T2* reduction in patients with acute post-traumatic headache

Objectives Although iron accumulation in pain-processing brain regions has been associated with repeated migraine attacks, brain structural changes associated with post-traumatic headache have yet to be elucidated. To determine whether iron accumulation is associated with acute post-traumatic headache, magnetic resonance transverse relaxation rates (T2*) associated with iron accumulation were investigated between individuals with acute post-traumatic headache attributed to mild traumatic brain injury and healthy controls. Methods Twenty individuals with acute post-traumatic headache and 20 age-matched healthy controls underwent 3T brain magnetic resonance imaging including quantitative T2* maps. T2* differences between individuals with post-traumatic headache versus healthy controls were compared using age-matched paired t-tests. Associations of T2* values with headache frequency and number of mild traumatic brain injuries were investigated using multiple linear regression in individuals with post-traumatic headache. Significance was determined using uncorrected p-value and cluster size threshold. Results Individuals with post-traumatic headache had lower T2* values compared to healthy controls in cortical (bilateral frontal, bilateral anterior and posterior cingulate, right postcentral, bilateral temporal, right supramarginal, right rolandic, left insula, left occipital, right parahippocampal), subcortical (left putamen, bilateral hippocampal) and brainstem regions (pons). Within post-traumatic headache subjects, multiple linear regression showed a negative association between T2* in the right inferior parietal/supramarginal regions and number of mild traumatic brain injuries and a negative association between T2* in bilateral cingulate, bilateral precuneus, bilateral supplementary motor areas, bilateral insula, right middle temporal and right lingual areas and headache frequency. Conclusions Acute post-traumatic headache is associated with iron accumulation in multiple brain regions. Correlations with headache frequency and number of lifetime mild traumatic brain injuries suggest that iron accumulation is part of the pathophysiology or a marker of mild traumatic brain injury and post-traumatic headache.

Maintaining Medical Resources to Treat Paediatric Injuries during COVID-19 Lockdown Is Essential—An Epidemiological Analysis of a Level 1 Trauma Centre in Central Europe

Background: This study examined the effect of the COVID-19 pandemic and the resulting decrease in the incidence of various categories of injuries, with the main focus on fractures and mild traumatic brain injuries in a paediatric population. Methods: This retrospective cohort study evaluated all children from 0 to 18 years of age presenting with an injury at the level 1 trauma centre of the University Clinic of Orthopaedics and Trauma Surgery in Vienna during the lockdown from 16 March to 29 May 2020 compared to records over the same timeframe from 2015 to 2019. Results: In total, 14,707 patients with injuries were included. The lockdown did not lead to a significant decrease in fractures but, instead, yielded a highly significant increase in mild traumatic brain injuries when compared to all injuries that occurred (p = 0.082 and p = 0.0001) as well as acute injuries (excluding contusions, distortions and miscellaneous non-acute injuries) (p = 0.309 and p = 0.034). Conclusions: The percentage of paediatric fractures did not decrease at the level 1 trauma centre, and a highly significant proportional increase in paediatric patients with mild traumatic brain injuries was observed during the COVID-19 lockdown. Therefore, medical resources should be maintained to treat paediatric trauma patients and provide neurological monitoring during pandemic lockdowns.

Evaluation of Common Concussion Tools Used in a Sport’s Setting

Sports medicine advancements are continuously evolving allowing professionals to utilize tools to provide for their athletes’ care. These tools have allowed clinicians to better diagnose and determine the extent of an athlete’s injury. Over the last 20 years, an emphasis has been placed on mild traumatic brain injuries (mTBI) and/or concussions. This focus on mTBI and concussions has led to an understanding of the mechanism of injury (MOI), development of grading/severity scales of injury, and diagnostic tools for properly assessing an athlete suffering from an injury to the brain. Clinicians understanding of concussion has excelled in recent years, but with advancement in technologies and diagnostic tools, all professionals need to understand the importance of incorporating tools into the diagnostic procedure. Thus, the purpose of this review is to evaluate common tools in practice, as well as newer tools, that could be utilized by sports medicine professionals.

Evaluation of Common Concussion Tools Used in a Sport’s Setting

Sports medicine advancements are continuously evolving allowing professionals to utilize tools to provide for their athletes’ care. These tools have allowed clinicians to better diagnose and determine the extent of an athlete’s injury. Over the last 20 years, an emphasis has been placed on mild traumatic brain injuries (mTBI) and/or concussions. This focus on mTBI and concussions has led to an understanding of the mechanism of injury (MOI), development of grading/severity scales of injury, and diagnostic tools for properly assessing an athlete suffering from an injury to the brain. Clinicians understanding of concussion has excelled in recent years, but with advancement in technologies and diagnostic tools, all professionals need to understand the importance of incorporating tools into the diagnostic procedure. Thus, the purpose of this review is to evaluate common tools in practice, as well as newer tools, that could be utilized by sports medicine professionals.