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Michael J. Ellis, Patrick J. McDonald, Dean Cordingley, Behzad Mansouri, Marco Essig, and Lesley Ritchie

S ports - related concussion is a form of traumatic brain injury (TBI) that affects millions of North Americans annually. 27 , 60 , 73 Historically, SRC has been viewed as a functional disturbance of cerebral metabolism and blood flow that results in temporary alterations in neurological functioning that resolve within 7–10 days. 68 , 69 More recently, however, increasing attention has focused on the more serious effects of concussion and subconcussive injuries including abnormalities documented on advanced structural neuroimaging studies and the long

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Kelly Russell, Erin Selci, Brian Black, and Michael J. Ellis

more subtle consequences of medical conditions or injuries on patient functioning that may not be captured by more traditional clinical outcome measures. 1 , 35 , 37 One condition that has the potential to result in immediate and long-term impairments in HRQOL is sports-related concussion (SRC). SRC is a form of traumatic brain injury (TBI) that often presents with a combination of symptoms that reflect disturbances in sleep and in physical, cognitive, and emotional functioning. 24 With proper medical assessment, education, and a gradual return to school and sport

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Michael J. Ellis, Dean Cordingley, Sara Vis, Karen Reimer, Jeff Leiter, and Kelly Russell

most common and debilitating symptoms that occur following mild traumatic brain injury (mTBI) in adults are those caused by dysfunction of the vestibular and oculomotor systems. Because of the rich reciprocal connections shared between these 2 neurological subsystems, symptoms of vestibulo-ocular dysfunction (VOD) often overlap and may include dizziness, vertigo, fogginess, motion sensitivity, disequilibrium, postural or gait imbalance, gaze instability, blurred vision, or diplopia. 1 , 11 , 18 , 24 Approximately 50%–90% of adults with mTBI exhibit signs and

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Dean Cordingley, Richard Girardin, Karen Reimer, Lesley Ritchie, Jeff Leiter, Kelly Russell, and Michael J. Ellis

11, 2016, who underwent graded aerobic treadmill testing. To qualify for inclusion in the study, patients had to be 19 years or younger at the time of testing and have a diagnosis of acute SRC or PCS secondary to an SRC. Patients with non–sports-related injuries, those with moderate or severe traumatic brain injuries, and those with traumatic abnormalities detected on clinical neuroimaging studies were excluded. This study was approved by the institutional ethics review board at the University of Manitoba. Definitions The diagnosis of concussion was made

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Michael J. Ellis, Dean M. Cordingley, Sara Vis, Karen M. Reimer, Jeff Leiter, and Kelly Russell

independent predictors of longer recovery following SRC. Although the focused vestibulo-ocular physical examination used in this study may help identify concussion patients who are at risk for PCS, the use of these tools in isolation by healthcare professionals without training in traumatic brain injury may permit other serious causes of visual disturbance to go undiagnosed among these patients. This is exemplified by the accumulating number of reported cases of patients who presented with visual and oculomotor disturbance following minor head injury and SRC that were

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Gerald Dieter Griffin

TO THE EDITOR: The paper by Ellis et al. 1 in the September issue (Ellis MJ, Leiter J, Hall T, et al: Neuroimaging findings in pediatric sports-related concussion. J Neurosurg Pediatr 16: 241–247, September 2015) serves to illustrate the need for “updating” our physician and athletic management community, including the families and individuals with concussion/mild traumatic brain injury (mTBI), on the newer objective radiological brain injury evaluations available today. The retrospective chart review, diagnostic conclusions, and follow-up by a single

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Michael J. Ellis, Lesley J. Ritchie, Mark Koltek, Shahid Hosain, Dean Cordingley, Stephanie Chu, Erin Selci, Jeff Leiter, and Kelly Russell

S ports-related concussion (SRC) is a form of traumatic brain injury (TBI) that affects thousands of children and adolescents annually in Canada and the United States. 42 , 51 The clinical presentation of pediatric SRC is highly individualized and often manifests as a combination of physical, cognitive, sleep, and emotional symptoms. Although many pediatric patients will recover to their neurological baseline within 1–4 weeks with an appropriate amount of physical and cognitive rest, 21%–73% of patients will experience symptoms that last longer than 1

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Michael J. Ellis, Jeff Leiter, Thomas Hall, Patrick J. McDonald, Scott Sawyer, Norm Silver, Martin Bunge, and Marco Essig

S ports-related concussion (SRC) is a form of traumatic brain injury (TBI) representing an emerging public health concern that affects approximately 1.6–3.8 million Americans 26 annually, with a significant proportion occurring in children and adolescents. The clinical presentation of acute SRC among pediatric patients is highly variable, often manifesting as a combination of physical, psychological, sleep, and affective symptoms. The vast majority of these patients will achieve complete neurological recovery within 1–4 weeks; however, 15%–20% will

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W. Alan C. Mutch, Michael J. Ellis, Lawrence N. Ryner, M. Ruth Graham, Brenden Dufault, Brian Gregson, Thomas Hall, Martin Bunge, and Marco Essig

impairments in cerebrovascular responsiveness in patients with cerebrovascular disorders such as stroke and traumatic brain injury (TBI). 1 , 2 , 9 , 10 , 24 , 36 , 37 , 40 To address these issues in concussion, a recent pilot study from our group introduced a novel MRI brain stress test utilizing blood oxygen level–dependent (BOLD) MRI during model-based prospective endtidal (MPET) CO 2 targeting. 41 Using post hoc statistical parametric mapping (SPM), we demonstrated qualitative global and regional alterations in response to CO 2 challenge among individual adults with