Progress in neurological surgery
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Concussions have long been understood to be an invisible injury. Indeed, conventional imaging techniques [computed tomography and magnetic resonance imaging (MRI)] are largely ineffective in elucidating concussive injuries. More advanced techniques are being used experimentally to help delineate the underlying pathophysiology of concussive injuries on metabolic as well as ultrastructural levels. ⋯ Each technique is briefly described, followed by a summary of the findings specific to concussive injuries. Overall, there is mounting evidence to suggest that each technique has utility in describing and explaining postinjury changes in the brain. Overall, concussive injuries are evident using the various aforementioned neuroimaging modalities and suggest at a minimum the concussed brain is different in the acute and subacute postinjury phases with several other studies suggesting that changes are persistent well beyond, especially in those patients with persistent symptoms.
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Over the last few decades, structural imaging techniques of the human brain have undergone significant strides. High resolution provided by recent developments in magnetic resonance imaging (MRI) allows improved detection of injured regions in patients with moderate-to-severe traumatic brain injury (TBI). In addition, diffusion imaging techniques such as diffusion tensor imaging (DTI) has gained much interest recently due to its possible utility in detecting structural integrity of white matter pathways in mild TBI (mTBI) cases. ⋯ The detection of white matter damage in concussion remains challenging, and development of imaging biomarkers for mTBI is still in great need. In this chapter, we discuss our experience with high-definition fiber tracking (HDFT), a diffusion spectrum imaging-based technique. We also discuss ongoing developments and specific advantages HDFT may offer concussion patients.
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Ice hockey is an aggressive and fast-paced sport which has a high risk of injury, concussions in particular. Although serious head injury has been recognized for nearly 50 years, an increase in mainstream media attention in recent years has led to unprecedented public awareness. ⋯ With over 1,000,000 youth hockey participants in Canada and the USA combined, concussion is an issue that reaches beyond the professional level. In this report we review the incidence, evaluation, treatment, return-to-play protocol, and prevention efforts related to concussion in ice hockey.
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Sport-related concussions affect millions of athletes every year, but they generally present no anatomic alterations when examined using conventional magnetic resonance imaging or a computed tomography scan. Because the damage occurring after a head injury seems to be more functional than structural, these techniques are unable to detect subtle alterations. ⋯ Electrophysiological methods, magnetic resonance spectroscopy, and diffusion tensor imaging are useful techniques that are sensitive to the effects of a brain trauma, which provide complementary information to allow a more complete understanding of the multiple pathophysiological processes involved in concussive events. This report summarizes recent data using neurophysiological and neuroimaging techniques to better understand the acute and chronic effects of sport-related concussions.
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The majority of traumatic brain injuries (TBI) in the USA are mild in severity. Sports, particularly American football, and military experience are especially associated with repetitive, mild TBI (mTBI). The consequences of repetitive brain injury have garnered increasing scientific and public attention following reports of altered mood and behavior, as well as progressive neurological dysfunction many years after injury. This report provides an up-to-date review of the clinical, pathological, and pathophysiological changes associated with repetitive mTBI, and their potential for cumulative effects in certain individuals.