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Article ; Online: The Pathophysiology of Concussion.

Choe, Meeryo C

2016 Volume 20, Issue 6, Page(s) 42

Abstract: Concussion is a significant issue in medicine and the media today. With growing interest on the long-term effects of sports participation, it is important to understand what occurs in the brain after an impact of any degree. While some of the basic ... ...

Abstract	Concussion is a significant issue in medicine and the media today. With growing interest on the long-term effects of sports participation, it is important to understand what occurs in the brain after an impact of any degree. While some of the basic pathophysiology has been elucidated, much is still unknown about what happens in the brain after traumatic brain injury, particularly with milder injuries where no damage can be seen at the structural level on standard neuroimaging. Understanding the chain of events from a cellular level using studies investigating more severe injuries can help to drive research efforts in understanding the symptomatology that is seen in the acute phase after concussion, as well as point to mechanisms that may underlie persistent post-concussive symptoms. This review discusses the basic neuropathology that occurs after traumatic brain injury at the cellular level. We also present the pathology of chronic traumatic encephalopathy and its similarities to other neurodegenerative diseases. We conclude with recent imaging and biomarker findings looking at changes that may occur after repeated subconcussive blows, which may help to guide efforts in understanding if cumulative subconcussive mechanical forces upon the brain are detrimental in the long term or if concussive symptoms mark the threshold for brain injury.
MeSH term(s)	Athletic Injuries/complications ; Athletic Injuries/diagnostic imaging ; Athletic Injuries/physiopathology ; Brain Concussion/complications ; Brain Concussion/diagnostic imaging ; Brain Concussion/physiopathology ; Evidence-Based Medicine ; Humans ; Neurocognitive Disorders/diagnostic imaging ; Neurocognitive Disorders/etiology ; Neurocognitive Disorders/physiopathology ; Neuroimaging ; Neurologic Examination ; Prognosis ; Recovery of Function ; Risk Factors ; Sports
Language	English
Publishing date	2016-06
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2055062-5
ISSN	1534-3081 ; 1531-3433
ISSN (online)	1534-3081
ISSN	1531-3433
DOI	10.1007/s11916-016-0573-9
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Post-Concussive Orthostatic Tachycardia is Distinct from Postural Orthostatic Tachycardia Syndrome (POTS) in Children and Adolescents.

Pearson, Rachel / Sheridan, Christopher A / Kang, Kaylee / Brown, Anne / Baham, Michael / Asarnow, Robert / Giza, Christopher C / Choe, Meeryo C

Child neurology open

2022 Volume 9, Page(s) 2329048X221082753

Abstract: Background: ...

Abstract	Background:
Language	English
Publishing date	2022-03-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	2785453-X
ISSN	2329-048X ; 2329-048X
ISSN (online)	2329-048X
ISSN	2329-048X
DOI	10.1177/2329048X221082753
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Article ; Online: Determining If Rest Is Best After Concussion.

Giza, Christopher C / Choe, Meeryo C / Barlow, Karen M

JAMA neurology

2018 Volume 75, Issue 4, Page(s) 399–400

MeSH term(s)	Brain Concussion/physiopathology ; Brain Concussion/rehabilitation ; Decision Making ; Humans ; Rest
Language	English
Publishing date	2018-03-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	2702023-X
ISSN	2168-6157 ; 2168-6149
ISSN (online)	2168-6157
ISSN	2168-6149
DOI	10.1001/jamaneurol.2018.0006
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Article: What Pediatricians Need to Know About the CDC Guideline on the Diagnosis and Management of mTBI.

Choe, Meeryo C / Gregory, Andrew J / Haegerich, Tamara M

Frontiers in pediatrics

2018 Volume 6, Page(s) 249

Abstract: Pediatric traumatic brain injury (TBI) is a growing health concern, with over half a million TBI-related emergency department (ED) visits annually. However, this is likely an underestimate of the true incidence, with many children presenting to their ... ...

