A Comparison of the Head Dynamic Response and Brain Tissue Deformation from Impacts Resulting in Concussion, Concussion with Persistent Post-Concussive Symptoms, and Subdural Hematoma

Objective: Concussions typically resolve within a few days however in a few cases the symptoms last for a month or longer and are termed persistent post-concussive symptoms (PPCS) with more serious brain trauma resulting in bleeds, such as subdural hematoma (SDH). Dynamic response and brain tissue deformation characteristics may provide a means of distinguishing between these three types of injuries. Methods: Reconstruction cases were recruited from sports medicine clinics and hospitals along with medical reports, video footage, and medical imaging. All subjects received a direct blow to the head resulting in head trauma symptoms, those that resolved in 9 days were termed concussions, those with symptoms longer than 18 months were PPCS and those presenting with subdural hematoma (SDH). An anthropometric dummy headform was dropped onto various impact surfaces using a monorail drop rig. Headform dynamic response data was collected and used as input into the University College Dublin Brain Trauma Model to obtain maximum principal strain and von Mises stress. Results: Both linear and rotational acceleration of the head increased in magnitude with an increase in injury severity (from concussion, to PPCS, and SDH). The PPCS group had peak resultant rotational accelerations similar to SDH and significantly higher than concussions. There were no significant differences for peak resultant linear accelerations between the two concussion groups however they were both significantly lower than the SDH group. Brain tissue deformation measures however, did not follow the same trend as dynamic response and resulted with SDH having the lowest values of stress and strain. PPCS had significantly higher values of strain than the SDH group, where both the concussion and PPCS groups had significantly higher stress values than the SDH group. Conclusion: This study supports the notion that there is a positive relationship between an increase in the dynamic response and the risk for more serious brain injury. Peak resultant linear acceleration may be more related to SDH meanwhile rotational acceleration may be more relatedto severity of concussion. Despite SDH being the more severe brain injury, on average this group had the lowest values for stress and strain as compared to concussion and PPCS. Finite element analysis of the SDH injuries examined brain tissue values for the group of elements in the model than corresponded to the location of the bleed which may not be reflective of the highest values if the entire cerebrum was considered. More importantly, SDH injuries are vascular injuries and may not necessarily result in damage to the brain. In summary, this study found that the dynamic response of an impact is reflective of injury severity. Understanding the relationship between the dynamic response and the nature of the injury provides important information for developing strategies for injury prevention.