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Sport-Related Concussion: Neuroimaging, Biomarker, Vestibular and Neuropsychological Studies

Gard, Anna LU (2024) In Lund University, Faculty of Medicine Doctoral Dissertation Series
Abstract (Swedish)
A sport-related concussion (SRC) is caused by a force transmitted to the brain during sports, and may lead to long-term disabilities and neurodegeneration. The underlying pathophysiological mechanisms causing persistent post-concussive symptoms (PPCS) lasting beyond the normal four-week period, have not been established. The aim of this thesis was to investigate mechanisms of persistent symptoms including vestibular dysfunction, white matter pathology and neuroinflammation in SRC athletes and PPCS. A retrospective cohort (Paper I) of ice hockey players retired due to SRC and prospective cohorts (Paper II-IV) of athletes with SRC and PPCS ≥ six months, were analysed. Athletes in Paper II-IV had severe PPCS and cognitive... (More)
A sport-related concussion (SRC) is caused by a force transmitted to the brain during sports, and may lead to long-term disabilities and neurodegeneration. The underlying pathophysiological mechanisms causing persistent post-concussive symptoms (PPCS) lasting beyond the normal four-week period, have not been established. The aim of this thesis was to investigate mechanisms of persistent symptoms including vestibular dysfunction, white matter pathology and neuroinflammation in SRC athletes and PPCS. A retrospective cohort (Paper I) of ice hockey players retired due to SRC and prospective cohorts (Paper II-IV) of athletes with SRC and PPCS ≥ six months, were analysed. Athletes in Paper II-IV had severe PPCS and cognitive impairments.

Paper I: Seventy-six former ice hockey players were assessed at a mean of five years after their latest SRC and were found to have a high symptom burden and a reduced quality of life.
Paper II: Twenty-one athletes with PPCS and 21 matched controls were evaluated. The athletes had a peripheral vestibular dysfunction suggesting an injury to the inferior vestibular nerve.
Paper III: Twenty-four athletes with PPCS and 12 controls were included. The athletes had increased levels of eight cerebrospinal fluid (CSF inflammatory biomarkers (IL-2, TNF-α, IL-15, TNF-β, VEGF, Eotaxin, IP-10, and TARC), and decreased levels of Eotaxin-3.
Paper IV: Twenty-two athletes with PPCS, and 22 controls were included. On diffusion imaging PPCS athletes had diverging metrics in 28% of analysed white matter tracts, which correlated with the CSF axonal injury marker neurofilament light.

Athletes with SRC and PPCS suffer long-term disabilities and reduced quality of life. We found evidence of injury to the inferior vestibular nerve, a persistent CSF neuroinflammation, and widespread white matter alterations. These results emphasize that repeated concussions may trigger prolonged injury processes in the brain, which potentially contributes to the persistent symptoms observed in these athletes. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Professor Iverson, Grant, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States
organization
alternative title
Idrottsrelaterad hjärnskakning: Neuroradiologiska, biomarkör, balans och neuropsykologiska studier
publishing date
type
Thesis
publication status
published
subject
keywords
Sport-related concussion, persistent post-concussive symptoms, traumatic brain injury, Ultra-high field MRI, White matter injury, neuroinflammation
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
issue
2024:103
pages
100 pages
publisher
Lund University, Faculty of Medicine
defense location
Segerfalksalen, BMC A10, Sölvegatan 17 i Lund. Join by Zoom: https://lu-se.zoom.us/j/62977679402
defense date
2024-11-22 13:00:00
ISSN
1652-8220
ISBN
978-91-8021-599-2
language
English
LU publication?
yes
id
b2e9f072-a420-4e7f-ba52-55ef6bef85f4
date added to LUP
2024-10-10 10:33:52
date last changed
2025-04-04 14:59:20
@phdthesis{b2e9f072-a420-4e7f-ba52-55ef6bef85f4,
  abstract     = {{A sport-related concussion (SRC) is caused by a force transmitted to the brain during sports, and may lead to long-term disabilities and neurodegeneration. The underlying pathophysiological mechanisms causing persistent post-concussive symptoms (PPCS) lasting beyond the normal four-week period, have not been established. The aim of this thesis was to investigate mechanisms of persistent symptoms including vestibular dysfunction, white matter pathology and neuroinflammation in SRC athletes and PPCS. A retrospective cohort (Paper I) of ice hockey players retired due to SRC and prospective cohorts (Paper II-IV) of athletes with SRC and PPCS ≥ six months, were analysed. Athletes in Paper II-IV had severe PPCS and cognitive impairments.<br/><br/>Paper I: Seventy-six former ice hockey players were assessed at a mean of five years after their latest SRC and were found to have a high symptom burden and a reduced quality of life. <br/>Paper II: Twenty-one athletes with PPCS and 21 matched controls were evaluated. The athletes had a peripheral vestibular dysfunction suggesting an injury to the inferior vestibular nerve.<br/>Paper III: Twenty-four athletes with PPCS and 12 controls were included. The athletes had increased levels of eight cerebrospinal fluid (CSF inflammatory biomarkers (IL-2, TNF-α, IL-15, TNF-β, VEGF, Eotaxin, IP-10, and TARC), and decreased levels of Eotaxin-3.<br/>Paper IV: Twenty-two athletes with PPCS, and 22 controls were included. On diffusion imaging PPCS athletes had diverging metrics in 28% of analysed white matter tracts, which correlated with the CSF axonal injury marker neurofilament light. <br/><br/>Athletes with SRC and PPCS suffer long-term disabilities and reduced quality of life. We found evidence of injury to the inferior vestibular nerve, a  persistent CSF neuroinflammation, and widespread white matter alterations. These results emphasize that repeated concussions may trigger prolonged injury processes in the brain, which potentially contributes to the persistent symptoms observed in these athletes.}},
  author       = {{Gard, Anna}},
  isbn         = {{978-91-8021-599-2}},
  issn         = {{1652-8220}},
  keywords     = {{Sport-related concussion; persistent post-concussive symptoms; traumatic brain injury; Ultra-high field MRI; White matter injury; neuroinflammation}},
  language     = {{eng}},
  number       = {{2024:103}},
  publisher    = {{Lund University, Faculty of Medicine}},
  school       = {{Lund University}},
  series       = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
  title        = {{Sport-Related Concussion: Neuroimaging, Biomarker, Vestibular and Neuropsychological Studies}},
  url          = {{https://lup.lub.lu.se/search/files/197009466/e-spik_ex_anna.pdf}},
  year         = {{2024}},
}