the 6-month depression outcome variable using the initial clinical, demographic, and imaging measures identified the top predictive models to include concussion diagnosis, and initial symptoms of depression, concussion symptoms, and sleep impairment with additional contribution from other measures of mental health, behavior impairment, and quality of life depending on the model (adjusted r-squared = 0.69 indicating strong predictive ability). This study supports further inclusion of mental health rehabilitation and imaging supplementing traditional cognitive rehabilitation strategies employed in these young athletes.
本研究对 22 名运动和娱乐性脑震荡 10 至 14 岁的患者进行了纵向评估，这些患者在受伤后 3 至 4 周仍有症状，与正常发育的对照组（n=24）相比。在受伤后 1 个月和 6 个月时，通过多模态磁共振成像（MRI）和多领域临床结果测量进行检查。与认知功能领域相比，脑震荡患者在 6 个月随访时表现出改善的迹象，而心理健康措施的改善程度较低，患者表现出持续的抑郁、行为障碍和脑震荡症状。定量神经影像学测量确定了具有慢性损伤迹象的指标，通过体素分割和来自弥散张量成像（DTI）的白质各向异性分数（FA）观察到区域性减少。尽管在严格校正后没有任何结果，但患者的胼胝体中部和后部以及右侧扣带回前皮质的体积减少（p<0.01）。FA 数据的检查表明，左侧额中回白质的 FA 显著降低（p=0.0003）。使用初始临床、人口统计学和影像学测量对 6 个月抑郁结果变量进行线性回归分析，确定了最佳预测模型，包括脑震荡诊断以及初始抑郁症状、脑震荡症状和睡眠障碍，其他心理健康、行为障碍和生活质量措施也有贡献，具体取决于模型（调整后的 r 平方=0.69，表明具有很强的预测能力）。这项研究支持进一步纳入心理健康康复和影像学，补充这些年轻运动员中使用的传统认知康复策略。
