A high school athlete walks off the football field after a devastating hit. His coach suspects he has sustained a concussion, so he's taken to the hospital. What follows is a battery of tests and physical exam -- culminating in a doctor's diagnosis of a likely concussion.
Now, a new study suggests that a novel imaging technique may cut this process down to a single scan which could definitively tell whether a patient is suffering from a concussion or not.
This technology, known as diffuse tensor imaging (DTI), may help detect concussions after a traumatic brain injury, since approaches like computed tomography (CT) scans and magnetic resonance imaging (MRI) fail to demonstrate evidence of brain abnormalities.
The study, published Friday in the journal Brain Imaging and Behavior, is particularly relevant at a time when more than 2,000 former NFL players have filed a lawsuit asserting that the league has deliberately withheld from its players the link between concussions and its long-term impacts on the brain.
Researchers at the Albert Einstein College of Medicine in New York compared 34 patients who sustained concussions with 30 healthy controls, looking for abnormalities across the entire brain of individual patients. What they found was striking: The diffuse tensor imaging demonstrated unique abnormalities in each individual who had a concussion -- abnormalities that would also be present in the more than 1 million Americans who sustain a concussion each year.
"The way patients manifest certain symptoms is extremely variable," said Dr. Michael Lipton, the study's lead author. "There are lots of differences in symptoms and deficits from concussions that patients have, such as cognitive impairment, anxiety, and headache."
Using the novel approach to imaging, physicians could confirm the unique, telltale signs of a concussion right away.
While the data showing that diffuse tensor imaging can distinguish unique brain abnormalities has been previously reported, the researchers took their study one step further and found that a new way of looking at the information from these scans -- an approach known as functional anisotropy, or FA for short -- can reveal whether the brain may have swelling.
Intriguingly, in a separate group of patients included in the study, people with concussions still had evidence of brain injury over one year after their head injury.
"The unique thing about this study is that there are brain abnormalities [still present] at multiple time points," said Dr. Jeff Bazarian, an associate professor of neurology and neurosurgery at the University of Rochester in Rochester, N.Y. "This highlights that the brain is abnormal on a cellular level for a long time."
Concussions occur mainly from motor vehicle accidents and falls, but can also appear after non-traumatic injuries such as whiplash. More than 300,000 adults and children are affected by sports-related concussions each year.
Although most people who have a concussion have no lasting effects, as many as 30 percent of people suffer from permanent brain damage, resulting in personality changes and memory impairment. In extreme circumstances, concussions, and their long-term repercussions, have been implicated in contributing to the suicides of prominent former NFL players like Junior Seau and Dave Duerson.
The problem is that no effective treatments, other than supportive therapy such as cognitive rehabilitation, currently exist for concussions.
"The treatments focused on biologically repairing the injury have not worked," Lipton said.
Reassuringly, the results of this study may not only help identify patients who sustain concussions, but may also, according to Lipton, offer a window into which types of interventions would be most effective.
"If someone comes up with an accurate biomarker of brain injury... that would open the door to studying drugs and other treatments that could potentially help brain injury," Bazarian said.
In general, Lipton said, this study raises awareness that even seemingly benign head injuries can lead to widespread brain abnormalities.
"A concussion which is seemingly quite mild is accompanied by real changes," he said.