Gender differences in transcranial doppler ultrasound measured features and self-reported symptoms after sports-related concussion

The possibility of gender-related differences in concussion severity and recovery remains a controversial subject. With some studies showing that female subjects suffer a longer period of symptom recovery as compared to males, while other studies have failed to demonstrate significant differences. In this retrospective study, we explored the gender-related effects of concussion on both self-reported symptoms and physiologic features (captured with TCD) that were previously shown to be related to concussion. A total of 75 subjects, with a mean age of 16.2 years (1.16), consisting of 51 males and 24 females, were assessed—at different points post-injury—after suffering a clinically diagnosed sports-related concussion. Subjects first answered a series of symptom related questions based on an integer rating scale. The velocity from the middle cerebral artery (MCA) was insonated bilaterally through transtemporal windows with TCD. After a baseline period, subjects participated in 4 breath-holding challenges. The Pulsatility Index (PI) was computed from the baseline section, while the Breath Hold Index (BHI) was computed from the challenge sections. Over the first 10 days post-injury, the female subjects had significantly higher symptom scores. In addition, the length of recovery was longer, lasting 14 days compared to 9 days, before the overall mean symptom score returned to baseline; The BHI and PI were not significantly different between genders. The elevated symptom scores for the female subjects without a significant correlation to physiologic measurements is possibly due to reporting bias. The population consisted of high school aged athletes who were motivated to return to play, perhaps explaining why the male population reported lower symptom severity than the female population. However, the potential of increased severity in the female population cannot be overlooked. This pilot study illustrates the need for more focused research on gender differences in concussion pathophysiology.

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