Abstract	Pediatric traumatic brain injury (TBI) is a growing health concern, with over half a million TBI-related emergency department (ED) visits annually. However, this is likely an underestimate of the true incidence, with many children presenting to their pediatrician. The Centers for Disease Control and Prevention (CDC) published a guideline on the diagnosis and management of pediatric mild traumatic brain injury (mTBI). We outline key points and a decision checklist for pediatricians based on this evidence-based guideline.
Language	English
Publishing date	2018-09-12
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2711999-3
ISSN	2296-2360
ISSN	2296-2360
DOI	10.3389/fped.2018.00249
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Article ; Online: A Multicenter Look at Multidisciplinary Youth Concussion/Mild Traumatic Brain Injury Programs: The Four Corners Youth Consortium (4CYC).

Choe, Meeryo C / Rosenbaum, Philip / Rivara, Frederick P / Gioia, Gerard A / Giza, Christopher C

Pediatric neurology

2020 Volume 107, Page(s) 84–85

MeSH term(s)	Adolescent ; Adult ; Athletic Injuries/diagnosis ; Athletic Injuries/therapy ; Brain Concussion/diagnosis ; Brain Concussion/therapy ; Child ; Child, Preschool ; Female ; Humans ; Interdisciplinary Research ; Male ; Patient Care Team ; Program Development ; Registries/statistics & numerical data ; Retrospective Studies ; Young Adult
Language	English
Publishing date	2020-01-31
Publishing country	United States
Document type	Letter ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	639164-3
ISSN	1873-5150 ; 0887-8994
ISSN (online)	1873-5150
ISSN	0887-8994
DOI	10.1016/j.pediatrneurol.2020.01.008
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Article ; Online: Pediatric Posttraumatic Headache: A Review.

Choe, Meeryo C / Blume, Heidi K

Journal of child neurology

2016 Volume 31, Issue 1, Page(s) 76–85

Abstract: Head injuries are common in pediatrics, and headaches are the most common complaint following mild head trauma. Although moderate and severe traumatic brain injuries occur less frequently, headaches can complicate recovery. There is currently an intense ... ...

Abstract	Head injuries are common in pediatrics, and headaches are the most common complaint following mild head trauma. Although moderate and severe traumatic brain injuries occur less frequently, headaches can complicate recovery. There is currently an intense spotlight on concussion and there has been a corresponding increase in the number of children seeking care for headache after mild traumatic brain injury or concussion. Understanding the natural history of, and recognition of factors that are associated with posttraumatic headache will help providers and families to limit disability and may prompt earlier intervention to address disabling headaches. While there are few studies on the treatment of posttraumatic headache, proper evaluation and management of posttraumatic headaches is essential to prevent further injury and to promote recovery. In this article, we will review the current definitions and epidemiology of pediatric posttraumatic headache and discuss current recommendations for the evaluation and management of this syndrome in children and adolescents.
MeSH term(s)	Humans ; Pediatrics ; Post-Traumatic Headache/diagnosis ; Post-Traumatic Headache/epidemiology ; Post-Traumatic Headache/therapy
Language	English
Publishing date	2016-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	639288-x
ISSN	1708-8283 ; 0883-0738
ISSN (online)	1708-8283
ISSN	0883-0738
DOI	10.1177/0883073814568152
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Article ; Online: Frontoamygdala hyperconnectivity predicts affective dysregulation in adolescent moderate-severe TBI.

Bickart, Kevin C / Olsen, Alexander / Dennis, Emily L / Babikian, Talin / Hoffman, Ann N / Snyder, Aliyah / Sheridan, Christopher A / Fischer, Jesse T / Giza, Christopher C / Choe, Meeryo C / Asarnow, Robert F

Frontiers in rehabilitation sciences

2023 Volume 3, Page(s) 1064215

Abstract: In survivors of moderate to severe traumatic brain injury (msTBI), affective disruptions often remain underdetected and undertreated, in part due to poor understanding of the underlying neural mechanisms. We hypothesized that limbic circuits are integral ...

