Abstract
Sport-related concussion is associated with acute disturbances in neurometabolic function, with effects that may last weeks to months after injury. However, is presently unknown whether these disturbances resolve at medical clearance to return to play (RTP) or continue to evolve over longer time intervals. Moreover, little is known about how these neurometabolic changes correlate with other measures of brain physiology. In this study, these gaps were addressed by evaluating ninety-nine (99) university-level athletes, including 33 with sport-related concussion and 66 without recent injury, using multi-parameter magnetic resonance imaging (MRI), which included single-voxel spectroscopy (SVS), diffusion tensor imaging (DTI) and resting-state functional MRI (fMRI). The concussed athletes were scanned at the acute phase of injury (27/33 imaged), medical clearance to RTP (25/33 imaged), one month post-RTP (25/33 imaged) and one year post-RTP (13/33 imaged). We measured longitudinal changes in N-acetyl aspartate (NAA) and myo-inositol (Ins), over the course of concussion recovery. Concussed athletes showed no significant abnormalities or longitudinal change in NAA values, whereas Ins was significantly elevated at RTP and one month later. Interestingly, Ins response was attenuated by a prior history of concussion. Subsequent analyses identified significant associations between Ins values, DTI measures of white matter microstructure and fMRI measures of functional connectivity. These associations varied over the course of concussion recovery, suggesting that elevated Ins values at RTP and beyond reflect distinct changes in brain physiology, compared to acute injury. These findings provide novel information about neurometabolic recovery after a sport-related concussion, with evidence of disturbances that persist beyond medical clearance to RTP.
Highlights
Concussion involves biomechanical forces acting on the brain, leading to behavioural disturbances, typically in the absence of overt anatomical injury
Control athletes with prior history of concussion (HOC) reported a median of 2 prior concussions with IQR [1, 2], that occurred a median of 31 months [12, 56] prior to imaging (27/31 occurring >1 year prior to imaging)
This single-voxel spectroscopy (SVS) study expands on prior literature by focusing on changes within the hand region of the primary motor cortex from acute injury to RTP, with follow-up at one month and one year post-RTP
Summary
Concussion involves biomechanical forces acting on the brain, leading to behavioural disturbances, typically in the absence of overt anatomical injury. Since the seminal animal work of Giza and Hovda (Giza and Hovda, 2001), it has been established that neurometabolic disturbances are a key component of concussion pathophysiology. In this domain, magnetic resonance single-voxel spectroscopy (SVS) has been a critical tool providing benchmarks of normal and disturbed neurometabolic function (Dimou and Lagopoulos, 2014). Studies have typically focused on metabolites that are both robustly detected and commonly associated with brain health.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
