Cerebrovascular reactivity impairment after sport-induced concussion.

PURPOSE This study evaluated cerebrovascular reactivity (CVR) after a sport-induced concussion, also called mild traumatic brain injury (mTBI), by monitoring middle cerebral artery blood velocity (vMCA) with transcranial Doppler ultrasonography and simultaneous end-tidal carbon dioxide (PETCO(2)) measurements. METHODS Thirty-one athletes (16-25 yr old) participated in this study. The participants were divided into two groups-healthy (n = 21) and mTBI (n = 10). Participants in the mTBI group suffered an mTBI within the last 7 d (x- = 4.5 ± 1.1 d). Outcome measures included vMCA and PETCO(2) in response to breath holding (5 × 20 s, 40-s rest) and hyperventilation (5 × 20 s, 40-s rest). RESULTS Resting vMCA values between groups were not significantly different. Percentage change of vMCA was significantly different after the recovery period of the second hyperventilation (P = 0.034). mTBI subjects failed to return to resting levels after each breath hold. PETCO(2) changes mirrored the vMCA changes. CONCLUSIONS These data suggest that normal CVR responses may be disrupted in the days immediately after occurrence of mTBI. Transcranial Doppler ultrasonography combined with expired gas measurements provides a useful method for assessing CVR impairment after mTBI. Further research, including serial monitoring after mTBI and analysis of CVR response to exercise, is warranted before any firm conclusions can be drawn.