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Int J Sports Med. 2019 Sep 10. doi: 10.1055/a-0958-9548. [Epub ahead of print]

MRI Brain Changes After Marathon Running: Results of the Berlin Beat of Running Study.

Author information

Department of Neurology, Charité, Universitätsmedizin Berlin, Berlin, Germany.
Center for Stroke Research, Charité Universitätsmedizin Berlin, Berlin, Germany.
Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany.
SMS Medical Institute Berlin GmbH, Berlin, Germany.
SCC EVENTS GmbH, Berlin, Germany.
Carl Remigius Medical School, Physician Assistance, Hamburg, Germany.
Berlin Academy of Sports Medicine, Sports Medicine, Berlin, Germany.
Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.
Clinical Trial Center Würzburg, University of Würzburg, Würzburg, Germany.
Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.
Department of Cardiology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.
Charité Universitätsmedizin Berlin, German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.
Charité Universitätsmedizin Berlin, Excellence Cluster NeuroCure, Berlin, Germany.
German Center for Cardiovascular Research (DZHK), Berlin, Germany.
Department of Neurology, Jüdisches Krankenhaus Berlin, Berlin, Germany.


Several studies report neurological complications such as brain injury induced by ischemia or edema following exhaustive endurance sport. We aimed to detect the frequency of acute brain lesions after a marathon race. In the prospective observational Berlin Beat of Running study, 110 experienced endurance athletes underwent 3-Tesla brain MRI exams 2-3 days prior and within 2 days after a marathon run. MRI results were compared to an age- and sex-matched control group of 68 non-athletes, including the "Age-Related White Matter Changes" (ARWMC) scale to assess white matter lesions (WML) in the brain. 108 athletes (median age 48 years, 24% female, 8% with hypertension; 0% with diabetes) completed the race. No athlete reported neurological deficits, but a single acute ischemic lesion was detected in diffusion-weighted MRI after the race in one athlete. No other acute brain lesions compared to prior MRI were found. An ARWMC score ≥4 was found in 15% of athletes and 12% of non-athletic controls (p=0.7). Chronic ischemic lesions were not found in athletes but in four controls (6%) (p=0.02). In conclusion, acute ischemic brain lesions may be found in endurance runners. Every seventh endurance athlete and every ninth control showed evidence for substantial white matter lesions.


Conflict of interest statement

CK, JH, JL, HH, TL and WH report no conflict of interest. KGH received lecture honoraria from Bayer HealthCare, Sanofi-Aventis, Pfizer, Bristol-Myers Squibb, Boehringer Ingelheim, Daiichi Sankyo, Medtronic; honoraria for consulting from Edwards Lifesciences, Bayer HealthCare, Pfizer, EIP Pharma as well as research grants from Bayer HealthCare and Sanofi-Aventis. ME report lecture fees and study grants paid to the Charité from Sanofi-Aventis and Bayer Vital GmbH. MK received consulting, lecture and advisory board fees from ALK, Berlin Chemie, Novartis, Mundipharma and Teva. LB reports research support from German Federal Ministry of Research and Education, Else Kröner-Fresenius-Foundation, contract research from the Max Planck Institute for Human Development (Department Lifespan Psychology), Berlin and analyze & realize GmbH, Berlin. PUH reports grants from German Ministry of Research and Education, German Research Foundation, European Union, Federal Joint Committee (G-BA) within the Innovationfond, Charité–Universitätsmedizin Berlin, Berlin Chamber of Physicians, German Parkinson Society, University Hospital Würzburg, Robert Koch Institute, German Heart Foundation, University Göttingen (within FIND-AF randomized, supported by an unrestricted research grant to the University Göttingen from Boehringer-Ingelheim), University Hospital Heidelberg (within RASUNOA-prime, supported by an unrestricted research grant to the University Hospital Heidelberg from Bayer, BMS, Boehringer-Ingelheim, Daiichi Sankyo), grants from Charité–Universitätsmedizin Berlin (within Mondafis, supported by an unrestricted research grant to the Charité from Bayer), outside the submitted work. JBF has received consulting, lecture, and advisory board fees from BioClinica, Cerevast, Artemida, Brainomix, and Lundbeck. GJJ serves as a consultant for Cipio Partners (Munich, Germany) and Elron (Tel Aviv, Israel).

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