Cerebral blood flow alterations in brain regions associated with cardiovascular autonomic control following mild traumatic brain injury: an arterial spin labelling study  — The Association Specialists
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Cerebral blood flow alterations in brain regions associated with cardiovascular autonomic control following mild traumatic brain injury: an arterial spin labelling study  (21439)

Jacinta Thorne 1 2 3 , Sarah C Hellewell 1 2 , Gill Cowen 4 5 , Jun Chih 4 , Michael Bynevelt 6 , Anoek Van Houselt 7 , Aleksandra Gozt 8 , Andre Avila 1 2 5 , Caerwen Beaton 1 2 5 , Melissa Papini 1 2 5 , Francesca Buhagiar 9 , Amanda Jefferson 5 , Elizabeth Thomas 4 , Alexander Ring 3 , Antonio Celenza 10 , Glenn Arendts 10 , Melissa Licari 11 , Dan Xu 5 , Stephen Honeybul 12 , Suzanne Robinson 13 , Carmela Pestell 9 , Daniel Fatovich 14 , Melinda Fitzgerald 1 2
  1. Perron Institute for Neurological and Translational Science , Nedlands, WA, Australia
  2. Curtin Health Innovation Research Institute, Curtin University , Bentley, WA, Australia
  3. School of Allied Health , Curtin University , Bentley, WA, Australia
  4. School of Population Health , Curtin University, Bentley, WA, Australia
  5. Curtin Medical School , Curtin University , Bentley , WA, Australia
  6. Neurological Intervention and Imaging Service, Sir Charles Gairdner Hospital , Perth, WA, Australia
  7. Curtin University, Nedlands, WA, Australia
  8. Connectivity Traumatic Brain Injury Australia, Nedlands, WA, Australia
  9. School of Psychological Science , University of Western Australia, Nedlands, WA, Australia
  10. Division of Emergency Medicine, University of Western Australia, Nedlands, WA, Australia
  11. Telethon Kids Institute, Nedlands, WA, Australia
  12. Department of Neurosurgery , Sir Charles Gairdner Hospital , Nedlands, WA, Australia
  13. School of Health and Development , Deakin University , Melbourne, VIC, Australia
  14. Emergency Medicine, Royal Perth Hospital , Perth, WA, Australia

Purpose: Following mild traumatic brain injury (mTBI) some individuals experience heart rate (HR) alterations and exercise intolerance(1,2). It is postulated these alterations are related to autonomic nervous system dysfunction and impaired cerebral blood flow (CBF)(3), yet the neurobiological mechanisms remain unclear.

Methods: Prospective observational study of 30 adults aged 18-65 years within ten days of mTBI, and 33 age- and sex-matched controls. HR and exercise intolerance were assessed using the Buffalo Concussion Bike Test(4), and symptoms using the Post-Concussion Symptom Scale(5). Pseudo-continuous arterial spin labelling was used to examine the relationship between CBF in brain regions recognised for their role in cardiovascular autonomic response (insular cortex, anterior cingulate cortex (ACC) and amygdala)(6,7), with resting HR and exercise intolerance.

Results: Resting HR (p=0.042) and HR change (p=0.004) were significantly lower for mTBI participants than controls. CBF was increased in the right insula (p=0.027) and right amygdala (p=0.025) in people who had recently sustained mTBI compared to controls. A positive association between resting HR and CBF in the left insula (r=0.378, p=0.033) and right ACC (r=0.423, p=0.016) was identified for controls, but not mTBI participants. Similarly, a positive association was observed between CBF in the left insula and right ACC and both symptom severity and autonomic-type symptoms in controls, but not following mTBI.

Conclusion:  This study provides preliminary evidence that the natural regulatory relationship between CBF and resting HR may be disrupted in brain regions involved in cardiovascular autonomic control following mTBI.

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