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J Neurotrauma. 2017 Nov 15;34(22):3097-3106. doi: 10.1089/neu.2017.5020. Epub 2017 Aug 4.

A Prospective Transcranial Doppler Ultrasound-Based Evaluation of the Acute and Cumulative Effects of Sport-Related Concussion on Neurovascular Coupling Response Dynamics.

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1 School of Health and Exercise Sciences, University of British Columbia , Kelowna, British Columbia, Canada .
2 Department of Kinesiology and Applied Physiology, University of Delaware , Newark, Delaware.


Sport-related concussion has been shown to alter cerebral blood flow (CBF) both acutely and chronically, and may exert cumulative effects across multiple injuries. Such dysfunction may be mediated by trauma-induced deficits to CBF control mechanisms, though our understanding of these effects is limited, including dynamics of neurovascular coupling (NVC) responses (i.e., CBF responses to neurologic demand). A total of 179 junior-level contact sport athletes completed preseason testing; 42 reported never having experienced a concussion (Hx-) while 31 had endured three or more (Hx3+). A total of 18 athletes suffered concussions during the study period and were re-tested 3 days, 2 weeks, and 1 month post-injury. NVC dynamics were indexed via CBF velocity in the posterior (PCAv) and middle (MCAv) cerebral arteries during cycles of 20 sec eyes closed and 40 sec eyes open to a visual stimulus (reading). Acutely following concussion, peak rate of PCAv increase during the activation phase was delayed by over 50% and PCAv response magnitude was elevated by over 30%, compared with preseason. Response magnitude remained elevated at 2 weeks despite symptom resolution. Independent medical clearance for full return-to-play was inversely related to the magnitude of increase in the NVC response at 3 days post-injury. No post-injury changes were observed in MCAv, blood pressure, or end-tidal carbon dioxide levels during visual stimulation. No NVC metric differences were observed between the Hx- and Hx3+ groups at preseason. Via multiple potential mechanisms, acute sport-related concussion may induce compensatory alterations in NVC response dynamics that may be related to clinical recovery. Such effects do not appear to be persistent across multiple injuries.


cerebral blood flow; neurovascular coupling; return-to-play; sport-related concussion; transcranial Doppler ultrasound

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