What is an LP or a lumbar puncture? What is a spinal tap?

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What is a Lumbar Puncture

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Study: Concussions take longer to heal from than previously believed

A study analysed people's cerebrospinal fluid to show that it takes longer to heal from concussions than previously believed.

Scientists at the Sahlgrenska Academy, University of Gothenburg, have shown that analysis of the cerebrospinal fluid after concussion can be used to determine the magnitude of brain injury and to follow its course. The studies show that recovery from concussion takes much longer time than previously known, and this may be of major significance for athletes of all ages in return to play considerations.

Sanna Neselius is a scientist at the Sahlgrenska Academy and member of the medical commission of the Swedish Boxing Federation. Her previous studies have shown that amateur boxing causes damage to nerve cells, that can take more than two weeks to heal. This discovery led to her being offered a place in the International Olympic Committee's expert group for boxing-related head injuries.

Sanna Neselius has now defended her doctoral thesis at the Sahlgrenska Academy, in which she shows that sports-related concussion heals much slower than previously known.

Four months recovery

"It has previously been believed that concussion heals in 7-10 days, and the Swedish Boxing Federation has decided the rest period to be of one month after a concussion, in order to be on the safe side. But our studies show that a concussion, such as may be experienced after being knocked out, can take more than four months to heal," says Sanna Neselius, who is herself a former boxer.

Further, the results show that repetitive head trauma in boxing, damages nerve cells in the brain, even though the boxer may not show any concussion symptoms.

Prevent resuming too early

Concussion is one of the most common sports-related injuries, and more athletes experience it every year. In recent years, focus has been directed on the effects of repeated concussions, in which athletes in such sports as ice hockey may be affected by long-term effects.

The cerebrospinal fluid samples analysed by Sanna Neselius and her colleagues can be followed until normalization and thereby be a valuable tool to prevent athletes resuming sport too early.

"The assessment today is often based on physical symptoms, neuropsychological tests, and the neurological examination of the athlete. Our studies show that these tests are not sensitive enough, nor can we rely on the athletes self-reported lack of symptoms. Concussion symptoms usually pass after a few days, but the neurological damage may still be present," says Sanna Neselius.

Safe rehabilitation

She continues: "The first sample is recommended to be taken 10-14 days after the concussion. This allows us to see the magnitude of the injury, and gives an idea of how long the healing process will be. I hope that brain injury markers in the cerebrospinal fluid, and hopefully also later in blood, can be used at all levels in all sports. By this we can use individual measurements to plan and guarantee safe rehabilitation."

Sanna Neselius points out that the brains of children and adolescents are more sensitive and require longer time to heal.

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Hot weather may play a role in concussions - Even a 2 percent loss in body volume is important!

A study showed that hot weather and dehydration can increase a person's chance of having a concussion.

A loss of just two percent of the body's water volume to dehydration -- a feat easily achieved during prolonged exercise in hot weather -- can lead to a significant reduction in the amount of cerebrospinal (CSF) fluid that a person has. CSF acts as a cushion to protect the brain from hitting against the inside of the skull during jarring movements. For football players, games conducted in hot and humid conditions could present the perfect storm of risk factors to up their chances for a concussion.

Researchers at the University of Windsor investigated whether the incidence of concussion increased along with the temperature. J. Craig Harwood presented the research team's findings in a poster session on Monday, April 28, at the Experimental Biology Meeting. Experimental Biology is an annual meeting comprised of more than 14,000 scientists and exhibitors from six sponsoring societies and multiple guest societies. With a mission to share the newest scientific concepts and research findings shaping current and future clinical advances, the meeting offers an unparalleled opportunity for exchange among scientists from throughout across the United States and the world who represent dozens of scientific areas, from laboratory to translational to clinical research.www.experimentalbiology.org

Harwood et al. compiled data on 420 NCAA FBS game-time concussions that occurred during games played outside over a five year period (2008-2012). They also looked at environmental conditions (temperature, humidity, and wind speed) during those games.

From the authors: "The relationship between hydration status and injury occurrence, such as skeletal muscle cramps, is well known, but more information is needed regarding physiological status and the risk of more severe injury like concussion. We were initially interested in the link between dehydration and concussion frequency/severity, however this type of observation was obviously problematic (e.g., measuring game time hydration status in thousands of athletes prior to head injury). Hydration status was unknown, and factors like helmet function (which is compromised in cold conditions) may hide true differences.

We hypothesized that if a relationship existed, we would be able to observe an increase in concussion frequency during games that took place under extreme conditions. But given the primary playing season (i.e., Fall), very few games were played in environmental extremes. Additionally, the high level of competition likely insured that athletes were well prepared for games in all conditions. In the end, the overall rates of concussions were consistent across game time temperatures, but a link between dehydration and concussion rate may still exist.

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Biomarkers predict outcomes for children's brain injuries

Biomarkers found in cerebrospinal fluid can predict outcomes for pediatric traumatic brain injuries.

The study aims to systematically review the literature on brain injury biomarkers, defined as any injury biomarker detected in cerebrospinal fluid (CSF) or blood injury biomarkers primarily expressed in the brain parenchyma, to determine outcome prediction in pediatric severe traumatic brain injury (sTBI). Based on the status of current sTBI biomarker research, the authors recommend that future research should be directed at both novel biomarker discovery and validation of biomarker panels in large, well–designed longitudinal studies.

Methods

• A search of MEDLINE, EMBASE, PsycINFO, Pubmed, and the Cochrane Database, as well as grey literature sources, personal contacts, hand searches, and reference lists.
• The search terms used were traumatic brain injury, biomarkers, prognosis, and children.
• No language, publication type, or publication date restrictions were imposed.
• All articles were critically reviewed by two clinicians independently.

Results

• A total of 7,150 articles were identified initially with 16 studies identified for review.
• Eighteen different biomarkers were examined; 11 in CSF and 7 in blood.
• Outcomes assessed included either in–hospital mortality or functional state (hospital discharge, 3–months or 6–months; Glasgow Outcome Scale or Pediatric Cerebral Performance Category).
• Significant correlations were established between sTBI outcomes and various biomarkers in CSF (IL–6, IL–8, IL–1β, S100β, NGF, NSE, DCX, ET–1, HMGB–1, cytochrome C) and blood (GFAP, NF–H, UCH–L1, SBDP–145, leptin).
• Mixed results were obtained for blood S100β.
• Outcome did not correlate with several biomarkers in either CSF (BDNF, GDNF, α–Syn) or blood (NSE, MBP).
• The Class of Evidence was considered II in 1 study and III in the remaining 15 studies.

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