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Transcranial Doppler Ultrasound for Concussion in Amateur Athletes
Charles Tegeler, Jong Yeol Kim, Greg Collins, Don Steelman, Winston-Salem, NC; Kevin Westwood, Lewisville, NC; Patrick Reynolds, David Martin, Jason Greenberg, and David Stump, Winston-Salem, NC.
Background: There are 300,000 sports-related concussions (SRC) in the USA yearly. Most are mild and brief, but deficits can be severe or persistent, especially with repeat SRC. Return to play decisions (RTPD) are based on symptoms, symptom-based guidelines, or neurophysiological testing (NPSY). A mismatch in brain metabolism (increased) and blood flow (decreased) has been suggested. Response and function of cerebral vessels after SRC is poorly understood but may be important regarding RTDP. Transcranial Doppler ultrasound (TCD) is safe, noninvasive, and can study cerebral hemodynamicsand responsiveness. The pilot study assesses TCD changes after SRC in amateur athletes.
Methods: TCD testing at rest and with continuous bilateral MCA monitoring during hyperventilation, breath holding, and leg up tilt; a neurological exam; and computerized NPSY (ImPACT) were done at baseline and following SRC in 91 athletes at Wake Forest University (82 football, 1 soccer) and Forsyth Country Day School (4 football, 4 soccer).
Results: Thus far, there are 8 SRCs (3 with baseline testing). NPSY showed impairment after all SRC. Initial TCD analysis shows differnces in response to breath holding after SRC.
Conclusion: This work-in-progress pilot study shows that TCD is feasible in amateur athletes at risk for SRC and can assess cerebral hemodynamics and responsiveness. Initial results suggest differnces in response to breath-holding after SRC. TCD may reveal pathophysiological mechanisms of SRC, identify opportunities for acute treatments, and provide an additional objective measure to assist with return-to-play decisions.
Supported in part by the William M.McKinney Neurosonology Fund.
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