Selective head cooling in the acute phase of concussive injury: a neuroimaging study

Alexa E Walter; Xiaoxiao Bai; James Wilkes; Thomas Neuberger; Wayne Sebastianelli; Semyon M Slobounov

doi:10.3389/fneur.2023.1272374

Selective head cooling in the acute phase of concussive injury: a neuroimaging study

Front Neurol. 2023 Oct 27:14:1272374. doi: 10.3389/fneur.2023.1272374. eCollection 2023.

Authors

Alexa E Walter^{1

2}, Xiaoxiao Bai^#³, James Wilkes¹, Thomas Neuberger⁴, Wayne Sebastianelli^{5

6}, Semyon M Slobounov¹

Affiliations

¹ Department of Kinesiology, The Pennsylvania State University, University Park, PA, United States.
² Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States.
³ Social, Life, and Engineering Science Imaging Center, The Pennsylvania State University, University Park, PA, United States.
⁴ Department of Biomedical Engineering, and Social, Life, and Engineering Science Imaging Center, Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA, United States.
⁵ Department of Athletic Medicine, The Pennsylvania State University, University Park, PA, United States.
⁶ Department of Orthopaedics, Penn State Health, State College, PA, United States.

^# Contributed equally.

Abstract

Introduction: Neurovascular decoupling is a common consequence after brain injuries like sports-related concussion. Failure to appropriately match cerebral blood flow (CBF) with increases in metabolic demands of the brain can lead to alterations in neurological function and symptom presentation. Therapeutic hypothermia has been used in medicine for neuroprotection and has been shown to improve outcome. This study aimed to examine the real time effect of selective head cooling on healthy controls and concussed athletes via magnetic resonance spectroscopy (MRS) and arterial spin labeling (ASL) measures.

Methods: 24 participants (12 controls; 12 concussed) underwent study procedures including the Post-Concussion Symptom Severity (PCSS) Rating Form and an MRI cooling protocol (pre-cooling (T1 MPRAGE, ASL, single volume spectroscopy (SVS)); during cooling (ASL, SVS)).

Results: Results showed general decreases in brain temperature as a function of time for both groups. Repeated measures ANOVA showed a significant main effect of time (F = 7.94, p < 0.001) and group (F = 22.21, p < 0.001) on temperature, but no significant interaction of group and time (F = 1.36, p = 0.237). CBF assessed via ASL was non-significantly lower in concussed individuals at pre-cooling and generalized linear mixed model analyses demonstrated a significant main effect of time for the occipital left ROI (F = 11.29, p = 0.002) and occipital right ROI (F = 13.39, p = 0.001). There was no relationship between any MRI metric and PCSS symptom burden.

Discussion: These findings suggest the feasibility of MRS thermometry to monitor alterations of brain temperature in concussed athletes and that metabolic responses in response to cooling after concussion may differ from controls.

Keywords: arterial spin labeling; athletes; concussion; magnetic resonance imaging; magnetic resonance spectroscopy; selective head cooling.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was partially supported by the National Collegiate Athletic Association Grant #106031 for preparation of the final version of this manuscript. No external funding was provided to conduct this research.