Traumatic Brain Injury (TBI) in children, while the brain is in a state of rapid change and development, can adversely impact their development, their extended environment, and their families. The extant literature has identified several physiological, genetic, and environmental variables that predict outcomes following pediatric TBI; nonetheless, the individual course of recovery and later development of a given child is uniquely shaped by injury-related factors (e.g., nature and extent of the injury itself, the developmental status of the child) as well as a number of personal and family variables (e.g., pre-injury cognitive, genetic, and psychological status of the child, family functioning and resources, coping style). Furthermore, the effects of a brain injury during development may or may not become evident immediately after injury depending on a number of factors. Instead, observing trajectories of development over time may allow for a better understanding of the long-term consequences in many functional domains that interest researchers, clinicians, and families. The current paper reviews the chronic aspects of medical/health, cognitive/academic, emotional/behavioral, and family/social outcomes following pediatric TBI, with the goal of providing monitoring and treatment strategies for affected children and their families, as well as serving as a resource for researchers designing studies to better understand this heterogeneous population.

Background: Atrophy of the corpus callosum (CC) is a documented consequence of moderate-to-severe traumatic brain injury (TBI), which has been expressed as volume loss using quantitative magnetic resonance imaging (MRI). Other advanced imaging modalities such as diffusion tensor imaging (DTI) have also detected white matter microstructural alteration following TBI in the CC. The manner and degree to which macrostructural changes such as volume and microstructural changes develop over time following pediatric TBI, and their relation to a measure of processing speed is the focus of this longitudinal investigation. As such, DTI and volumetric changes in the CC in participants with TBI and a comparison group at approximately 3 and 18 months after injury as well as their relation to processing speed were determined. Methods: Forty-eight children and adolescents aged 7–17 years who sustained either complicated mild or moderate-to-severe TBI (n = 23) or orthopedic injury (OI; n = 25) were studied. The participants underwent brain MRI and were administered the Eriksen flanker task at both time points. Results: At 3 months after injury, there were significant group differences in DTI metrics in the total CC and its subregions (genu/anterior, body/central and splenium/posterior), with the TBI group demonstrating significantly lower fractional anisotropy (FA) and a higher apparent diffusion coefficient (ADC) in comparison to the OI group. These group differences were also present at 18 months after injury in all CC subregions, with lower FA and a higher ADC in the TBI group. In terms of longitudinal changes in DTI, despite the group difference in mean FA, both groups generally demonstrated a modest increase in FA over time though this increase was only significant in the splenium/posterior subregion. Interestingly, the TBI group also generally demonstrated ADC increases from 3 to 18 months though the OI group demonstrated ADC decreases over time. Volumetrically, the group differences at 3 months were marginal for the midanterior and body/central subregions and total CC. However, by 18 months, the TBI group demonstrated a significantly decreased volume in all subregions except the splenium/posterior area relative to the OI group. Unlike the OI group, which showed a significant volume increase in subregions of the CC over time, the TBI group demonstrated a significant and consistent volume decrease. Performance on a measure of processing speed did not differentiate the groups at either visit, and only the OI group showed significantly improved performance over time. Processing speed was related to FA in the splenium/posterior and total CC only in the TBI group on both occasions, with a stronger relation at 18 months. Conclusion: In response to TBI, macrostructural volume loss in the CC occurred over time; yet, at the microstructural level, DTI demonstrated both indicators of continued maturation and development even in the damaged CC, as well as evidence of potential degenerative change. Unlike volumetrics, which likely reflects the degree of overall neuronal loss and axonal damage, DTI may reflect some aspects of postinjury maturation and adaptation in white matter following TBI. Multimodality imaging studies may be important to further understand the long-term consequences of pediatric TBI.

BACKGROUND: Recent evidence suggests that autonomic nervous dysfunction may be one of many potential factors contributing to persisting post-concussion symptoms.OBJECTIVE: This is the first systematic review to explore the impact of concussion on multiple aspects of autonomic nervous system functioning.METHODS: The methods employed are in compliance with the American Academy of Neurology (AAN) and PRISMA standards. Embase, MEDLINE, PsychINFO, and Science Citation Index literature searches were performed using relevant indexing terms for articles published prior to the end of December 2016. Data extraction was performed by two independent groups, including study quality indicators to determine potential risk for bias according to the 4-tiered classification scheme of the AAN.RESULTS: Thirty-six articles qualified for inclusion in the analysis. Only three studies (one Class II and two Class IV) did not identify anomalies in measures of ANS functioning in concussed populations.CONCLUSIONS: The evidence supports the conclusion that it is likely that concussion causes autonomic nervous system anomalies. An awareness of this relationship increases our understanding of the physical impact of concussion, partially explains the overlap of concussion symptoms with other medical conditions, presents opportunities for further research, and has the potential to powerfully inform treatment decisions.

Generalized whole brain volume loss has been well documented in moderate-to-severe traumatic brain injury (TBI), as has diffuse cerebral atrophy based on magnetic resonance imaging (MRI) volumetric methods where white matter may be more selectively affected than gray matter. However, specific regional differences in gray matter thickness of the cortical mantle have not been previously examined. As such, cortical thickness was assessed using FreeSurfer^® software to identify regions of significant gray matter cortical thinning in MRI scans of 16 young TBI subjects (age range, 9–16 years) compared to 16 demographically matched controls. Significant cortical thinning was observed globally in the TBI group compared to the cohort of typically developing children. Reduced cortical thickness was related to reported deficits in working memory. TBI-induced cortical thickness reductions are probably due to a combination of focal and diffuse effects and have implications for the neurobehavioral sequelae of TBI.

Human structural neuroimaging studies have supported the preferential effects of healthy aging on frontal cortex, but reductions in other brain regions have also been observed. We investigated the regional network pattern of gray matter using magnetic resonance imaging (MRI) in young adult and old rhesus macaques (RMs) to evaluate age effects throughout the brain in a nonhuman primate model of healthy aging in which the full complement of Alzheimer's disease (AD) pathology does not occur. Volumetric T1 MRI scans were spatially normalized and segmented for gray matter using statistical parametric mapping (SPM2) voxel-based morphometry. Multivariate network analysis using the scaled subprofile model identified a linear combination of two gray matter patterns that distinguished the young from old RMs. The combined pattern included reductions in bilateral dorsolateral and ventrolateral prefrontal and orbitofrontal and superior temporal sulcal regions with areas of relative preservation in vicinities of the cerebellum, globus pallidus, visual cortex, and parietal cortex in old compared with young RMs. Higher expression of this age-related gray matter pattern was associated with poorer performance in working memory. In the RM model of healthy aging, the major regionally distributed effects of advanced age on the brain involve reductions in prefrontal regions and in the vicinity of the superior temporal sulcus. The age-related differences in gray matter reflect the effects of healthy aging that cannot be attributed to AD pathology, providing support for the targeted effects of aging on the integrity of frontal lobe regions and selective temporal lobe areas and their associated cognitive functions.