Acute and Subacute Changes in Neural Activation during the Recovery from Sport-Related Concussion

Thomas A. Hammeke,1 Michael McCrea,2 Sarah M. Coats,3 Matthew D. Verber,4 Sally Durgerian,5 Kristin Flora,6 Gary S. Olsen,7 Peter D. Leo,5 Thomas A. Gennarelli,2 AND Stephen M. Rao8

1Clement J. Zablocki VA Medical Center & Department of Psychiatry & Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
2Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
3Rehabilitation Institute at St. Mary’s Hospital, Enid, Oklahoma

4Department of Chemistry, University of North Carolina, Chapel Hill, North Carolina 5Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin 6Department of Psychology, Franklin College, Franklin, Indiana
7Department of Neuropsychology, Marshfield Clinic, Marshfield, Wisconsin

8Schey Center for Cognitive Neuroimaging, Neurological Institute, Cleveland Clinic, Cleveland, Ohio (RECEIVED December 21, 2012; FINAL REVISION May 30, 2013; ACCEPTED June 3, 2013)

Abstract

To study the natural recovery from sports concussion, 12 concussed high school football athletes and 12 matched uninjured teammates were evaluated with symptom rating scales, tests of postural balance and cognition, and an event-related fMRI study during performance of a load-dependent working memory task at 13 h and 7 weeks following injury. Injured athletes showed the expected postconcussive symptoms and cognitive decline with decreased reaction time (RT) and increased RT variability on a working memory task during the acute period and an apparent full recovery 7 weeks later. Brain activation patterns showed decreased activation of right hemisphere attentional networks in injured athletes relative to controls during the acute period with a reversed pattern of activation (injured . controls) in the

same networks at 7 weeks following injury. These changes coincided with a decrease in self-reported postconcussive symptoms and improved cognitive test performance in the injured athletes. Results from this exploratory study suggest that decreased activation of right hemisphere attentional networks mediate the cognitive changes and postconcussion symptoms observed during the acute period following concussion. Conversely, improvement in cognitive functioning and postconcussive symptoms during the subacute period may be mediated by compensatory increases in activation of this same attentional network. (JINS, 2013, 19, 1–10) 

Journal of the International Neuropsychological Society (2013), 19, 1–10. Copyright E INS. Published by Cambridge University Press, 2013. doi:10.1017/S135561771300070