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Utilization of Brain Network Activation in the Concussed Female Athlete – A Case Report
EP23843
Poster Title: Utilization of Brain Network Activation in the Concussed Female Athlete – A Case Report
Submitted on 26 Feb 2016
Author(s): Ilan J. Danan, M.D., M.Sc., Vernon B. Williams, M.D.
Affiliations: Kerlan-Jobe Ceders-Sinai
This poster was presented at Pink Concussions International Summit on Female Concussion and TBI
Poster Views: 1,209
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Poster Information
Abstract: PATIENT PRESENTATION
33 year-old female equestrian with a history of eight clinically diagnosed concussions and chronic migraines presented in April 2015 with a repeat concussion with loss of consciousness (LOC). She suffered a fall from her horse and, as per witnesses, remained unconscious for approximately 15 minutes. She presents with worsening headaches with associated visual dysfunction. She also complained of worsening memory and an inability to maintain focus and attention. SCAT3 symptom score = 21.
CLINICAL COURSE
A MRI brain with DTI was ordered, along with fMRI, and a BNA study. Advanced MRI suggested diminished signal in the left hemisphere on ASL and fragmentation on default mode of resting state BOLD, suggestive of a left fontraparietal injury. Also a left Sylvian fissure punctate suggestive of a chronic hemorrhage was identified. She was sent for a neuropsychological analysis along with QEEG and neurofeedback. Over the course of four months, she remained compliant with neuropsychological therapy and underwent a total of four BNA studies. With clinical improvement (SCAT3 symptom score = 6) came a noticeable improvement in BNA results.
DISCUSSION
A concussion, or mild traumatic brain injury (mTBI), is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces. The biomechanical forces involved in a mild traumatic brain injury trigger a metabolic cascade involving multiple processes, that often result in a post-concussive setting of varied signs and symptoms. Objective tools ranging from serum biomarker studies to imaging modalities to brain networking have all been studied as potential diagnostic tools in both the immediate long-term setting following a head injury. Brain Network Activation (BNA) is a non-invasive, multichannel EEG-based platform used to evaluate specific brain functionalities. It is meant to be used in the setting of monitoring disease progression or recovery, and/or response to therapeutic interventions in the setting of head injury. In this case, it was clear that the patient was suffering from sequelae from her multiple head injuries, both physiologic and pathologic Over the course of a four month period in which she was dedicated to neuropsychological and neurofeedback training, our patient noted a significant clinical improvement that was well documented. In addition, she saw her greatest improvement on BNA testing from 9/2015 to 12/2015.
CONCLUSION
Approach to concussion management, in both the short-term and long-term setting, remains primarily clinical. Current research seeks a more objective means of assessing not only potential structural abnormalities following a mild TBI, but also an improved means of assessing a patient’s neurocognitive status. BNA has proven to be an effective, supportive tool in allowing clinicians and patients to objectify one’s progress post head injury.
Summary: Approach to concussion management, in both the short-term and long-term setting, remains primarily clinical. Current research seeks a more objective means of assessing not only potential structural abnormalities following a mild TBI, but also an improved means of assessing a patient’s neurocognitive status. BNA has proven to be an effective, supportive tool in allowing clinicians and patients to objectify one’s progress post head injury.References: 1. McCrory, P. et al. Consensus States on Concussion in Sport: the 4th International Conference on Concussion
in Sport held in Zurich, November 2012. Br J Sports Med. 2013; 47:250-258.
2. Papa, L. Ramia, M.M. Edwards, D. Johnson, R.D., Slobounov, S.M. Systematic Review of Clinical
Studies Examining Biomarkers of Brain Injury in Athletes After Sports-Related Concussion. J Neurotrauma.
2015; 32(10): 661-673.
3. Orr, C.A., Albaugh, M.D., Watts, R., Garavan, H., Andrews, T., Nickerson, J.P., Gonyea, J., Hipko, S.,
Zweber, C., Logan, K., Hudziak, J.J. Neuroimaging biomarkers of a history of concussion observed in asymptomatic
young athletes. J Neurotrauma. Oct 2015.
4. Johnson, B., Zhang, K., Gay, M., Horovitz, S., Hallett, M., Sebastianelli, W., Slobounov, S. Alteration of
brain default network in subacute phase of injury in concussed individuals: resting-state fMRI study. Neuroimage.
Jan 2012; 59(1): 511-518.
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