Research 37

Decreased Cerebral Blood Continues
7 Months Post Trauma

Comments by Dr. Mladenoff:

The authors found lower regional cerebral blood flow in pediatric mTBI patients on average seven months post-injury, despite normal conventional MRI and neuropsychological performance.

It has been theorized that pediatric concussion may be primarily a neurophysiologic injury, affecting cerebral blood flow without evidence of measurable structural, metabolic, neuronal, or axonal injury.

The results suggest that pediatric concussion may produce a pathophysiologic process resulting in altered cerebral blood flow, with a variable and possibly protracted time frame for resolution.

The subjects recieved a targeted neuropsychological and parent-report battery focused on attention-related and executive functions and episodic memory. Screening measures for intellect, academic achievement, language, psychomotor skills, and affective/behavioral status were also administered.

There is no discussion  of investigating the neuro-inflammatory factors present in mTBI in the subjects. There is no sleep history evaluated and there is no physical clinical presentation determined in the history.  One of the major areas of concern is the evaluation/observation of neuropsychological status and totally ignoring the neurophysiologic process.

One of the initial  sequelae of head trauma is altered blood flow to the brain and initial triggering of the neuro-inflammatory cascade.  When initially evaluating a concussion there is limited evidence of the necessity of MRI and/or CTScan. The question therefore becomes what procedural methods  or technology  can be used to determine cerebral blood blow as soon as possible after head trauma.
Decreased cerebral blood flow in chronic pediatric mild TBI: an MRI perfusion study. Yang Wang, John D West, Jessica N Bailey, Daniel R Westfall, Hui Xiao, Todd W Arnold, Patrick A Kersey, Andrew J Saykin, Brenna C McDonald. Developmental Neuropsychology 2015, 40 (1): 40-4

We evaluated cerebral blood flow (CBF) in chronic pediatric mild traumatic brain injury (mTBI) using arterial spin labeling (ASL) magnetic resonance imaging perfusion. mTBI patients showed lower CBF than controls in bilateral frontotemporal regions, with no between-group cognitive differences. Findings suggest ASL may be useful to assess functional abnormalities in pediatric mTBI.

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