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A pediatric perspective on concussion pathophysiology

Choe, Meeryo C.a; Babikian, Talinb; DiFiori, Johnc,d; Hovda, David A.e,f; Giza, Christopher C.a,e

doi: 10.1097/MOP.0b013e32835a1a44
NEUROLOGY: Edited by Scott L. Pomeroy and Robert C. Tasker

Purpose of review According to recent Centers for Disease Control (CDC) data, the annual incidence of traumatic brain injury (TBI) in the United States is 1.6–3.2 million, of which the majority is classified as mild. Over half of these injuries occur in the pediatric population, and can often be attributed to a sports-related mechanism. Although postconcussion symptoms are usually short-lived, more lasting deficits can occur, which can be particularly disruptive to the developing brain. Recent literature detailing the pathophysiology of mild TBI (mTBI), with attention to pediatric studies, is presented.

Recent findings Although concussion generally does not produce any structural damage on conventional computed tomography (CT) or MRI, advanced neuroimaging modalities reveal microstructural and functional neurobiological changes. Diffuse axonal injury, metabolic impairment, alterations in neural activation and cerebral blood flow perturbations can occur and may contribute to acute symptomatology. Although these physiological changes usually recover to baseline in 7–10 days, sustaining recurrent injury before full recovery may increase the potential for persistent deficits.

Summary Understanding the pathophysiology of concussion in the pediatric population can potentially open therapeutic avenues to decrease symptom persistence and prevent further injury. Future studies in the pediatric population are necessary given the pathophysiologic differences between the developing and adult brains.

aDepartment of Pediatrics, Division of Pediatric Neurology, David Geffen School of Medicine and Mattel Children's Hospital at UCLA

bDepartment of Psychiatry and Biobehavioral Sciences, Division of Child and Adolescent Psychiatry

cDepartment of Family Medicine, Division of Sports Medicine

dDepartment of Orthopaedics, David Geffen School of Medicine at UCLA; UCLA Department of Intercollegiate Athletics

eDepartment of Neurosurgery

fMolecular and Medical Pharmacology, UCLA Brain Injury Research Center, California, USA

Correspondence to Meeryo Christa Choe, MD, Division of Pediatric Neurology, Department of Pediatrics, David Geffen School of Medicine at UCLA, 22-474 MDCC, 10833 LeConte Ave, Los Angeles, CA 90095-1752, USA. Tel: +1 310 825 6196; fax: +1 310 825 5834; e-mail: mchoe@mednet.ucla.edu

© 2012 Lippincott Williams & Wilkins, Inc.