Abstract	In survivors of moderate to severe traumatic brain injury (msTBI), affective disruptions often remain underdetected and undertreated, in part due to poor understanding of the underlying neural mechanisms. We hypothesized that limbic circuits are integral to affective dysregulation in msTBI. To test this, we studied 19 adolescents with msTBI 17 months post-injury (TBI: M age 15.6, 5 females) as well as 44 matched healthy controls (HC: M age 16.4, 21 females). We leveraged two previously identified, large-scale resting-state (rsfMRI) networks of the amygdala to determine whether connectivity strength correlated with affective problems in the adolescents with msTBI. We found that distinct amygdala networks differentially predicted externalizing and internalizing behavioral problems in patients with msTBI. Specifically, patients with the highest medial amygdala connectivity were rated by parents as having greater externalizing behavioral problems measured on the BRIEF and CBCL, but not cognitive problems. The most correlated voxels in that network localize to the rostral anterior cingulate (rACC) and posterior cingulate (PCC) cortices, predicting 48% of the variance in externalizing problems. Alternatively, patients with the highest ventrolateral amygdala connectivity were rated by parents as having greater internalizing behavioral problems measured on the CBCL, but not cognitive problems. The most correlated voxels in that network localize to the ventromedial prefrontal cortex (vmPFC), predicting 57% of the variance in internalizing problems. Both findings were independent of potential confounds including ratings of TBI severity, time since injury, lesion burden based on acute imaging, demographic variables, and other non-amygdalar rsfMRI metrics (e.g., rACC to PCC connectivity), as well as macro- and microstructural measures of limbic circuitry (e.g., amygdala volume and uncinate fasciculus fractional anisotropy). Supporting the clinical significance of these findings, patients with msTBI had significantly greater externalizing problem ratings than healthy control participants and all the brain-behavior findings were specific to the msTBI group in that no similar correlations were found in the healthy control participants. Taken together, frontoamygdala pathways may underlie chronic dysregulation of behavior and mood in patients with msTBI. Future work will focus on neuromodulation techniques to directly affect frontoamygdala pathways with the aim to mitigate such dysregulation problems.
Language	English
Publishing date	2023-01-04
Publishing country	Switzerland
Document type	Journal Article
ISSN	2673-6861
ISSN (online)	2673-6861
DOI	10.3389/fresc.2022.1064215
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Article ; Online: Diagnosis and management of acute concussion.

Choe, Meeryo C / Giza, Christopher C

Seminars in neurology

2015 Volume 35, Issue 1, Page(s) 29–41

Abstract: Mild traumatic brain injury (mTBI), or concussion, constitutes a significant percentage of the millions of TBIs sustained in the United States each year. Symptoms are typically short-lived, and may correlate to physiologic changes in the acute period ... ...

Abstract	Mild traumatic brain injury (mTBI), or concussion, constitutes a significant percentage of the millions of TBIs sustained in the United States each year. Symptoms are typically short-lived, and may correlate to physiologic changes in the acute period after injury. There are many available tools that can be utilized on the sideline as well as in the clinical setting for assessment and diagnosis of concussion. It is important to use validated tests in conjunction with a thorough history and physical examination. Neurocognitive testing may be helpful in the subacute period. Management should begin with removal from risk if a concussion is suspected, and once diagnosis is made, education and reassurance should be provided. Once symptoms have resolved, a graded return-to-play protocol can be implemented with close supervision and observation for return of symptoms. Management should be tailored to the individual, and if symptoms are prolonged, further diagnostic evaluation may be necessary.
MeSH term(s)	Animals ; Brain Concussion/complications ; Brain Concussion/diagnosis ; Brain Concussion/therapy ; Cognition Disorders/diagnosis ; Cognition Disorders/etiology ; Disease Management ; Humans ; Neuroimaging ; Neuropsychological Tests
Language	English
Publishing date	2015-02
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	603165-1
ISSN	1098-9021 ; 0271-8235
ISSN (online)	1098-9021
ISSN	0271-8235
DOI	10.1055/s-0035-1544243
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: CARE4Kids Study: Endophenotypes of Persistent Post-Concussive Symptoms in Adolescents: Study Rationale and Protocol.

