BRAIN WHITE MATTER ALTERATIONS IN STRUCTURAL INTEGRITY AND CONNECTIVITY FOLLOWING A SPORTS-RELATED CONCUSSION: EVALUATION OF THE POTENTIAL AMELIORATING EFFECT OF A JUGULAR VEIN COMPRESSION COLLAR DEVICE

Abstract

Background:Sports-related concussion is a significant public health problem which may result in exacerbated or prolonged neurologic deficits. A neck collar device has been developed to apply mild jugular vein compression, increasing intracranial blood volume, with the intent of reducing brain slosh and preventing damage to brain microstructure from head impact exposure.Hypothesis/Purpose:We aimed to quantify the alterations in white matter (WM) diffusion properties and network structural connectivity in high school athletes after sports-related concussion and to test the effect of a jugular vein compression collar device worn during the concussive event.Methods:379 athletes (male American football and female Soccer) were included in this report. Of the 16693 total athlete exposures, 40 resulted in a diagnosed concussion and were included in these analyses. Prospective longitudinal MRI data were collected at pre-season and post-concussion: 20 athletes were in the non-collar group (12M, age =15.93±1.27yrs) and 20 athletes were in the non-collar group (16M, age=16.37±1.06yrs). DTI parameters, including fractional anisotropy (FA), and mean, axial and radial diffusivity (MD/AD/RD), were calculated to determine post-concussion alterations in WM diffusion properties. Graph analysis was utilized to quantify post-concussion changes in WM structural connectivity.Results:Diffusion property results revealed significant pre-season to post-concussion increases in MD, AD and RD within the non-collar group (p<0.05), but no change was found in the collar group (p>0.05). The pre-season to post-concussion MD, AD, or RD increase was significantly greater (p<0.05, Figure 1) in the non-collar group than the collar group. Graph analysis revealed a pre-season to post-concussion decrease in mean local efficiency in the non-collar group (p=0.036) and a significant increase in mean local efficiency in the collar group (p=0.017). The pre-season to post-concussion change in the mean local efficiency was significantly different in the non-collar group, when compared to the collar group (p=0.0024, Figure 2).Discussion & Conclusion:Results indicate that sports related concussion is associated with alterations in WM diffusion properties. The mean local efficiency of the network, a structural connectivity index reflecting network wiring redundancy and tolerance to brain injury, was also found to decrease after the concussion. Results indicate that wearing a neck collar device has the potential to limit these WM changes following a concussive event. Further studies are warranted to investigate the temporal progression of these changes for preventing long-term, neurologic squeala.Figure 1.White matter regions with significant greater increase in MD, AD, and/or RD in the non-collar group than the collar group.Figure 2.Mean local efficiency of brain network showed significant decrease in the non-collar group (p=0.036) and significant increase in the collar group (0.017), with a significant group difference in the change (p=0.0024).