Abstract
Sport-related concussions are now recognized as a major public health concern: the number of participants in sport and recreation is growing, possibly playing their games faster, and there is heightened public awareness of injuries to some high-profile athletes. However, many clinicians still rely on subjective symptom reports for the clinical determination of recovery. Relying on subjective symptom reports can be problematic, as it has been shown that some concussed athletes may downplay their symptoms. The use of neuropsychological (NP) testing has enabled clinicians to measure the effects and extent of impairment following concussion more precisely, providing more objective metrics for determining recovery. Nevertheless, there is a remaining concern that brain abnormalities may exist beyond the point at which individuals achieve recovery in self-reported symptoms and cognition measured by NP testing. Our understanding of brain recovery after concussion is important, not only from a neuroscience perspective, but also from the perspective of clinical decision-making for safe return-to-play. A number of advanced neuroimaging tools, including blood oxygen level dependent functional magnetic resonance imaging (fMRI), have independently yielded early information on abnormal brain functioning. In the two cases presented in this article, we report contrasting brain activation patterns and recovery profiles using fMRI. Importantly, fMRI was conducted using adapted versions of the most sensitive computerized NP tests administered in our current clinical practice to determine impairments and recovery after sport-related concussion. One of the cases is consistent with the concept of lagging brain recovery.
Highlights
CASE 1 JZ is a 20-year-old male varsity hockey player who sustained a concussion on November 25 while participating in a game
A total symptom score of 3 was reported on the University of Toronto concussion symptom scales (UTCSS) with mild symptoms of difficulty concentrating, difficulty reading, and feeling “off ” or “not normal”/in a “fog.” The UTCSS is a symptom scale analogous to other symptom scales which provides a formal method of documenting post-concussion symptoms
With the increased prevalence of sports concussion, and the potentially enduring effects that have been correlated with repeated concussions [39, 40], novel assessment tools – such as neuroimaging and electrophysiological biomarkers – are needed to assist us in better understanding the mechanisms associated with concussion and the recovery process
Summary
CASE 1 JZ is a 20-year-old male varsity hockey player who sustained a concussion on November 25 while participating in a game. At the time of the NP consultation (December 15), JZ reported no cognitive complaints and no history of significant medical difficulties/disorders/diseases, early childhood or developmental difficulties, mental health difficulties, alcohol/substance use issues, attention deficit disorder, learning disorder, or behavioral problems His scores on the Automated Neuropsychological Assessment Metrics (ANAM) battery were compared to a normative database for male athletes in his age group as well as his baseline test scores. At the time of NP consultation, HC reported no history of significant medical difficulties/disorders/diseases, early childhood or developmental difficulties, mental health difficulties, alcohol/substance use issues, attention deficit disorder, learning disorder, or behavioral problems His ANAM mood scores at the time of consultation were considered normal, with low levels of anxiety, restlessness, fatigue, depression, and anger; as well as elevated levels of vigor and happiness. HC was medically cleared to resume full sport participation on November 17
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