Sex-Based Differences in Transcranial Doppler Ultrasound and Self-Reported Symptoms After Mild Traumatic Brain Injury

Abstract

The possibility of sex-related differences in mild traumatic brain injury (mTBI) severity and recovery remains a controversial subject. With some studies showing that female subjects suffer a longer period of symptom recovery, while others have failed to demonstrate differences. In this study, we explored the sex-related effects of mTBI on self-reported symptoms and transcranial Doppler ultrasound (TCD) measured features in an adolescent population. Fifty-eight subjects were assessed—at different points post-injury—after suffering an mTBI. Subjects answered a series of symptom questions before the velocity from the middle cerebral artery was measured. Subjects participated in breath-holding challenges to evaluate cerebrovascular reactivity. The Pulsatility Index (PI), the ratio of the first peaks (P2R), and the Breath-Hold Index (BHI), were computed. Linear mixed effects models were developed to explore the interactions between measured features, sex, and time since injury while accounting for within subject variation. Over the first 10 days post-injury, the female group had significant interactions between sex and time since injury that was not present in the TCD features. This is the first study to compare sex-related differences in self-reported symptoms and TCD measurements in adolescents suffering an mTBI. It illustrates the pitfalls clinicians face when relying on subjective measures alone during diagnosis and tracking of mTBI patients. In addition, it highlights the need for more focused research on sex-related differences in concussion pathophysiology.

Monitoring of Neuroendocrine Changes in Acute Stage of Severe Craniocerebral Injury by Transcranial Doppler Ultrasound Image Features Based on Artificial Intelligence Algorithm

“…In this study, GCS will be used to evaluate the degree of coma in patients with severe brain injury [ 20 ]. The GCS scale includes three standard scoring systems, namely, optimal eye-opening (maximum: 4 points), optimal language response (maximum: 5 points), and optimal motor response (maximum: 6 points).…”

The Incidence, Cost, and Burden of Concussion in Women’s Rugby League and Rugby Union: A Systematic Review and Pooled Analysis

“…There is a growing body of evidence [29][30][31][32] identifying that following sports-related concussion, female athletes experience greater symptom severity and take longer to recover when compared with male athletes. There is likely a combination of intrinsic and extrinsic factors that contribute to this observed sex difference.…”

Targeting the Cerebrovascular System: Next-Generation Biomarkers and Treatment for Mild Traumatic Brain Injury

“…The information gained from such studies would provide a foundation to rigorously examine the utility of promising interventions that may promote CVI recovery. Another important factor that should be incorporated into future studies is the role of biological sex, particularly considering that initial evidence suggests sex differences in CVI after mTBI (Bai and others 2019; Hamer and others 2020; Major and others 2020; Thibeault and others 2019). In addition, as aging has an influential effect on the deterioration of the cerebrovasculature (Takechi and others 2013; Yang and others 2020), future studies should include both aged and non-aged subjects to investigate CVI after mTBI (Sun and others 2020).…”