817 Robotic Semi-Automated Transcranial Doppler Assessment of Cerebrovascular Autoregulation in Post Concussional Syndrome: Methodological Considerations

D Z Khan,K P Budohoski,M Czosnyka,P Smielewski,M M Placek,F Anwar,P J A Hutchinson,A Helmy,M Bance

doi:10.1093/bjs/znab135.003

Abstract

Abstract Introduction Post-concussive syndrome (PCS) refers to a constellation of physical, cognitive, and emotional symptoms after traumatic brain injury (TBI). Despite its incidence, the underlying mechanisms are unclear. We hypothesised that impaired cerebral autoregulation (CA) is a contributor. Method A prospective, observational study was integrated into outpatient clinics at a tertiary neurosurgical centre. Data points included: demographics, symptoms (Post-Concussion Symptom Scale [PCSS]), neuropsychological assessment (Cambridge Neuropsychological Test Automated-Battery [CANTAB]) and cerebrovascular metrics (Mxa co-efficient and the transient hyperaemic-response ratio [THRR]) - via transcranial Doppler (TCD), plethysmography and bespoke software (ICM+). Results 12 participants were recruited with 2 excluded after unsuccessful cerebrovascular TCD insonation. 10 participants (5 TBI patients, 5 healthy controls) were included in the analysis (median age 26.5, male:female 7:3). Median PCSS scores were 6/126 (TBI subgroup). Median CANTAB percentiles were 78 (healthy controls) and 25 (TBI). Mxa was calculated for 90% and THRR for 50% of participants. Median study time was 127.5 minutes and feedback (n = 6) highlighted the perceived acceptability of the study. Conclusions This pilot study has demonstrated a feasible and reproducible assessment of PCS and CA metrics (non-invasively) in a real-world setting. By scaling this methodology, we hope to test whether CA changes are correlated with symptomatic PCS in patients post-TBI.

Highlights

Traumatic brain injury (TBI) is a global challenge
Participant demographics In total, 12 participants were initially recruited for this pilot study—6 healthy controls and 6 patients with TBI
Two participants were excluded from analysis after unsuccessful insonation of the middle cerebral artery (MCA) during transcranial Doppler (TCD) assessment

Summary

Introduction

Traumatic brain injury (TBI) is a global challenge. An estimated 50 million cases of TBI occur yearly worldwide resulting in significant mortality, morbidity, and global economic expense ($US400 billion per year).[1,2]Mild TBI (mTBI), commonly defined by a GlasgowComa Scale (GCS) score between 13 and 15, represents 90% of TBI cases.[3]. Traumatic brain injury (TBI) is a global challenge. An estimated 50 million cases of TBI occur yearly worldwide resulting in significant mortality, morbidity, and global economic expense ($US400 billion per year).[1,2]. Mild TBI (mTBI), commonly defined by a Glasgow. Coma Scale (GCS) score between 13 and 15, represents 90% of TBI cases.[3] Post-concussion syndrome (PCS). Refers to a constellation of physical, cognitive, emotional, and psychiatric symptoms including headache,.

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