Sex differences in outcome following sports-related concussion

Broshek, Donna K.; Kaushik, Tanya; Freeman, Jason; Erlanger, David; Webbe, Frank M.; Barth, Jeffrey T.

doi:10.3171/jns.2005.102.5.0856

Cited by 437 publications

(383 citation statements)

References 28 publications

Supporting

Mentioning

358

Contrasting

Unclassified

Order By: Relevance

“…Another study found that juvenile males and females did not differ on a range of sensorimotor outcomes, which is consistent with our findings of motor‐related deficits in both male and female rats given RmTBI 67. Clinical studies of sex differences following mTBI in high school and collegiate students are currently conflicted; some have reported females are more likely to be cognitively impaired and experience more subjective and objective symptoms,11 while others have reported no differences in the number of symptoms, but sex differences in the type of symptoms experienced 64. Given the significant degree of brain maturation occurring during this critical period of development, sex‐dependent variations, and the differences in symptomology associated with single versus repetitive mTBI, it is not surprising that clinical studies have failed to produce reliable results regarding symptom presentation.…”

Section: Discussionsupporting

confidence: 89%

“…As males and females often report different PCS symptoms,11, 12 understanding whether or not underlying structural or epigenetic changes following mTBI and RmTBI contribute to these heterogeneous outcomes is an important undertaking. Owing to sex differences in brain maturation,7 an injury at a given age has the potential to affect the developmental trajectory of males and females in distinct ways.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Sex matters: repetitive mild traumatic brain injury in adolescent rats

Wright

O’Brien

Shultz

et al. 2017

Ann Clin Transl Neurol

View full text Add to dashboard Cite

ObjectiveWhether sex differences contribute to the heterogeneity of mild traumatic brain injury (mTBI) and repeated mTBI (RmTBI) outcomes in adolescents is unknown. Therefore, this study examined changes in, and differences between, male and female rats following single mTBI and RmTBI.MethodsRats were given a single mTBI, RmTBI (i.e., 3x), or sham injuries. Injuries were administered using a lateral impact model that mimics forces common in human mTBI. After the final injury, rats underwent extensive behavioral testing to examine cognition, motor function, and anxiety‐ and depressive‐like behavior. Postmortem analyses investigated gene expression and structural changes in the brain.ResultsMany of the outcomes exhibited a sex‐dependent response to RmTBI. While all rats given RmTBI had deficits in balance, motor coordination, locomotion, and anxiety‐like behavior, only male rats given RmTBI had short‐term working memory deficits, whereas only females given RmTBI had increased depressive‐like behavior. Volumetric and diffusion weighted MRI analyses found that while RmTBI‐induced atrophy of the prefrontal cortex was greater in female rats, only the male rats exhibited worse white matter integrity in the corpus callosum following RmTBI. Sex‐dependent changes in brain expression of mRNA for glial fibrillary acidic protein, myelin basic protein, and tau protein were also observed following injury.InterpretationThese findings suggest that in adolescent mTBI, sex matters; and future studies incorporating both male and females are warranted to provide a greater understanding of injury prognosis and better inform clinical practice.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Sex matters: repetitive mild traumatic brain injury in adolescent rats

Wright

O’Brien

Shultz

et al. 2017

Ann Clin Transl Neurol

View full text Add to dashboard Cite

show abstract

“…While acute neuroprotective effects of oestrogen have been suggested in a rodent WD impact-acceleration model, 253 exacerbated outcomes following repeated mTBIs in female soccer players indicate complexities. 254 Finally, pediatric populations exhibit different responses to adults experiencing a similar head trauma, 255 and limited studies have been conducted assessing younger populations. 235,236,256,257 Conclusions Long-term cognitive impairments following CNS injury and in neurodegenerative diseases have been associated with prolonged oxidative stress conditions 131,258 and impaired signal conduction along dysmyelinated axons.…”

Section: Barriers To Clinical Translationmentioning

confidence: 99%

Repeated mild traumatic brain injury: potential mechanisms of damage

2016

Cell Transplant

View full text Add to dashboard Cite

Mild traumatic brain injury (mTBI) represents a significant public healthcare concern, accounting for the majority of all head injuries. While symptoms are generally transient, some patients go on to experience long-term cognitive impairments and additional mild impacts can result in exacerbated and persisting negative outcomes. To date, studies using a range of experimental models have reported chronic behavioral deficits in the presence of axonal injury and inflammation following repeated mTBI; assessments of oxidative stress and myelin pathology have thus far been limited. However, some models employed induced acute focal damage more suggestive of moderate-severe brain injury and are therefore not relevant to repeated mTBI. Given that the nature of mechanical loading in TBI is implicated in downstream pathophysiological changes, the mechanisms of damage and chronic consequences of single and repeated closed-head mTBI remain to be fully elucidated. This review covers literature on potential mechanisms of damage following repeated mTBI, integrating known mechanisms of pathology underlying moderate-severe TBIs, with recent studies on adult rodent models relevant to direct impact injuries rather than blast-induced damage. Pathology associated with excitotoxicity and cerebral blood flow-metabolism uncoupling, oxidative stress, cell death, blood-brain barrier dysfunction, astrocyte reactivity, microglial activation, diffuse axonal injury, and dysmyelination is discussed, followed by a summary of functional deficits and preclinical assessments of therapeutic strategies. Comprehensive characterization of the pathology underlying delayed and persisting deficits following repeated mTBI is likely to facilitate further development of therapeutic strategies to limit long-term sequelae.

show abstract

“…[19][20][21] Other research suggests that females may also be at higher risk of concussion and have slower recovery times. [22][23][24] Therefore, more aggressive prevention strategies may be indicated in these groups as well as among adult beginners.…”

Section: Discussionmentioning

confidence: 99%