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DTI Shows Corpus Callosum Injury after Second Concussion in Female Adolescent Cleared for Return to Play
Poster Title: DTI Shows Corpus Callosum Injury after Second Concussion in Female Adolescent Cleared for Return to Play
Submitted on 26 Feb 2016
Author(s): Elisabeth A. Wilde, Summer Ott, Brian Biekman, Coy Van Valkenburgh, Mary Newsome, Xiaoqi Li, Jill V. Hunter, Xiaodi Lin, Trevor Wu, Brian A. Taylor, Pramod Dash, & Harvey S. Levin
Affiliations: Baylor College of Medicine ,University of Texas Health Science Center at Houston ,Texas Children’s Hospital
Poster Views: 1,498
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Poster Information
Abstract: Methods
18 year old female soccer player who had second concussion in January, 2015. No LOC or PTA.
Day 3: Reports that mild headache and balance problem on day of injury have cleared.
-ImPACT scores below baseline on verbal and visual memory composites .
Day 7: Complains of balance problems and dizziness; ImPACT Visual Memory Composite below baseline.
Day 10: Asymptomatic and ImPACT scores returned to baseline. Cleared to return to play (RTP).
Day 17: RTP.
Day 30: MRI, DTI, resting state fMRI on 3T Siemens; neuropsychological tests.
First concussion: Playing soccer in 2012; no LOC or PTA, but symptomatic for 3 months and resumed play while symptomatic against medical advice. Played soccer for 15 years
No history of neurologic or psychiatric disorder; typical development and good student.

Despite having been cleared for RTP on Day 10, this asymptomatic athlete whose cognitive performance recovered to baseline had DTI on Day 30 with both FA and MD outside the range of orthopedic controls and of the other concussed players, suggesting reduced microstructural integrity of her corpus callosum. While only a single case, the DTI data indicate residual white matter injury 30 days after a second concussion in an athlete whose other findings show clinical recovery.
Dissociation between meeting criteria for RTP and atypical DTI suggesting white matter injury is consistent with recent imaging studies showing reduced functional and/or structural connectivity in student athletes who had been cleared for RTP (Bazarian et al., 2012; Borich et al., 2015; Slobounov et al., 2014).
This report and related studies suggest that imaging be considered in RTP especially in athletes who sustained more than one concussion.
The contribution of repetitive head impacts remains to be partitioned from concussions. The athlete described here had played soccer for 15 years.

Summary: Case of a second concussion in an adolescent whose diffusion tensor imaging (DTI) indicates white matter injury on Day 30 after having been cleared for return to play. 
References: Acknowledgements

This work was supported by the National Institutes of Health grant 5R21-NS086714. The funding source had no role in the interpretation of data or in the creation of this poster. The contents of this poster are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health. The authors wish to thank James Montier, Baylor College of Medicine, for his assistance in the preparation of this poster.

Corresponding Author:
Summer Ott, Psy,D.
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