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Antonio A. F. DeSalles, Pauline G. Newlon, Yoichi Katayama, C. Edward Dixon, Donald P. Becker, Henry H. Stonnington and Ronald L. Hayes

postconcussive syndrome. Thus, there is at present some evidence of morphopathological and functional alterations that could mediate prolonged disruptions in higher-order function following concussion. Most neurophysiological studies in head injury have investigated the primary responses of neural pathways in relation to specific environmental stimuli. No experimental studies have systematically examined concussive effects on neural processes associated with attentional phenomena. This report describes the application of an evoked potential paradigm toward an evaluation of

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Mark S. Dias, Kathleen A. Lillis, Carmela CALVO, Steven H. Shaha and Veetai Li

minor injuries that no LOC, amnesia, or other symptoms occurred, and others have included children with persistent vomiting or lethargy, posttraumatic seizures, the pediatric postconcussive syndrome, or posttraumatic migraine. The inclusion of various groups of children can obviously affect the outcomes of a study, and one must therefore be exact in defining the study population. Our definition ( Table 2 ) encompassed those children with significant enough head injuries that, previously, we would have admitted them for observation, but excluded those with such minor

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Stefano Signoretti, Roberto Vagnozzi, Barbara Tavazzi and Giuseppe Lazzarino

after concussion and to avoid a second mTBI soon afterward that could lead to a more severe injury. Sports-Related Concussion The outlined experimental results have implications not only for the clinical sequelae associated with postconcussive syndromes, but also support the current concerns regarding athletes in terms of when they should return to play after sustaining a concussion on the field. As we know, athletes often sustain repetitive head impacts, frequently during a short time course consistent with the timing used in the reported studies. Clearly

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Samuel S. Shin, Timothy Verstynen, Sudhir Pathak, Kevin Jarbo, Allison J. Hricik, Megan Maserati, Sue R. Beers, Ava M. Puccio, Fernando E. Boada, David O. Okonkwo and Walter Schneider

without macroscopic lesions . J Neurol Neurosurg Psychiatry 77 : 850 – 855 , 2006 12 Niogi SN , Mukherjee P : Diffusion tensor imaging of mild traumatic brain injury . J Head Trauma Rehabil 25 : 241 – 255 , 2010 13 Niogi SN , Mukherjee P , Ghajar J , Johnson C , Kolster RA , Sarkar R , : Extent of microstructural white matter injury in postconcussive syndrome correlates with impaired cognitive reaction time: a 3T diffusion tensor imaging study of mild traumatic brain injury . AJNR Am J Neuroradiol 29 : 967 – 973 , 2008 14 Niogi

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Nadia Gosselin, Carolina Bottari, Jen-Kai Chen, Sonja Christina Huntgeburth, Louis De Beaumont, Michael Petrides, Bob Cheung and Alain Ptito

, Theoret H , Mongeon D , Messier J , Leclerc S , Tremblay S , : Brain function decline in healthy retired athletes who sustained their last sports concussion in early adulthood . Brain 132 : 695 – 708 , 2009 20 De Beaumont L , Tremblay S , Poirier J , Lassonde M , Théoret H : Altered bidirectional plasticity and reduced implicit motor learning in concussed athletes . Cereb Cortex 22 : 112 – 121 , 2012 21 Dischinger PC , Ryb GE , Kufera JA , Auman KM : Early predictors of postconcussive syndrome in a population of

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Matthew L. Dashnaw, Anthony L. Petraglia and Julian E. Bailes

-Engström E , Flink R , Ungerstedt U , Carlson H , Hillered L : Epileptic seizure activity in the acute phase following cortical impact trauma in rat . Brain Res 637 : 227 – 232 , 1994 67 Niogi SN , Mukherjee P , Ghajar J , Johnson C , Kolster RA , Sarkar R , : Extent of microstructural white matter injury in postconcussive syndrome correlates with impaired cognitive reaction time: a 3T diffusion tensor imaging study of mild traumatic brain injury . AJNR Am J Neuroradiol 29 : 967 – 973 , 2008 68 Nixon RA : The regulation of

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Inga K. Koerte, David Kaufmann, Elisabeth Hartl, Sylvain Bouix, Ofer Pasternak, Marek Kubicki, Alexander Rauscher, David K. B. Li, Shiroy B. Dadachanji, Jack A. Taunton, Lorie A. Forwell, Andrew M. Johnson, Paul S. Echlin and Martha E. Shenton

50 Miles L , Grossman RI , Johnson G , Babb JS , Diller L , Inglese M : Short-term DTI predictors of cognitive dysfunction in mild traumatic brain injury . Brain Inj 22 : 115 – 122 , 2008 51 Niogi SN , Mukherjee P : Diffusion tensor imaging of mild traumatic brain injury . J Head Trauma Rehabil 25 : 241 – 255 , 2010 52 Niogi SN , Mukherjee P , Ghajar J , Johnson C , Kolster RA , Sarkar R , : Extent of microstructural white matter injury in postconcussive syndrome correlates with impaired cognitive reaction time

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Phiroz E. Tarapore, Anne M. Findlay, Sara C. LaHue, Hana Lee, Susanne M. Honma, Danielle Mizuiri, Tracy L. Luks, Geoffrey T. Manley, Srikantan S. Nagarajan and Pratik Mukherjee

T raumatic brain injury is a major cause of morbidity and disability worldwide. In the US, an estimated 1.7 million people sustain a TBI annually. 8 Of these injuries, about 75% are concussions or other forms of mild TBI. 25 Direct and indirect costs of TBI totaled an estimated $60 billion in 2000 for the US alone. 10 Despite the fact that nearly 80% patients with TBI are treated in an emergency department and released, long-term sequelae of even mild TBI such as persistent postconcussive syndrome can occur in up to 25% of patients. 33 However, there

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Julian E. Bailes, Anthony L. Petraglia, Bennet I. Omalu, Eric Nauman and Thomas Talavage

well as clinical studies to determine the effects of concussion, has exponentially increased. 86 In fact, it is now often stated that the mTBI research produced during the past decade supersedes the volume and content of all previous information. An emerging concept is the phenomenon of subconcussive impacts, as new evidence highlights their ubiquity in contact sports and explosive blasts, as well as their potential to contribute to the development of subacute and chronic sequelae such as depression, postconcussive syndrome, posttraumatic stress disorder, mild

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Takeshi Sasaki, Ofer Pasternak, Michael Mayinger, Marc Muehlmann, Peter Savadjiev, Sylvain Bouix, Marek Kubicki, Eli Fredman, Brian Dahlben, Karl G. Helmer, Andrew M. Johnson, Jeffrey D. Holmes, Lorie A. Forwell, Elaine N. Skopelja, Martha E. Shenton, Paul S. Echlin and Inga K. Koerte

individuals within the first 10 days. 37 However, in some individuals a concussion may result in symptoms lasting for more than 3 months, also known as prolonged postconcussive syndrome. 39 Moreover, repeated concussions have been associated with the development of chronic traumatic encephalopathy. 40 To date, diagnosis and management of concussion are largely based on clinically observed or self-reported symptoms. However, this approach is both incomplete and inaccurate because symptoms may either not be reported by the athlete or not be associated with a concussion. 9