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While a brain injury can be difficult to locate, new research identifies a single region of the brain that can be used to examine the impact of a concussion or repeated hits to the head.

The finding, published today in Science Advances, also supports the emerging idea that traumatic brain injury is not limited to people who sustain a concussion; it can result from repetitive head hits that are clinically silent--those that do not produce the visible signs or symptoms of a concussion. These subconcussive hits have been increasingly recognized as a potential threat to long-term brain health and as a possible cause of chronic traumatic encephalopathy (CTE).

Jeffrey Bazarian, M.D., M.P.H., professor of Emergency Medicine, Neurology, Neurosurgery and Public Health Sciences at the University of Rochester Medical Center and a co-author of the study says that the location of a brain injury varies widely from person to person. This is a major obstacle for physicians trying to diagnose brain injury using imaging techniques.

"This study is important because we found that no matter where the head gets hit, the force is translated into a single region of the brain known as the midbrain," noted Bazarian, who treats concussion patients and conducts research related to traumatic brain injury. "Midbrain imaging might be a way in the future to diagnose injury from a single concussive head hit, as well as from repetitive sub-concussive head hits."

University of Rochester fourth-year medical student Adnan Hirad, Ph.D., the first author of the research added, "Our findings do not dispute the fact that head-injury effects are distributed throughout the brain, but the midbrain may serve as a 'canary in a coal mine' in terms of identifying damage. From this study we know that the midbrain region, which is linked to brain functions often affected by a concussion, is the place to look to identify the impact of clinically defined concussions with visible symptoms and silent brain injuries that can't be observed simply by looking at or behaviorally testing a player, on or off the field."

Jeffrey J. Bazarian, M.D., M.P.H., professor in the department of Emergency Medicine, led the development of new recommendations to assist emergency physicians caring for patients with sport-related concussion in the emergency department. Published in the Annals of Emergency Medicine, the recommendations include information on making a prompt diagnosis, providing the best treatment and offering appropriate advice to patients and caregivers.

As chair of the American College of Emergency Physicians Sport-Related Head Injury Prevention Task Force, Bazarian drafted the recommendations with the help of emergency medicine colleagues from across the country. In the newly published article, the group highlights the important role that emergency physicians can play in mitigating headaches, dizziness, nausea, and other post-concussive symptoms that occur in the hours and days following concussion by adhering to best clinical practices. The group also emphasizes the role emergency physicians can play in preventing a subsequent sport-related concussion.

"Unlike concussions from falls or other accidents that are out of people's control, we have the unique opportunity to use the ED visit as a prevention tool to limit future sport-related concussions," said Bazarian, who treats patients and conducts research related to mild traumatic brain injury. "Through counseling while the patient is in the ED, emergency physicians can educate patients on things like the appropriate amount of physical and cognitive rest, the importance of following up with a primary care physician or specialist as needed, and the fact that continued exposure to head impacts could hurt their neurologic health in the long term."

The task force also calls for the development of evidence-based guidelines and additional research, including recognizing obstacles to identifying sport-related concussion patients in the ED; finding objective prognostic indicators of postsport-related concussion recovery; and determining the efficacy of medications commonly administered in the ED to treat concussive symptoms.

In addition to Bazarian, Pediatric Emergency Medicine fellow Gemmie Devera, M.D. contributed to the work. Concussion experts from Mayo Clinic, University of South Carolina School of Medicine, Brown University, Baystate Medical Center, University of Illinois College of Medicine, Harvard Medical School, Orlando Regional Medical Center, Emory University and Stanford University also contributed to the recommendations.