Giza, Christopher C / Gioia, Gerard / Cook, Lawrence J / Asarnow, Robert / Snyder, Aliyah / Babikian, Talin / Thompson, Paul / Bazarian, Jeffery J / Whitlow, Christopher T / Miles, Christopher M / Otallah, Scott / Kamins, Joshua / Didehbani, Nyaz / Rosenbaum, Philip E / Chrisman, Sara P D / Vaughan, Christopher G / Cullum, Munro / Popoli, David M / Choe, Meeryo /

Gill, Jessica / Dennis, Emily L / Donald, Christine L Mac / Rivara, Frederick P

Journal of neurotrauma

2023 Volume 41, Issue 1-2, Page(s) 171–185

Abstract: Treatment of youth concussion during the acute phase continues to evolve, and this has led to the emergence of guidelines to direct care. While symptoms after concussion typically resolve in 14-28 days, a portion (∼20%) of adolescents endorse persistent ... ...

Abstract	Treatment of youth concussion during the acute phase continues to evolve, and this has led to the emergence of guidelines to direct care. While symptoms after concussion typically resolve in 14-28 days, a portion (∼20%) of adolescents endorse persistent post-concussive symptoms (PPCS) beyond normal resolution. This report outlines a study implemented in response to the National Institute of Neurological Diseases and Stroke call for the development and initial clinical validation of objective biological measures to predict risk of PPCS in adolescents. We describe our plans for recruitment of a Development cohort of 11- to 17-year-old youth with concussion, and collection of autonomic, neurocognitive, biofluid, and imaging biomarkers. The most promising of these measures will then be validated in a separate Validation cohort of youth with concussion, and a final, clinically useful algorithm will be developed and disseminated. Upon completion of this study, we will have generated a battery of measures predictive of high risk for PPCS, which will allow for identification and testing of interventions to prevent PPCS in the most high-risk youth.
MeSH term(s)	Humans ; Adolescent ; Child ; Post-Concussion Syndrome/diagnosis ; Endophenotypes ; Brain Concussion/psychology
Language	English
Publishing date	2023-08-25
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	645092-1
ISSN	1557-9042 ; 0897-7151
ISSN (online)	1557-9042
ISSN	0897-7151
DOI	10.1089/neu.2023.0073
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Article: Diagnosis and Management of Acute Concussion

Choe, Meeryo C. / Giza, Christopher C.

Seminars in Neurology

(Traumatic Brain Injury)

2015 Volume 35, Issue 01, Page(s) 29–41

Series title	Traumatic Brain Injury
Abstract	Mild traumatic brain injury (mTBI), or concussion, constitutes a significant percentage of the millions of TBIs sustained in the United States each year. Symptoms are typically short-lived, and may correlate to physiologic changes in the acute period after injury. There are many available tools that can be utilized on the sideline as well as in the clinical setting for assessment and diagnosis of concussion. It is important to use validated tests in conjunction with a thorough history and physical examination. Neurocognitive testing may be helpful in the subacute period. Management should begin with removal from risk if a concussion is suspected, and once diagnosis is made, education and reassurance should be provided. Once symptoms have resolved, a graded return-to-play protocol can be implemented with close supervision and observation for return of symptoms. Management should be tailored to the individual, and if symptoms are prolonged, further diagnostic evaluation may be necessary.
Keywords	mild traumatic brain injury ; concussion ; diagnosis ; return-to-play
Language	English
Publishing date	2015-02-01
Publisher	Thieme Medical Publishers
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	603165-1
ISSN	1098-9021 ; 0271-8235
ISSN (online)	1098-9021
ISSN	0271-8235
DOI	10.1055/s-0035-1544243
Database	Thieme publisher's database

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