Imaging and Treatment Strategies for Persistent Post-Concussive Symptoms Introduction The outpatient management for individuals with persistent post-concussive symptoms is variable and can be frustrating for both...
Imaging and Treatment Strategies for Persistent Post-Concussive Symptoms The outpatient management for individuals with persistent post-concussive symptoms is variable and can be frustrating for both patients, parents and providers. Affected patients or parents of affected children will sometimes request CT scans or MRI scans. For many clinicians, advanced imaging is typically used for prolonged symptoms to rule out any structural abnormalities such as Arnold-Chiari malformations, tumors or hemorrhage.
CT scans historically have been utilized to identify fracture, intracranial hemorrhage, contusion, mass effect and herniation related to head trauma. Conventional MRI scans offer superior visualization of soft tissue brain structures and can detect post traumatic encephalomalacia, reactive gliosis, hemosiderin deposits and microbleeds, although these are only typically seen in more severe forms of TBI, or traumatic brain injury. Some studies have suggested MRI is superior in detecting lesions associated with closed head trauma or TBI (3-4).
There is paucity in data regarding conventional imaging in patient with PPCS. Compared MRI imaging in twenty young adults that sustained a concussion with brief ( 2 weeks used as criteria in this study) and found two total relevant abnormal findings in 32 studies in 23 patients that included MRIs, CT scans and x-rays. There were five incidental findings reported, which included 3 with arachnoid cysts.
This study was done in a university setting and cost a total of more than $129,000 for these two findings. Conventional studies of x-rays, CTs and MRIs are not sensitive in detecting diffuse axonal injury, which has been shown to be commonly associated with mild TBIs. Additionally, CTs and MRIs have been not been shown to correlate with clinical symptoms (10-11).
Due to this, there has been a shift over the past decade investigating advanced imaging such as diffusion tensor imaging, MR-SPECT and functional MRI (fMRI). Diffusion tensor imaging of the brain (courtesy of researchgate.net) Diffuse tensor imaging (DTI) Diffuse tensor imaging (DTI) is an MRI-based imaging technique that can generate images of brain white matter tracts by measuring the the water molecule diffusion within white matter. DTI can also provide information regarding grey matter integrity for indicators of concussion, such as gliosis and necrosis.
If you are experiencing symptoms that may be related to persistent post-concussive symptoms (ppcs): imaging and treatment strategies, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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